Surgeons remove Meru boy's large intestine, he returns to school

Surgeons were forced to remove the entire large intestine of a school boy who developed small tumours that spread all over his colon.

They also removed the rectum, as there was no other way to successfully treat this rare condition, which affects one in 100,000 children.

The 13-year-old boy was operated on late last year at the PCEA Chogoria Mission Hospital, a Level 5 facility in Meru.

He has already returned to school in Standard 8 and will sit the KCPE this year.

This delicate surgery successfully performed in a county facility represents the growing surgical capacity in Kenya, where such services were previously available only at the national referral hospitals.  

Medics who treated the boy reported the case last week in the Clinical Case Reports journal.

They are doctors Elijah Mwaura, Dennis Mukamati, Mark Waithaka, Victor Mutua and Maurice Mugao of Chogoria Mission Hospital. Others are Edwin Mogere of Murang'a Level 5 Hospital and Chris von Csefalvay of the US-based data consultancy firm Starschema Inc.

“A 13‐year‐old boy who presented to our facility with a history of painless hematochezia (passage of fresh blood from anus) for three years. He developed pallour (pale colour) and generalised body weakness over time,” they said.

Blood tests revealed abnormally small red blood cells poorly filled with iron.

There were also some non-cancerous polyps (small growths) in the throat.

“Colonoscopy illustrated multiple pedunculated polyps (mushroom-like tissue growths attached to the surface of the colon by a thin stalk) throughout the colon,” the doctors reported.

They diagnosed this as Juvenile polyposis syndrome (JPS), a hereditary disease characterised by multiple polyps throughout the throat, stomach, intestines and rectum.

“JPS is rare, with an approximated incidence of one in 100,000 individuals. Patients with JPS are at increased risk for developing colorectal and gastric cancer,” they reported.

The medics said the removal of the large intestines was the only way to save the boy’s life.

People can survive without the large intestine, whose primary role is the absorption of water and electrolytes to concentrate the stool.

However, such people need medication, otherwise, they would pass watery stool quite often.

After removing the large intestines and the rectum, the surgeons created an internal J-shaped pouch from the end of the small intestine to the anus, allowing the boy to eliminate waste normally.

This procedure avoids the need for a permanent opening in the abdomen (stoma) for passing stool.

Their medical report is titled, “Juvenile polyposis syndrome: A case report.”

An image of the removed intestine, which had been cut open, shows 109 polyps.

The boy was discharged on day three after the operation and was able to eat small meals and retain waste in the small intestine.

“He complained of faecal incontinence for a few days, which resolved in one week. The patient was reviewed at our surgical clinic at three‐months post‐operation,” the doctors reported.

“He had gained weight and did not have any complaints other than opening of bowels four to six times a day.”

Follow‐up endoscopies at three months revealed one polyp near the rectal opening and five gastric polyps, the medics reported.

“The patient together with his guardian preferred the gastric polyps and the anorectal stump polyp to be resected after completion of his primary school education. He is currently in his final year.”

They said these remaining polyps should be removed to reduce the risk of malignancy.

(Edited by V. Graham)