Kerala - Thiruvananthapuram   

Rare paediatric surgery at SAT

Thiruvananthapuram:

The Paediatric Surgery Department of SAT Hospital here has hit the headlines once again by successfully performing a large intestinal graft to fabricate a fully functional vagina for a 10-year-old girl, who was born with the rare condition of vaginal atresia or absence of vagina.

The surgery, which was performed on February 13, was pronounced fully successful when the child was brought in for follow-up on Wednesday.

“This is the first time perhaps in the State that a large intestine graft was successfully performed on a child to correct congenital vaginal atresia,” S. Prathapan, the Associate Professor of Paediatric Surgery and head of PS Unit III at SAT Hospital, who led the surgery team, said.

The girl, residing at Pallikkal, had been referred to SAT Hospital by a local hospital following severe abdominal pain. An ultrasound scan done on the child had indicated a lump filled with pus, immediately behind the urinary bladder and below the uterus.

Detailed clinical investigations done at SAT and a further MRI scan revealed that the child was born without a vagina. A laparoscopy done on the child revealed that she had a normally functioning uterus, fallopian tubes and ovaries. The abdominal pain had been caused by the secretions from the uterus which had accumulated behind the bladder as there was no vagina to allow the outflow.

“Vaginal atresia is a rare condition and it usually goes undetected till adolescence when the child is expected to start having normal monthly periods. As she had a normal uterus and ovaries, it was important that we recreate a functional organ for her so that her future married life and fertility is not affected,” Dr. Prathapan said.

The surgeons took a segment about 7 cm from the colon, retaining all nerves and blood vessels, and stitched it to the uterus to connect it from the inside to the external genitalia. The rest of the intestine was then stitched up.

The open abdominal surgery took five hours as the stitches had to be put in an area not easily accessible.

“The organ we recreated will be ‘live’, with blood supply and sensations in tact. The intestinal graft will act as a normal vagina and when the child attains puberty, she will have monthly periods also. The only problem in future would be that the girl will have to opt for an elective Caesarean section delivery instead of a normal delivery,” Dr. Prathapan said.

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