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Baby born with his ' inside' out.

DOCTORS at the All- India Institute of Medical Sciences ( AIIMS) are once again facing the challenge to do corrective surgeris on a baby born with his internal organs out.

The doctors will soon perform a complicated multiplestage surgery on a 15- day- old boy who was born with his urinary, intestinal and genital organs protruding out of the abdomen.

The baby, born on November 12, is suffering from a rare congenital disorder called cloacal exstrophy in which innerabdominal structures are exposed. The defect may also result in other complications such as imperforate anus and spinal defects.

It occurs during the prenatal development of the lower abdominal wall structures. ( The cloaca is the part of an embryo that develops into these structures).

The child was born in Safdarjung Hospital and was referred to AIIMS for surgery. " This is a very rare anomaly. The survival chances are slim, but there are skilled surgeons in AIIMS who can handle this case. So, we referred the baby to the institute," said Dr Sameer Acharya, paediatric consultant, Safdarjung Hospital.

" Initially, it was difficult to make out whether the baby was a boy or a girl. After we recognised his testes outside his body, we realised it was a boy," he said.

Cloacal exstrophy occurs in one out of 2.5 lakh to four lakh births. Normally, as a baby grows inside the womb, the bladder and the urinary system separate from the bowel and the gastrointestinal system to form two separate systems by formation a urorectal septum.

Abdominal tissues also close and form the abdominal wall of muscles and skin covering the lower abdomen, pelvis, perineum and genitalia.

But in this case, the urinary,

intestinal and genital systems are clubbed, hampering the normal functions of these organs.

The baby was born prematurely in the eighth month of pregnancy. Its weight at the time of birth was about two kg.

" The baby was brought to the AIIMS paediatric emergency on November 13. It's a rare condition, but we have handled such cases in which the babies survived.

Multiple surgeries will be needed to save him," said Dr D. K. Gupta, head of the paediatrics department at AIIMS. The baby's parents, Manju and Satpal Singh from Mandi village near Mehrauli, say they are praying for a miracle. " I couldn't believe my baby was born like this and was shocked when doctors told me he wouldn't survive for more than two days. It is god's grace that he is alive even after 15 days," said Manju.

The treatment process has already started. The baby was in the intensive care unit ( ICU) for 10 days before being shifted to the paediatric ward on Wednesday.

His weight has now come down to less than one kg. " The child is stable and responding to the treatment. Currently, he has no control over urine and the bladder is open. Colostomy will be done; the genitals will need to be reconstructed along with the intestine," said Dr Gupta.

" The surgery will be done in many stages. The date of the surgery has not been decided so far," he added.

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Publication:Mail Today (New Delhi, India)
Date:Nov 27, 2009
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