His repeated episodes of stomachache were mistaken for constipation and masked his undiagnosed medical condition. One mum shares the harrowing experience with EVELINE GAN.
For three weeks, little Zayden Tok had an on-and-off stomachache that was so intense, it would wake him in the middle of the night.
His mum, Tan Zilan, also noticed something unusual about his stools; they were purplish-red in colour and coated with mucus.
Despite raising her concerns to a paediatrician, she was told that it was “just constipation colic”.
“We gave him prune juice and stool softeners, rubbed Ruyi oil and applied garlic paste on his stomach, but the pain persisted,” the 35-year-old logistics executive recounts. She took her toddler to see the same doctor three times.
But what was thought to be constipation almost killed Zayden, then two, who was in fact, bleeding internally from a condition known as Meckel’s diverticulum. This is due to an abnormal bulge or pouch in the small intestine that is present at birth.
Zayden ended up getting two blood transfusions and had to undergo surgery that left him with a 7 to 8cm-long scar.
Gut instinct saved her son’s life
By sharing her child’s health scare, Zilan hopes to warn other parents not to take their little ones’ stomachache complaints lightly.
In September last year, Zayden was at his grandma’s house when he started having one of his episodes of intense tummy pain.
“He asked for Ruyi oil, then started crying very loudly. The pain seemed worse than usual. When the pain subsided, we could see he was thoroughly exhausted and his whole face had turned very white,” says Zilan, who has a younger son aged one.
This time, maternal instinct spurred her to send Zayden to Mount Alvernia Hospital’s emergency department. That decision saved his life.
Noting that the toddler had looked very pale, the doctor ordered a blood test.
“He also looked at the photo of Zayden’s unusual stools, which I had kept in my phone, and said it wasn’t normal. When the results of the blood test came back, we were shocked to learn that his haemoglobin level was so low,” Zilan says.
By then, her son’s haemoglobin level had plummeted to around 5.2, which was less than half of the normal reading of around 12 to 13 for children, she adds.
“The doctor at the emergency department suspected that Zayden had been bleeding internally for some time as most people would faint if their haemoglobin level went so low suddenly,” she shares.
In hindsight, Zilan feels “terrible” for not taking her son to the hospital earlier. Although Zayden started looking increasingly pale after his tummy issues started, he had continued going to school and playing as usual, which lulled her into a false sense of security.
“When his tummy wasn’t acting up, he behaved normally. Plus, during those three weeks, his paediatrician did not say anything (about Zayden’s pale appearance) so we did not suspect anything,” she says.
“Imagine our confusion upon learning he had been probably bleeding internally for some time, and the guilt we felt for letting him go through the pain for so long.”
Tummy ache or sign of something serious?
“Mummy, my tummy hurts.” Every parent hears this complaint from time to time.
In kids, reasons for tummy troubles can vary widely, and trying to ﬁgure out what’s causing the pain can be challenging.
For instance, diarrhoea and gastroenteritis (commonly known as stomach ﬂ u) are common reasons why kids with tummy pain show up at the children’s emergency department. Even constipation or emotional issues like stress and anxiety can cause stomach aches.
In some cases, it may signal more serious illnesses like Meckel’s diverticulum, which is due to an abnormal bulge or pouch in the small intestine that is present at birth. This can lead to dangerous complications like bleeding and blockage in the intestines.
So, how can you tell when something is seriously wrong?
If your child only has abdominal pain without other symptoms, he will probably need to be checked by a doctor, advises Dr Kao Pao Tang, head and senior consultant at NUH’s Children's Emergency.
Most common illnesses have other accompanying symptoms. For example, a child with gastroenteritis would probably have fever, vomiting and diarrhoea, or had contact with an infected person, while those with constipation would have a history of not moving their bowels, Dr Kao says.
And if the severe isolated pain persists, it may be a sign of a more serious condition. “Even if the pain is not persistent, but your child looks unwell between bouts of abdominal pain, then he deﬁnitely requires medical attention,” he adds.
In babies, look out for bouts of inconsolable crying, tensing or distension of abdomen, Dr Kao says. They may also curl up their legs. And if they look pale or unwell, you should at least consult a general practitioner, he adds.
The American Academy of Paediatrics advises heading for the emergency room immediately if your child passes lots of blood in his stools, vomits blood, or has tarry or black- coloured stools.
