UC Davis expertise saves infant from unnecessary surgery
Briana Martin’s second pregnancy seemed fairly uneventful. Though she was carrying twins, there had been no problems or complications. So while her husband usually accompanied her to appointments at a local community hospital, she went alone to what she assumed would be a routine 29-week check-up.
It was at that visit that her pregnancy — and her life— would become anything but routine.
“My perinatologist told me that my ultrasound showed the stomach of one of my twins, the smaller one, was larger than it should at that gestational age,” Briana said.
Her doctor referred to the larger infant “Baby A” and the smaller one as “Baby B.” “He said that for sure Baby B would need to have surgery.”
Briana said that she was stunned by the physician’s assessment. She is a nurse, and her husband is a physician. She immediately recognized the seriousness of her doctor’s diagnosis.
“I asked him again. Are you sure that there’s no way that this is going to resolve on its own?” she said.
Her physician told her that, because the infant’s stomach appeared enlarged, there likely was a partial bowel obstruction that prevented the infant from eliminating. The baby, a little girl, would almost certainly require surgery soon after birth to correct the condition, she was told.
“’Typically we identify it sooner,’” her doctor told her, “’but at least we caught it now,’” Briana recalled.
“I was a mess when he told me that the baby had a bowel obstruction,” Briana said. “A lot of times, if there’s an intestinal blockage there are a lot of other things wrong genetically.”
Briana immediately called her husband, Sean, and told him what had happened. Sean called Briana’s physician, who said that he would immediately refer the couple to a pediatric surgeon.
However, Sean Martin is himself surgeon and familiar with physicians and their expertise in Northern California. He told Briana’s doctor that he knew of someone who might be able to help, and that they would seek treatment elsewhere.
He immediately called Diana Farmer, renowned fetal and pediatric surgeon and Professor and Chair of the Department of Surgery at UC Davis Health System.
“He knew of Farmer, and knew how awesome she was, and he just contacted her,” Briana said.
Sean and Briana met with Farmer, who told the couple that the first step would be confirming the infant’s diagnosis by meeting with a UC Davis fetal radiologist. Farmer arranged for Briana to be seen by Department of Radiology Professor John McGahan.
McGahan is an internationally respected diagnostic and interventional radiologist who pioneered the use of several innovative techniques, including the use of radiofrequency ablation with expertise in fetal imaging, to treat primary and metastatic tumors.
At their appointment with McGahan, the couple brought in radiologic images from the community hospital. She said that McGahan discussed it with other fetal treatment team members —perinatologists and radiologists, and fetal surgeons — . After conferring, they agreed.
“This isn’t any type of a bowel obstruction,” Briana recalled McGahan saying. “It appears to be a cyst on the left adrenal gland.”
The adrenal glands sit atop the kidneys, with the left adrenal gland adjacent to the stomach. The couple was told that cysts of the type on their daughter’s adrenal gland frequently resolve on their own. Another ultrasound confirmed the diagnosis: The mass that appeared on the ultrasound actually was a cyst.
“We went to the other hospital and they kept giving us the wrong diagnosis, two or three times,” Briana said. “But the UC Davis experts were able to determine immediately what it was, and saved her from having a completely unnecessary surgery.”
A few weeks later Briana delivered of two healthy twin girls. The larger child, “Baby A,” is named Makena and is four minutes older than her sister, “Baby B” who is named Alana. They are eight months old and thriving.
“Alana’s cyst is almost completely gone,” Briana said. “In fact, it’s kind of funny. She’s now the larger, chunkier twin. I got to breastfeed her right away and everything – there was nothing wrong with her stomach or intestines!”
The babies are being seen by Dr. Farmer for their follow up care at UC Davis, Briana said.
“As soon as I got to UC Davis I felt completely comfortable and at ease,” she said, “I was able to have a completely normal vaginal delivery because they knew their stuff.”