The procedure took one and a half hours to complete. (Representational)Surgeons at a city hospital operated on a six-year-old with an obstruction in the bowel using an endoscopic technique that is mainly used in adults. The girl from Kashmir came to the hospital four weeks ago with a history of not being able to swallow food for almost three years.
“When she came to us, she was very thin, emaciated, and marasmic (protein malnutrition). She weighed 8-10 kg lower than the normal weight. We diagnosed her to be suffering from Achalasia Cardia (a disorder that results in the muscle at the base of the food pipe where the food enters the stomach becoming tight),” said Dr Anil Arora, head of department of gastroenterology at Sir Ganga Ram hospital. The girl repeatedly regurgitated from her mouth and nose.
The condition is not often seen in children, with less than 5% of all cases reported in those below 15 years of age globally. The usual treatment for the condition is open surgery, but due to her condition, the doctors decided to perform an endoscopic procedure that the hospital has been doing in adults for around seven years.
The procedure called POEM or per oral endoscopic myotomy is an endoscopic procedure that involves cutting the internal lining of the food pipe, creating a tunnel between the muscle layers and the inside lining of the food pipe, and then cutting the tight muscle at the stomach and food pipe junction. The procedure took one and a half hours to complete.
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“The challenge for us was to do this novel procedure in such a low weight child of this young age, one of the youngest in India to the best of our knowledge, and low weight of the child at 11 kg, lowest weight to the best of our knowledge in India, as there was a substantial risk of infection, aspiration and respiratory problem in the child. There were limitations of the use of adult endoscopic equipment and accessories used in POEM procedure to be used in a small child,” said Dr Arora.
He added, “We have already successfully performed this procedure in 427 cases till date in our hospital. But this procedure in a young child of six years weighing only 11 kg has been performed for the first time in India.”
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