The ability to know

Already 6 and allowed to hold that rabbit!

When I started school I was convinced that my father was the most important person in all the world, and I remember boasting (yes!) that my dying grandfather was the sickest man on earth.  The flipside was that I was also deeply embarrassed about being the only child on earth with a scar on his belly.  How vain.

It was not until my early teens that I first heard about someone else having had pyloric stenosis, but he was lucky enough to survive without surgery.  I was marked for life… still unique.

Only in my later 20s did I discover that I was not so special after all.  Working in my first church I learnt an important lesson: infant surgery may not be commonplace but it’s not rare either.  In that small group of just 120 Christian people there were three more lads who’d also had pyloric stenosis: one of them had been treated medically and the other two had scars similar to my own.  How freakish was that!  In fact this condition occurs in about 3-5 in every 1,000 Caucasian babies (and in 4 boys to every girl).

Over the years since I have come to know about several more people who survived becoming a fearful fountain of mother’s milk early in their lives.  But the explosion of my understanding of this condition and the many issues around infant surgery, from circumcision to correcting defective hearts, only came to me with the internet.  So many people, websites and research papers!  The world has truly shrunk and our knowledge has been greatly enlarged and sometimes distended.

About 4 in every 1000: everyone (whether they realise it and are interested or not) knows several people who have had pyloric stenosis or another previously fatal condition of infancy.

Here are just some of them; most can obviously only be remedied by surgery.  Google for the details or go to Wikipedia if you’re interested to know more.

Those of us who survived infant surgery are not cruelly different, we’re grateful survivors thanks to the time and place of our birth (and I believe, God’s goodness).

I’ve learnt that the food passage is the greatest trouble maker in newborns: more babies have gastro issues, and for a number of these there is no medical remedy.  Parents have to submit their precious newborn to a surgeon and wait for the results. For some this is only the beginning of a long journey.

Upper abdominal surgery on infants

Pyloric stenosis is an overgrowth of the stomach’s outlet muscle which causes a baby to vomit forcefully, quickly resulting in usually deadly problems such as dehydration and salt and fluid imbalances.  It is by far the most common infant condition to be remedied by non-elective surgery, although it can sometimes be remedied by less traumatising and more cosmetically attractive means.

Infant hiatus hernia or oesophogeal hernia A small part of the top of the stomach attaches to the esophagus, pushing up through the diaphragm and causing sometimes no symptoms, sometimes manageable reflux or possibly severe problems that need surgical intervention.

Diaphragmatic hernia – A defect or hole in the diaphragm that allows the abdominal contents to move into the chest cavity.

Omphacele – An abdominal wall defect in which the intestines, liver and occasionally other organs remain outside the abdomen inside the peritoneal sac because of a defect in the development of the muscles of the abdominal wall.

Gastroschesis is a defect in the abdominal wall through which some of the intestinal contents freely protrude; it is more limited than an omphacele.

Necrotizing enterocolitis – A medical condition mostly seen in premature babies, where portions of the bowel undergo necrosis (tissue death).

Intussusception – A part of the intestine has telescoped into another, which can often result in an obstruction and death of that part of the intestine.

Volvulus with or without malrotation – Malrotation describes the failure of the bowel to coil correctly before birth: it is quite common and often causes no problems. Volvulus is a complication of malrotation and occurs when the bowel twists so the blood supply to that part of the bowel is cut off.

Bowel obstruction – Intestinal obstruction may be complete (atresia) or incomplete (stenosis).  Atresia may occur in any part of the food canal, from the esophagus to the anus (which may be unformed or imperforate).  In each part of the food canal, several problems are possible: e.g., a duodenal diaphragm or web can develop inside the gut before birth: this is a form of atresia; stenosis of the duodenum is a partial blockage.

Hirschsprung’s Disease is a condition of the colon (lower passage) which occurs in one in 4000-5000 infants.  The nerves in the lower bowel and/or anus are absent, paralysing that part of the food canal and causing chronic constipation.  A surgical remedy (removal of the colon and creation of a stoma) has been used since 1948 and this has in recent years been much improved in various ways, including a “pull-through” procedure by which the paralysed section is removed and the functioning part of the bowel is connected to the anus. Genetic mapping has also been helpful.

Medical knowledge has developed greatly during the past century.  100 years ago an effective surgical remedy for the most common condition in babies, pyloric stenosis, was just being discovered and had yet to be published.  Most projectile vomiting babies dehydrated and died of organ failure.

Today most of the conditions I’ve listed can be remedied, either medically or by surgery. However, the causes of many are still poorly understood.

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