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Eight-year-old Jhanvijith Kelath had been suffering from fever, vomiting, and stomach pain for three days when her family decided to take her to a paediatrician. Enlarged liver was the primary diagnosis — but a team of experts discovered something else: Part of her intestine was already dead.
Doctors at Dubai-based NMC Royal Hospital found out that Jhanvijith was suffering from a rare clinical condition that resulted in multiple intestinal complications.
Experts have said her ultrasound and CT scan reports were "frightening". Besides an enlarged liver, cysts were also detected in her small intestine with gangrene. Her official diagnosis was hepatomegaly, with mesenteric lymphadenitis.
The specialists immediately took action and conducted a two-hour surgery, mainly to remove the dead, gangrenous part of her intestine.
Dr Ananth Pai Kalsank, Medical Director & Specialist - General Surgery at NMC Royal Hospital, Dubai, explains, "Cysts are growths that can appear anywhere along the gastrointestinal tract or reproductive organs like the ovaries. Sometimes in the gastrointestinal tract, the cysts appear to duplicate the cells and structures of the organs they are attached to. For this reason, gastrointestinal cysts are often called duplication cysts.
However, diagnosing a duplication cyst is difficult, even with modern imaging techniques such as CT or magnetic resonance imaging – especially when no structural connection exists between the cyst and the normal bowel."
Explaining the reasons for their occurrence, Dr Ananth Pai added that the intestinal duplication cyst occurs when an abnormal development of intestinal tissue is attached to or adjacent to the intestines. It can occur anywhere from the oesophagus (the muscular tissue connecting the mouth to the stomach) to the rectum.
Dr Nilesh Kumar Panchal, HOD, specialist paediatrician at the hospital, said the exact cause of this abnormal development of the intestinal tissue is unknown. “An isolated intestinal duplication cyst is an extremely rare congenital anomaly – meaning that it happens before your baby is born in the gastrointestinal tract. They are mostly detected in infancy and early childhood when symptoms such as abdominal pain and obstruction occur. Only a few cases have been reported/published in the English-language medical literature. Early surgical management will prevent further complications of this condition."
During the surgery, Dr Annigeri found a rare clinical condition called an isolated enteric "duplication cyst" of the small intestines (twining of bowel) with gangrene. There was also a hole in the cyst. The specialist was able to remove the dead part of the intestine.
Dr Nilesh Kumar Panchal, specialist paediatrician at the hospital, said the exact cause of this abnormal development of the intestinal tissue is unknown.
“An isolated intestinal duplication cyst is an extremely rare congenital anomaly — which means it happens before your baby is born. They are mostly detected in infancy and early childhood when symptoms such as abdominal pain and obstruction occur. Only a few cases have been reported/published in the English-language medical literature. Early surgical management will prevent further complications of this condition,” said Dr Panchal.
Parents are urged to be on the lookout for danger signs like yellow vomit and severe abdominal pain with bloated stomach.
In addition, a spell of fever with loss of appetite and absence of bowel movement require an urgent visit to the doctor.
Jhanvijith has recovered well, able to return to school after a week of recovery. She is now playing sports after just four weeks.
Deepthi Kelath, the child's mother, said: "After a week, Jhanvijith was doing well, free from symptoms, taking a full oral diet with the surgical wound healing fast. I am happy at the outcome and shall remain grateful to my daughter's doctors and nurses at the hospital.
Functions of a family-friendly car
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