Paras Hospitals and its team of exceptional gastroenterologists and GI surgeons recently treated a rare congenital defect – Volvulus and Midgut Malrotation – that included the twisting of the intestine. This congenital defect (defect since birth) occurs in approximately 1 in 500 live births. However, the true incidence of malrotation is unknown, since many asymptomatic patients fail to present.
The diagnosis and procedure was performed on 15 yr old Harsh Yadav, a class 10 student from New Delhi. The son of a farmer started to complain of severe abdominal pain for the last 3 months. His pains used to commence post meals. According to Harsh’s mother, “ I suspected that the pain may be due to worms in the stomach or due to the junk food that children are fond of eating. However even after deworming him and keeping a close watch on his diet, his situation did not improve. We even gave him local ayurvedic churans and ghols, but nothing seemed to help him.”
Post a severe episode, Harsh was admitted in Paras Gurgaon. The gastroenterologists performed routine investigations and a contrast CT. The CT scan of the abdomen revealed a volvulus of the midgut. It is a complete twisting of a loop of intestine around its mesenteric attachment site. This can occur at various locations of the gastrointestinal (GI) tract, including the stomach, small intestine, caecum, transverse colon and sigmoid colon. This twisting of the intestine was responsible for the pain.
The team of gastroenterologists – Dr. Rajnish Monga, Sr Consultant and Dr. Anukalp Prakash, Consultant, shared the case with the GI Surgery team. The diagnosis was also done in association with the robust radiology team headed by Dr. Sanjay Dhawan.
According to Dr. Subrat Raul, Sr Consultant GI Surgery, “Approximately 90% of patients with malrotation are diagnosed within the first year of life, 80% of who are diagnosed within the first month of life. This defect takes place when the baby is in the mother’s womb. In older patients, it may present more insidiously with cyclical vomiting, recurrent abdominal pain, protein-calorie malnutrition, and immunodeficiency. Once intestinal ischemia develops, pain becomes the most pronounced symptom.”
“Volvulus is such a devastating complication in children, evidence supports operative treatment of asymptomatic malrotation. In Harsh’s case also we recommended surgery. It was a complex surgery that included removal of the obstruction and stitching of the intestine in the right order. The surgery was co-performed by Dr Abhishek Vyas,” adds Dr. Subrat.
Today post surgery Harsh is doing better. “It was great to see him ask for food and eat without complaining of pain. It is hardest for a mother to see her child in pain. It was our negligence due to which he suffered. Had we consulted the right doctors earlier our child would not have suffered. Thanks to the team at Paras for treating Harsh and making him well again,” shares Harsh’s mother.
All that Harsh can think of is, “Eating a lot without any pain!”, shares the jovial young boy.