Journalism of Courage
Doctors at Jehangir Hospital in Pune performed surgery to save an eight-year-old boy who had fallen from a cycle and developed abdominal pain due to a rare intestinal hole (a loss of continuity of the bowel wall), according to the hospital authorities.
Aditya’s father Ashok from Ranjangaon, 50 km from Pune, said the cycle’s handlebar hit the boy’s stomach as he fell from it on August 13. He was initially stable but had abdominal pain, the father said.
“X-ray and ultrasound did not show any significant injury also but progressively, he developed some abdominal distention,” Aditya’s parents said. They took him to Jehangir Hospital where doctors suspected an internal injury and a CT scan confirmed that some air had leaked out of the intestines, indicating an injury to the bowel. With the help of investigations, it was confirmed to be some very unusual type of intestinal perforation.
Dr Dasmit Singh, a paediatric surgeon at Jehangir Hospital, said: “Initially the injuries were contained but as the pain and distention went on increasing, we got a CT scan done, suspecting intestinal perforation. However, the exact injured part of the intestine could be identified only during the surgery. During the surgery, it was discovered that it was a very rare type of injury that had happened as the duodenum, which is the beginning of the small intestine, was injured at both the front and back walls hinting that there was a severe compression that had happened because of the cycle’s handlebar. To fix this was quite a difficult task.”
During the surgery on August 14, Dr Singh and his team, including Dr Varsha Soni, found out that bile was collected in the peritoneum and when the peritoneum could no longer contain the secretion it ruptured into the abdominal cavity and which led to further complications.
“All of this was discovered during the surgery so we set upon repairing it. We cleaned up all the muck that was in the abdomen. The posterior wall of the intestine was repaired first and then the anterior wall was fixed as it had to be done in a certain manner to avoid future narrowing of the intestine to obviate any long-term problems. Post-operatively the patient was placed on a ventilator as the sepsis had spread into the whole body and the patient’s condition needed aggressive management in the pediatric intensive care unit for ten days,” said Dr Singh.
“Multiple tubes were placed in the retro-peritoneum and next to the duodenum, to drain any leaked fluid. Initially, there was some drainage because of the excessive amount of peritoneal fluid, which reduced over a while and the duodenum progressively healed. In the postoperative day, a dye study was done to delineate the stomach and the duodenum and the study confirmed that there were no leakages, indicating good healing of the anastomosis”, added Dr Singh.
In addition to all this, the patient was facing other problems too, the doctor said. His heart rate was very low and he had very high blood pressure which even led to an episode of fits. However that was treated and the patient started showing signs of improvement, Dr Singh said.
Dr Sagar Lad and his team of paediatricians managed the multiplicity of intensive care medications to get the patient back to good health and he was discharged three days ago, an official statement said.
