Udupi, Aug 27: Department of Pediatric Surgery at Kasturba Medical College and Hospital, Manipal successfully performed complex and rare oesophagus duplications surgery on two pediatrics patients.
Oesophageal duplications are exceedingly rare congenital embryonal malformations. Out of these tubular types of duplications is still a rarer form of oesophageal duplication. Though the lesions are since birth, symptoms are rarely seen in childhood, but more symptomatic in adults. They may present with difficulty in swallowing, breathing difficulty, chest pain, epigastric discomfort, vomiting, stridor, cough, bleeding, and hematemesis or may be incidentally detected. Because of varied presentations, diagnosis is often difficult or delayed. The only option of managing these conditions is the surgical removal of the duplications.
Department of Paediatric Surgery, KMC, Manipal had two cases of oesophageal duplication, 11-month baby, and an 11-year girl. The 11-month baby presented with recurrent respiratory infections and difficulty in breathing. The 11-year patient presented with a recent change in voice, breathlessness in lying down position, and neck swelling. The patients were evaluated with x-ray, CT scan, and endoscopic evaluation. Even after a complete evaluation, it was not able to diagnose the duplication in the 11-year patient. It was a surprise to see complete duplication of the oesophagus during surgery.
Dr Vijay Kumar, professor, and head of Paediatric surgery with his team of doctors Dr Santhosh Prabhu, Dr Sundeep PT, Dr Harsha Acharya, and Dr Ranjani, could remove this duplication of the oesophagus by opening the neck and thorax(chest) of the patient. Dr Aravind Bishnoi, a cardiothoracic surgeon helped intraoperatively in one patient. Pediatric anesthetist Dr Ajith gave anesthesia support. Both patients recovered completely after surgery.
Dr Vijay Kumar says, these anomalies are extremely rare problems in children and may have different presentations at different age groups. Diagnosis may be difficult in some cases, even after a complete evaluation, as we had in one case here. A high level of suspicion in diagnosis is important. If not operated in time, it can give rise to different complications, and morbidity in these patients may increase. So timely diagnosis, understanding the correct anatomy before the major surgery and a good infrastructure with a team of experts is important in managing these extremely rare problems in children.
Dr Avinash Shetty, medical superintendent congratulated the Pediatric Surgery team and said that "this kind of complex surgery was possible at Kasturba Hospital, Manipal due to the team of expert doctors. With this, it gives new hopes to the pediatric patients of coastal and middle Karnataka.”