Not one, but two blood transfusions
The boy was then rushed to the National University Hospital (NUH) children’s emergency, where he received a blood transfusion to increase his blood count. He was also referred to the paediatric gastroenterology department.
The whole situation had felt like a nightmare to the Toks, who had no clear answers as to why their son was bleeding internally at that point. The next day, they were horrified to see Zayden passing out copious amounts of watery and bloody stools.
A series of tests later revealed that he had Meckel’s diverticulum, which could lead to life-threatening consequences.
Affecting about 2 per cent of the population, Meckel's diverticulum is a small bulge left over by the umbilical cord. It is a common malformation of the gastrointestinal tract, and NUH sees a “handful’ of such cases each year, says Prof Quak Seng Hock, head and senior consultant of NUH’s Division of Paediatric Gastroenterology, Nutrition and Hepatology.
Most people with Meckel’s diverticulum do not have symptoms, and can live healthily without problems, Prof Quak explains.
On the other hand, it can also cause complications such as bleeding, abdominal pain and intussusception of the intestine –this occurs when a part of the intestine folds into the section next to it, and causes a blockage.
Just hours after he was diagnosed, Zayden underwent surgery to remove the abnormal bulge in his small intestine. A second blood transfusion was required as his blood count was still low after the first one.
Understandably, his parents were a bundle of nerves while waiting outside the operating theatre.
“I remember feeling very nervous. We felt so much heartache for our son who not only had to undergo blood transfusions at such a young age, but also general anaesthesia for the surgery,” Zilan shares.
Although he was well enough to be discharged a week after the surgery, his ordeal did not end there. He was readmitted two weeks later as he started vomiting and experiencing tummy pain again, which could be due to the intestines “sticking together” after the surgery, Zilan explains.
“Thankfully, the problem resolved after he fasted for around two days. Otherwise, the doctors would have had to ‘cut him open’ again,” she adds.
Zayden’s health scare had been both frightening and exhausting for his parents, who had to leave their second child, then eight months old, with the grandparents.
Still breastfeeding her younger son at the time, Zilan shuttled to and from the hospital and her in-law’s home to deliver expressed breast milk.
“We were lucky that my parents-in-law were able to help us care for the baby. We were also fortunate that the insurance policy we bought for Zayden helped cover his hospital bill, which amounted to more than $10,000,” she says.
Throughout the entire ordeal, Zilan was amazed and proud to see how brave her little boy was. Despite the pain and discomfort, Zayden had been “an easy patient” during most of the hospital procedures.
“He cried once or twice at first when he got pricked for a blood test and when they put him on drip. But we explained to him that the doctors and nurses were doing their job to make him feel better.
“Although you could see he was nervous when they had to do all those tests on him, he remained quite calm,” his proud mummy shares.
All better now
Zayden has recovered well, and is now an active three-year-old. His parents recently lodged a complaint to the Singapore Medical Council about the paediatrician who had initially misdiagnosed her son’s tummy issues despite repeated visits to the clinic.
“Although we understand that it can be difficult to diagnose an uncommon condition like Meckel’s diverticulum, we feel that the doctor could have at least referred Zayden to a hospital for a blood test,” says Zilan, who has declined to comment further on the case as investigations are ongoing.
She has switched to another paediatrician and advises parents to consider seeking a second opinion if their child does not seem to be getting well after several weeks.
“It is also a good practice to take a photo of your child’s stools, if you notice anything unusual. Luckily for Zayden, I did not delete the photo of his bloody stools as that sounded the alarm bell for the emergency department doctor,” she says.
The incident also spurred Zilan to donate blood for the first time in January – her way of paying it forward. The altruistic act had always been at the back of her mind, but she had put it off as she had anaemia in her youth, and subsequently got pregnant and was breastfeeding.
She points out that without the precious contributions from donors, Zayden would not have received his blood transfusions in time.
“If no one wants to donate blood, then there won’t be any available when the need really arises. I’m thankful their life-saving donations,” she says.
Did you know?
Every unit of blood you donate can save three lives. Some 120,000 units of blood are needed every year to meet the transfusion needs of patients in Singapore.
This is equivalent to more than 400 units of blood a day. To learn more about blood donation, visit giveblood.sg.
PHOTOGRAPHY ANGELA GUO
ART DIRECTION LOY SZE JIN