According to Dr. Ton Thi Anh Tu, Department of Pediatric Surgery, Tam Anh General Hospital, TP HCM, pectus excavatum increases the risk of malnutrition, with An being a typical case. The deep indentation of the chest forces the respiratory muscles (diaphragm and intercostal muscles) to work harder for normal breathing. The body burns a significant amount of calories during this extra exertion. The resulting fatigue and weakness lead to loss of appetite.

A CT scan at Tam Anh General Hospital, TP HCM, revealed An's Haller index (a measure of pectus excavatum severity) was 4, while any score above 3.25 is considered severe and requires surgery. The indentation in An's chest was almost 5 cm deep, compressing the heart and lungs, restricting their function, and causing shortness of breath, chest tightness, limited mobility, poor appetite, and malabsorption.

The condition also caused fatigue, thinness, and malnutrition. Despite being 1.72 m tall, An weighed only 44 kg, resulting in a BMI of 14.8 (the normal BMI range for this age is 18.5-24.9).

An underwent surgery to correct the pectus excavatum. The surgical team inserted a thoracoscopic camera into An's chest to clearly visualize the heart, lungs, and major blood vessels. They then created a tunnel across the chest and inserted two metal bars to lift the indented sternum, restoring the chest to a more normal shape. The surgery was successful, and An was discharged a week later.

Dr. Tu (center) performing surgery to remove the chest support bars from the patient. Photo: Tam Anh General Hospital

Dr. Tu (center) performing surgery to remove the chest support bars from the patient. Photo: Tam Anh General Hospital

Pectus excavatum is a congenital chest wall deformity where the sternum and rib cartilages grow inwards, creating a depression in the chest. It is more common in boys than girls. The exact cause is still unknown, but genetic factors, abnormal rib cartilage development, and connective tissue disorders like Marfan and Ehlers-Danlos syndromes are considered risk factors.

The depth of the indentation and the symptoms vary. Patients have a noticeable depression in the center of the chest, often with rounded shoulders and a protruding abdomen. Moderate to severe cases cause shortness of breath, especially during exertion, reduced stamina, chest pain, rapid heartbeat, palpitations, and unexplained fatigue. The condition can also affect mental health due to self-consciousness about appearance.

Dr. Tu recommends timely intervention for children with pectus excavatum to ensure effectiveness. The ideal age for surgery is between 8 and 12 years old when the bones are still malleable and growing, making it easier to reshape the chest and promote healing.

Dr. Tu also stresses the importance of proper nutrition for children with pectus excavatum to support healthy development. Small, frequent meals prevent stomach distension, which can put pressure on the diaphragm and other organs, leading to bloating, shortness of breath, and early satiety. A diet rich in energy and nutrients is recommended, including foods like avocados, nuts, olive oil, salmon, tuna, chicken, fish, eggs, and milk. Soft, easily digestible foods like smoothies, soups, stews, and purees aid digestion and nutrient absorption.

Patients should consult with a doctor and nutritionist for a diet tailored to their specific condition, age, and health status. Adequate nutrition is crucial for the body to withstand surgery and the subsequent recovery process.

Dinh Lam

*The patient's name has been changed.