Thanks to new technology, intestines can now be stapled

Edrin Mbowa has until recently been passing stool through an opening on the stomach. The five year old minuscule bodied child was born with Hirschsprung’s Disease (HD), a condition that causes blockage of the intestine so that stool cannot pass through.

His mother, Rose Ndagire, a resident of Buikwe district says Mbowa struggled with constipation for one year until he eventually stopped producing stool. When he was two years old, he underwent an operation at Mulago Hospital and an opening was created on his stomach. Tubes for conveying waste out of his system were fitted and it is on these that he has survived for the past three years.

“Mbowa has not attended school despite him being of age because of this condition,” Ndagire laments. 

According to an article on www.myclevelandclinic.org, for people with HD, the healthy muscles of the intestine push the stool until it reaches the part of the intestine without cells. At this point, the stool stops moving and new stool begins to collect behind it.

“If is not treated early, hospital says stool can fill up the child’s large intestine, causing serious problems such as infection, bursting of the colon, and even death,” Dr Rose Mary Nassanga, the head of Eurology at Mulago said.

However, Mbowa now has regular bowel movements after undergoing an operation at just concluded two week paediatric camp at Mulago Hospital. 

About the camp:

The camp was a collaboration between Mulago’s Paediatric Unit and British Columbia Children’s Hospital in Canada. Its objective was to reduce the backlog of children in need of surgery and help in the complex malformations like where a child is born with no anus.

“We came here to share and exchange ideas and expertise and for the two weeks, we have received many children who need surgery and we have worked extra hours every day to provide as much surgical care as possible,” Dr Damian Duffy the Executive Director of the paediatric surgical evaluation office of the children’s hospital said. 

The conditions that are were addressed include: Hernias (when part of an internal organ or tissue bulges through a weak area of muscle), colostomy closure, liver problems, malformations like un-descended testis, kidney and Wilms tumours among others. 

Dr Duffy came along with a 14 man team including surgeons, physiologists, nurses, a child life worker and a logistics person. A total of $25,000 from private donations facilitated the operations of this team.

This is the third time the camp is taking place in Mulago and the team is planning a forth visit.  

Benefits& challenges:

Dr Nasser Kakembo, a paediatric surgeon of the unit says through the exchange of knowledge and skills, they were able to deal with many of the complicated cases. For example a child whose ends of the oesophagus were unconnected was operated upon and is still alive though under care.

“There has been a lot of sharing knowledge especially with joining intestines. We have been using stitches but they have introduced new technology where we use staplers,” he said. 

Also, the backlog of children in need of surgeries has been reduced.

The camp attracted children from as far as South Sudan, Kenya and Tanzania. 

However, Sr Mary Ganaffa Babirye the senior nursing officer of the paediatric ward says there is limited man power with only eight nurses and two operating surgeons. They are thus forced to work extra hours every day due to the high number of patients they receive- about 15 to 20 per day.

Also, the bed capacity is limited.

“We have only 60 beds and more often than not, there is an overflow of children. For example at the start of the camp, the ward had 80children and this forced us to improvise for them bedding on the floor,” she laments. 

Sr Ganaffa appeals to the administration to establish a single unit for the paediatric ward where the orthopaedic and burns and others are joined and not separated as they now are.