As a pediatric gastroenterologist at MassGeneral Hospital for Children (MGHfC), Christopher Moran, MD, is no stranger to infantile vomiting. But there was something unusual about the case of Sahai Bhalani.
In the fall of 2016, when Sahai was just four weeks old, he vomited a small amount of clotted blood after a routine feeding. Alarmed, his parents — Bansi and Avish Bhalani of Revere, Massachusetts — brought him to a local emergency room, where doctors unable to find a problem released him. But Sahai kept getting sick — often right after feeding. When a follow-up exam revealed he wasn’t gaining weight, the decision was made to bring Sahai to MGHfC.
The Pediatric Gastroenterology and Nutrition Program at MGHfC specializes in providing compassionate care to children with a wide range of gastrointestinal and nutritional disorders. Mass General has assembled some of the most visionary minds in medicine and its multidisciplinary care teams are known for tackling some of the most rare and complex cases in the world.
“At first glance, it was a common presentation of a common problem,” Dr. Moran says.
Infantile vomiting is normal and Sahai didn’t exhibit any tell-tale signs of a broader issue. There was no indication he was in pain; no blood in his stool; no fever; he was active; his development was on track, and most of all, he seemed hungry and eager to feed.
Dr. Moran and his MGHfC colleague Batul Kaj, MD, suspected an allergy related to the infant formula Sahai’s mother was using as a supplement. But changing formula had no significant effect.
Over the next year, the team explored other potential causes, including gastroesophageal reflux disease. Meanwhile, Sahai’s mother, Bansi Patel, started introducing food purees into his diet. He tolerated the purees better than solid or soft foods and started gaining weight. But the vomiting continued.
In the summer of 2018, Dr. Moran and Dr. Kaj ordered an X-ray of Sahai’s upper GI tract. “We try to avoid unnecessary radiation in kids, especially for cases that resemble reflux disease,” he says. “But this had gone beyond the normal range.
Cause of Vomiting Revealed
Results of the X-ray were puzzling. The imaging appeared to indicate a hiatal hernia. This occurs when the stomach bulges above the diaphragm. However, there was concern that abnormal narrowing might be the result of something else. Dr. Moran ordered an endoscopy to be sure.
It revealed the true scope of the problem. The average infant esophagus is similar in diameter to a common drinking straw. At the site of the narrowing, Sahai’s esophagus was, according to Dr. Moran, no wider than “a pin hole.” Stunned, Dr. Moran shared the images with his colleague Allan Goldstein, MD, the surgeon-in-chief at MGHfC.
With a glance, Dr. Goldstein knew he was looking at a rare condition known as a stenosis. It is caused by a thickening of the muscular fibers in the esophageal wall.
“Esophageal stenosis in infants is rare — but as it happened, I had written a chapter about it for a textbook,” Dr. Goldstein says. “It can be a challenge feeding any young child, but adding an anatomic obstacle like this, it was a miracle he was growing.”
An attempt to open the stenosis using balloon dilation failed. In the fall of 2018, Dr. Goldstein used a minimally invasive surgical technique to remove the narrowed section and reattach the esophagus.
“It’s such an accomplishment to send him to school, and he just loves it.”
A Life-Changing Experience
Within a week, Sahai was home and eating again. Within a month, he had eaten his first solid food. One year removed from surgery, Sahai — happy and healthy — celebrated his third birthday with a first: cupcakes at school with his friends.
“He’s doing amazing,” Bansi Patel says. “It’s such an accomplishment to send him to school, and he just loves it.”
Sahai is now gaining appropriate weight for his age and eating a wide-variety of foods. And although he can still give his parents some trouble at the dinner table, these days it’s more the garden-variety challenges of feeding a picky toddler.
“Mass General has such a special place in my heart,” Mrs. Patel says. “As scary as it was, I always left the doctor’s office feeling good. I knew that Dr. Moran, Dr. Goldstein and the others were using all the information to make the best choice. It’s been life changing for us.”
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