A newborn's twist leads to emergency surgery

Caring for a newborn is full of twists and turns. Feelings of joy and contentment one moment can turn to fear and worry the next. That's how Nicole and Corbin Burkard of Eau Claire, Wisconsin, felt after their third daughter, Ellie, was born in February.

"She was just perfect and looked like her older sister," says Nicole. "She just fit right in."

The new family of five was settling into a routine at home when Nicole and Corbin noticed something wasn't quite right.

"She was a pro breastfeeder but now she wasn't eating. I also had a hard time keeping her awake," says Nicole, a Mayo Clinic Health System nurse. "She wasn't peeing at all either. I felt like something was wrong."

When Ellie began to vomit bright yellow liquid, the couple took their 5-day-old newborn to the Emergency Department at Mayo Clinic Health System in Eau Claire.

Ellie was examined by emergency medicine physician Robert Tillotson, D.O.  

"If there is a significant change in a baby's behaviors within the first weeks of life, it's important to be evaluated right away," says Dr. Tillotson. "Ellie's sudden symptoms of profound drowsiness, lack of urination and bilious vomiting indicated that she could have intestinal malrotation."

Intestinal malrotation is a condition in which the intestine doesn't develop or rotate correctly in utero. Some of the intestines can be in the wrong location at birth. For some infants, malrotation leads to a twist of the intestine that causes the blood supply to be cut off. This is called malrotation with volvulus and requires immediate surgery.

"Asymptomatic malrotation occurs in between 1 in 200 to 1 in 500 live births and symptomatic malrotation occurs in only 1 in 6,000 births," explains Mayo Clinic pediatric surgeon Denise Klinkner, M.D. "The bowel can recover if the blood supply is restored within six hours. If not diagnosed promptly, infants could lose a significant amount of intestine, leaving them with complications like short gut, total parenteral nutrition dependency or possibly intestinal transplant. Prompt recognition and treatment are life-changing."

The Eau Claire team explained to the Burkards that Ellie would require emergency surgery at Mayo Clinic. The weather that evening grounded the medical helicopter, so Ellie was loaded into an ambulance for the 90-mile trip to Rochester, Minnesota. Nicole and Corbin followed behind in the family's car.

Once they arrived, the family met with Mayo Clinic Children's Center neonatologist Christopher Colby, M.D., who explained what they could expect with Ellie's surgery and recovery. Even though Nicole had years of health care experience, she was worried for her daughter. But she was reassured by the compassion and expertise of her colleagues.

"All the staff was just phenomenal," she says. "It made me feel like we were in the best possible place for Ellie."

A contrast study quickly confirmed the diagnosis, and Ellie's surgery began within one hour of her arrival in Rochester. Dr. Klinkner used Ladd's procedure to untwist and reposition Ellie's intestine and restore the blood flow. She also removed Ellie's appendix because its abnormal position could make acute appendicitis more difficult to diagnose in the future.

Ellie's surgery was a success, and she stayed in the neonatal ICU for five days to ensure her bowels recovered before returning home.

Early identification and quick treatment led to a positive outcome for Ellie, says Dr. Klinkner.

"Ellie's mom is a registered nurse and an experienced mother, so she recognized the problem and brought her in early," says Dr. Klinkner. "New parents should watch for symptoms of intestinal malrotation in the first weeks of life when about 75% of cases happen."

Symptoms that should be evaluated promptly by a health care team include fever, low energy, poor appetite, swollen abdomen, vomiting green or yellow liquid, and little or no urine or bowel movements.

Six weeks after surgery, Ellie has recovered and is doing great. And her parents are recovering from this twist in her first month of life.

"She is perfect, and you can't tell anything even happened," says Nicole. "Everything went as smoothly as possible. It brings tears to my eyes when I think about her and our whole experience. We are so very thankful for the care that Ellie received."