Our long experience with prenatal diagnosis and planning for optimum care allows us to offer the highest quality treatment whether intervention is indicated before or after birth.
Under the direction of Dr. Michael Harrison, the Fetal Treatment Center was the first institution to develop fetal surgery techniques. The first open fetal surgery in the world was performed at UCSF since the early 1980's. We presently have more experience with fetal surgery and endoscopic fetal intervention (FETENDO fetal surgery) than any other institution in the world. We are dedicated to bowel obstruction research and treatment innovation.
A baby's gastrointestinal tract is divided into 2 segments: the small intestine and the large intestine. The small intestine is made up of 3 parts: the duodenum (the segment connected to the stomach), the jejunum (where most the liquid in food is absorbed), and the ileum (which empties into the large intestine). The large intestine is also called the colon. There are many causes of bowel obstruction in the fetus. Most are caused by an atresia, a narrowing at some point in the small intestine. A bowel obstruction is named by the place in the small intestine where it occurs: duodenal atresia, jejunal atresia, ileal atresia, or colon atresia.
Your fetus’s bowel obstruction may have been discovered one of two ways. You may have undergone a routine ultrasound which showed a segment of bowel which was dilated, or larger than normal. This is a clue to your doctor that there is a problem with the intestine. This dilation happens because while in the uterus the fetus constantly swallows amniotic fluid. This narrowing can slow down or stop the flow of amniotic fluid in the intestine causing it to swell, so that is appears too large in an ultrasound.
The second way a bowel obstruction can be discovered is by the development of polyhydramnios, (the build up of too much amniotic fluid). Because of the blockage in the intestine, the normal flow of amniotic fluid is stopped. It accumulates on the outside of the baby- inside your uterus. Your uterus size may suddenly grow very large alerting your doctor to a possible problem. Your doctor may then order an ultrasound study. The ultrasound study can confirm a problem in the intestine.
Your baby should be born at a hospital with an intensive care nursery and a pediatric surgeon. Soon after birth your child will have surgery to repair the abnormal piece of intestine. The pediatric surgeon will repair your baby's intestine in one of two ways. If the stricture, or narrowing, is small the surgeon may be able to remove the damaged segment, taper the dilated portion, and sew the two ends of the intestine together.
If the narrowing is long, or if the surgeon believes the intestine is damaged and cannot be used for a period of time, a temporary stoma may be placed. A stoma is a surgically created opening in the abdomen in which the small bowel is brought out through the abdominal wall. It is through this opening, or stoma, that stool will pass. With the stoma in place, the baby will not pass stool through the anus. The use of a stoma is usually temporary and the baby will need another operation to reconnect the intestine and close the stoma.