•The Star spoke with Dr Danson Makanga, the surgeon who conducted the rare operation at Mpeketoni Hospital in Lamu.
•The rare case has been documented in the East African Health Commission Research (EAHCR) journal.
Image: East African Health Research Journal
There is hardly a typical day in a hospital. But still, some can be more atypical than others.
Such was one day at Mpeketoni Hospital in Lamu when a private car rushed in an 11-year-old boy.
A large section of a metre-long rod had torn through his rectum, into the abdomen. It was curved at the end, which means it could not be pulled back.
He was bleeding, and there was the danger he was already dying.
“The iron rod went through his anal orifice. The child reported some lower abdominal pain that was accompanied by some fresh bleeding from the rectum,” says Dr Danson Makanga, a general surgeon who saw the patient.
The mother said he had been walking home from school when he slid and fell on the metal rod in an abandoned construction site.
He was found six hours later and rushed to the nearby Mpeketoni Hospital in Lamu County.
The rare case has been documented in the East African Health Commission Research (EAHCR) journal.
The Star also spoke with Dr Makanga, who operated on the patient.
He said penetrating injuries in the anorectal region are rare in children but when they happen have high morbidity and mortality.
Such injuries are also rare in the general public and more common in the military, according to the EAHCR journal.
In the military, colorectal trauma is at five to 10 per cent compared to the civilian setting where it’s at one to three per of all injuries.
They also require a multidisciplinary approach.
“Ideally, it would have required a general surgeon, urologist and vascular surgeon. However, due to scarcity in the area the general surgeon and myself had to do it,” Dr Makanga explained.
According to the journal report, the child denied urine incontinence. He was fully alert, in moderate pain, and had mild conjunctival pallor. This is an unhealthy pale appearance to the clear membrane that coats inside of the eyelids and can be a sign of blood loss.
There were no other injuries around the anal area, except for the rod that went straight into the orifice.
He was immediately scheduled for an emergency laparotomy – a procedure that involves a surgeon making one large incision in the abdomen.
The medics said they cut through the midline of the belly. There was turbid fluid that was not foul-smelling.
Then they found the curved end of the rod.
“We cut abdomen to enter. This is because it had lodged at the iliac vessels (blood vessels that provide blood to the legs, pelvis, reproductive organs and other organs in the pelvic area). It had ruptured the urinary bladder, and the rectum, which were repaired,” Dr Makanga told the Star.
The iron rod, which was extracted through the abdomen, was hooked at one end.
It measured approximately a meter long, weighed about 400 grams and did not have rust on its surface, according to the medical report.
Dr Makanga said the entire operation took two hours.
The boy was nursed in the general ward for four days before being discharged, and no complications were encountered during the operation.
During his stay, there was no infection and he was passing stools normally per rectally.
He was also reviewed at the outpatient unit three weeks later after his abdominal incision had healed.
He did not have any abdominal signs or symptoms and had resumed his normal activities.
The Mpeketoni medics said this November case still stands out although the hospital continues to handle other complex surgeries.
The family asked that we do not reveal the boy's name. But he has long resumed schooling.
“He is as fit as a fiddle,” says Dr Makanga.
Edited by Henry Makori