Diagnosed with a rare disease, a 2year-old boy was unable to poop naturally since birth. The child had been solely dependent on daily enemas. He was finally cured via a rare surgery in Mumbai.
Scar-less surgery in a 2-year-old boy who suffered from chronic constipation since birth.
April 15:A two-year-old boy from Nashik, diagnosed with a rare disease, made him unable to poop naturally since birth. The disease, called Hirschsprung’s disease, affects 1 in 5,000 to 10,000 children and leads to severe constipation.
The child had been solely dependent on daily enemas for the last two years. After he turned one month, his parents began noticing that he was struggling with severe constipation, which soon became a constant cause of concern.
He was unable to pass stool for as long as 8 days. Despite multiple medications and daily enemas, his condition never improved. His stomach often swelled with gas, and his weight gain remained poor.
When the parents brought their son to Gleneagles Hospital in Mumbai, a few diagnostic tests like barium enema, endoscopy biopsy, and manometry confirmed the condition.
Hirschsprung’s disease occurs when nerve cells (ganglion cells) in the lower part of the large intestine fail to develop, causing stool to accumulate, leading to blockage and chronic constipation.
There is no medical management for this condition, and it can even become life-threatening due to infections. In very young babies, delayed passage of the first green poop (meconium) can be an early sign.
Older children usually suffer from swollen stomach, vomiting, poor weight gain, and constant constipation, while some may suffer from infections. The standard treatment of the condition requires major surgery that is either open or laparoscopic where the affected part of the intestine is removed and rejoined.
“However, in this child’s case, we used a minimally invasive technique called Per-rectal Endoscopic Myotomy (PREM), which avoids any external scarring. The child is free of symptoms, eating well, and passing stools without the requirement of enema. Not treating the child at the right time could have led to complications like enterocolitis, infection, and poor weight gain. Though this is a congenital condition, antenatal diagnosis is extremely difficult and the child becomes symptomatic after birth only,” said Dr. Vibhor Borkar, a paediatric gastroenterologist, who treated the boy.
PREM (per-rectal edoscopic myotomy) is a medical procedure in which doctors use a thin, flexible tube with a camera and tools (called an endoscope) to go inside through the rectum, without any cuts or stitches. They carefully cut the tight muscle to help it relax. This makes it easier for the person to poop normally.
It’s a minimally invasive procedure, which means it’s gentle on the body and helps patients recover faster.
Dr. Shankar Zanwar, interventional gastroenterologist, added that the procedure is done under general anaesthesia. The whole procedure is done endoscopically where a small cut is made just inside the anus of the patient. From this cut a tunnel is made within the layers of the intestine and a non-functional segment of the intestine which lacks nerves is cut internally.
The entry cut is then closed with clips. As the procedure is done endoscopically, no scar or cut is seen on the body surface and the patient is pain-free after the procedure. The entire operation lasted 3 hours.
Globally, only 13 such procedures have been reported, and this is the first case to be treated by the endoscopic method in Mumbai.
The boy who couldn’t poop for two years is now leading a normal life after the procedure. He is free from abdominal pain and swelling, without any external stitches, and no longer needs further medical intervention.
“The success of this surgery not only brings hope to families facing similar conditions,” said Dr Bipin Chevale, CEO of Gleneagles Hospital Mumbai.(IT)
