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It is Crohn's, but what killed our girl ???
Dr. Rathin Datta FRCS (England, Edinburgh & Glasgow)
It is Crohn's, but what killed our girl ???
PHOTO : GB Hospital, Agartala. File Photo

It was mid 70s,I was fond of leading the mobile Surgery team of GB hospital to the peripheral towns, a completely voluntary effort where the nursing and para medical personnel participated with enthusiasm. My little daughter, then aged 6 yrs would accompany me, she loved touring.

In a district hospital ,we had a full days work, the grateful citizens organized a short entertainment programme to be followed by dinner. In the variety programme a teenager sang. Romi my daughter was very impressed 'Baba she is very pretty and sings very well' I agreed. The father came and introduced. I knew him well, one of the finest gentleman that I had met in the state, rich& apolitical.Shampa was his darling daughter.

Shampa walked in my clinic after about a year; for the last few months, she had pain in her abdomen, irregular bowels, few rashes in the arms and mouth ulcers.On examining her I found there was an irregular lump in the right lower part ,visible peristalsis [distended bowels showing movement] and increased bowel sounds.

Provisional diagnosis of Sub Acute Intestinal obstruction due to:

1 Regional ileitis [or Crohn's disease]

2.Tuberculosis [ Ileocaecal TB ]

3.Cancer ( of the Ileo-caecum) in that order was made.

If it was today, lot more diagnostic armamentarium would be available e.g. colonoscopy, Capsule endoscopy, C T Scan, MRI etc but then we had only Xray, that also of not very high quality. Anyway Barium meal followthrough was done –the 40 minute film showed 'rat tail, deformity i.e. long narrowing of the terminal terminal small gut, signifying Crohns disease of the Ileum.

After a week's gut cleansing we opened the abdomen under general anesthesia with few bottles of blood.

My eyes having seen many cases in England told me, it was Chrohn's sure but was a very aggressive type , involving the last foot of small intestine and the part of the right colon and caecum.

Right Hemi colectomy was decided upon ,it meant removal of terminal foot of small intestine ,whole of caecum, ascending colon and part of transverse colon and the regional glands and then joining two cut ends. It is one of the most major surgical procedures that is done in human body. she required a generous amount of blood transfusion.
Recovery was uneventful. On the 10th day she was ready to go home & finally went.

Histopathology of the lesion showed very aggressive type of Crohns.

Crohns is a type of inflammatory bowel disease, which can affect any part of the bowel. Shampa had all the signs i.e. skin rashes, eye inflammation [uveitis], not uncommon [30 cases out of a lakh population in U.K].There is no specific medicine, very careful diet regulation and now-a-days Probiotics ieInfiximab etc can prolong life,but not cure.  By very careful management life can be prolonged and patient can lead a more or less normal life. Chances are that the disease may even burn out or at least have a period of remission alternating with activity.

I remembered, while I was Registrar of a colorectal surgery unit in England,I used to be the Secretary of the Colostomy club of the city where patients ,who had undergone surgery and ended up with colostomy were the members. There were patients who had been operated for Cancer Colon, Cancer rectum , Ulcerative colitis and Crohn's and were benefitted by the training and also the camaradiery. I had even organized weddings among the members.

After two years, when I saw Shampa last she was better, her rosy cheeks had returned, the father was keen for her marriage, But I had to tell Mr. Choudhury to wait – I had heard increased bowel sounds with my stethoscope [that meant recurrence].She was put on 5-ASA which act on mild Crohn's.

May be little disgusted they started engaging quacks and 'Bonaji' quacks.

Another year or so after ,she was brought in severely sick– she now had severe pain, occasional vomiting and purging. Abdomen felt ominous. We put her on high dose of steroid IV drip and naso gastric suction, she was feeling better. Our plan was to tide over this crisis and in the meantime arrange for the Probiotics which were already in the Indian market. We placed the order for the Probiotics.

I was angry, for I had become quite fond of the sweet girl.I told off the parents for wasting time with the quacks, as though, I would not be able to cure her completely, it was possible to give the patient long & comfortable life now that the Probiotics are available and we know better methods are also available too.

I had to go to N.E.C.(North Eastern Council] meeting at Shillong with the State Govt. team and told Shampa to be a good girl till I returned. On return I would take her home myself in my car. She said " I love Fiat cars, but take along Tutul ,he is fun. The little man had by then replaced the sister as my tour companion. My little son was a car maniac and a great company." Done " I said.

As usual I stayed in our ancestral house at Shillong and would return on the 4th morning. Return flight was from Guwahati at 10AM,I should leave Shillong by 5 AM. at the latest.

It was day break but still half dark , dawn in the hills of Shillong, I was half awake, There was Shampa regally dressed ,"'Kaku' she said accusingly, you promised but did not come to see me,I am leaving." I woke up but no one was there.

On landing at Agartala airport I madly drove ro G B Hospital, the No.10 cabin was empty, the sweeper was cleaning the floor. The Nurse informed-the night duty emergency medical officer thought the steroid was in too high dose, so had stopped the steroid altogether. The patient went into Steroid withdrawal shock, could not be resuscitated and died at 4-30 AM. The family had taken away the body only an hour back.

My whole surgical team including the nurses were upset, like me as all were fond of this sweet girl. There was no reason for her to die ,but for the rash action by the immature EMO. The disease burns itself up as years go by, we could not give this chance to this very dear patient of ours.

This is a true story, only names have been changed for privacy.

Dr. Rathin Datta, FRCS (England, Edinburgh & Glasgow).FFIMS (Athens) 

Surgeon & Sports Medicine Specialist, Retd. Chief Advisor of Surgery, GB & VM Hospitals, Govt of Tripura

Padmashree Awardee, winner of the Bangladesh Liberation war honour 

This article also published in Facebook simultaneously

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