Freetown, Sierra Leone, November 10, 2024 – In the early hours of the morning, a 36-week pregnant Sierra Leonean woman with sudden abdominal pain and abnormal fetal movement was urgently referred to the China-Sierra Leone Friendship Hospital.
Upon assessment, it was discovered that the woman was carrying twins, one of whom was diagnosed with a congenital giant umbilical hernia (Omphalocele) accompanied by intrauterine growth retardation (IUGR) and fetal distress.
A significant portion of the fetus’s liver and some intestines had protruded through the unsealed umbilical ring into a hernial sac, forming a large, external mass, which posed a highly complex and risky condition with a high risk of perinatal mortality.
The 25th Batch of China(Hunan) Medical Team (CMT) promptly organized a multidisciplinary consultation, developed an emergency treatment plan, and performed an emergency cesarean section, saving the lives of both mother and infants.
Upon admission, the pregnant woman complained of severe abdominal pain and abnormal fetal movement, appearing anxious and tense. Dr. Chen Zhihui, an Associate Chief Physician of Obstetrics and Gynecology quickly completed a preliminary clinical assessment and invited Dr. Zhang Min, an ultrasound expert, to perform an emergency ultrasound examination.
The scan revealed that the second twin in the twin pregnancy had a severe giant umbilical hernia (Omphalocele), with a cystic-solid mass about 7cms in diameter at the root of the umbilical cord. The mass contained the liver and part of the intestines, surrounded by fluid signals and a thin membrane, indicating the integrity of the hernial sac without signs of rupture. The estimated gestational age of this fetus was 32 weeks, consistent with IUGR, while the other fetus was estimated to be 33 weeks with stable vital signs and no obvious structural abnormalities.
Umbilical hernia is a rare but severe congenital abdominal wall defect characterized by a failure of abdominal wall development, causing fetal organs such as the liver and intestines to protrude through the defect at the base of the umbilical cord and be enveloped by the umbilical membrane. This complex malformation poses multiple risks during the perinatal period, including membrane rupture, acute fetal hypoxia, infection due to exposed organs, and hemodynamic disorders. The challenges of surgical management and postoperative care for umbilical hernia are particularly great in low-resource environments, further increasing the risk of perinatal mortality and neonatal complications.
Following the patient’s referral, Dr. Chen Zhihui swiftly initiated a multidisciplinary team consultation, involving Neonatology, Surgery, Anesthesiology, and Nursing teams, to devise a detailed treatment plan. Dr. Xu Zhijie, a Surgical expert, analyzed the potential difficulties and risks of primary hernia repair in the infant and proposed specific technical solutions for the proper repositioning and protection of the protruded organs. Dr. Lei Xiang, a Neonatology expert, assessed the risks of congenital pulmonary hypoplasia and respiratory distress in the hernia-affected fetus and developed a plan for resuscitation and monitoring. Professor Ling Feng, an Anesthesiology expert, put forward strategies for the safe anesthesia of both mother and child. After meticulous discussion, the team decided to proceed with an emergency cesarean section, while also preparing for postoperative care and repair of the hernia-affected fetus.
During the surgery, Dr. Chen Zhihui, Dr. Li Hucheng, and the Sierra Leonean obstetrics and gynecology team successfully delivered the twins in a short period. The first twin appeared healthy with a normal weight of 2200 grams. The second twin, affected by the hernia, weighed only 2000 grams and exhibited obvious respiratory distress immediately after birth, with intestines and part of the liver protruding outside the abdominal wall, covered only by a thin hernial sac. Dr. Lei Xiang promptly managed the airway and provided respiratory support, maintaining normal body temperature, while Dr. Xu Zhijie completed the temporary repositioning and fixation of the herniated organs in the operating room, laying the foundation for further treatment. Nurse Zhao Sha led the nursing team in ensuring stable body temperature for both mother and child and aseptic operation throughout the surgery, safeguarding every critical step.
Postoperatively, the infant with the umbilical hernia was transferred to the Neonatal Intensive Care Unit for enhanced monitoring and further treatment, while the healthy twin was moved to a standard ward. The mother made a good recovery post-surgery. The successful management of this complex case highlights the professional expertise and multidisciplinary collaboration of CMT in Africa. It also provides a significant medical practice case for the local healthcare community in Sierra Leone, exemplifying the deep friendship and exceptional technical skills of the CMT in the spirit of China-African medical cooperation.
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