Ghurburan is a four year old boy from Mauritius, picture with his mother and father below who can be seen to be anxious, but trusting, before the surgery. He was born with a blockage to the flow of urine from his bladder and so he had to be catheterised every day to empty his bladder. He had the blockage cleared during a previous visit to Mauritius by the Kind Cuts for Kids team. These visits are supported by the Society for Children Inoperable in Mauritius and the Mauritian Ministry of Health and Quality of Life. During the 2006 paediatric surgical team visit, he had his bladder enlarged with one of his ureters, the tube that takes the urine from the kidney to the bladder. This operation is becoming the best option for those with a large enough ureter and this operation is now preferable to the traditional technique that uses the bowel with its lining to make the bladder, a technique that can have a lot of potential complications. The successful operation took four hours and significantly reduced his risk of future renal failure.
Ghurburan?s family?s tears of fear turned to tears of joy as the boy made a rapid recovery. He was home within a week, with an improved outcome for his kidneys and without the need to catheterise his bladder to empty it, because the ureter had been used.
The surgeons involved in the procedure were either taught how to do the operation or had the chance to further their experience in what is a life saving operation, one that saves kidneys and enhances lifestyle by producing urinary continence.
Peerboccus, a beautiful little baby boy, was born with an imperforate anus (no hole where his anus should be). This meant that without treatment, he would have a total blockage resulting in swelling and pain. He required the blockage to be repaired, initially by the formation of a temporary colostomy, which brings the end of the bowel to an opening in the skin of the abdomen where a bag is attached to catch the bowel motion. This means that he will subsequently require a major procedure to form an anus in his lower bowel and to close the colostomy. He is like over 150 children around the world who have been helped by the Kind Cuts for Kids Foundation. In 2006 he wore a bag on his abdomen to collect his bowel motion.
The bowel was not the only problem; a kidney ultrasound and further x-rays (below) showed him to also have significant kidney damage with the very dilated ureter shown in the image. His bowel abnormality, after the colostomy, was not life threatening, but his kidney problems were making him repeatedly sick and rapidly ruining his kidneys, resulting in life threatening infections.
Surgery by the visiting team saved his kidneys, and his life, and next year we will reconstruct his bowel, to allow him to poo normally. The look of gratitude on the boy?s and mother?s face, and the look in the boy?s eyes in the early days after the surgery is a constant reminder of why we continue our work.
Gloria is a two year old girl from Papua New Guinea who, over the course of many weeks, began to be unwell, irritable, lethargic and developed a huge lump in her abdomen. The school teacher father had seen the swelling in the little girl?s abdomen develop over weeks, but the lack of easy access to a doctor was one of the many factors keeping her from treatment. Examination and X-rays showed the lump to be occupying much of her abdomen and half of the left side of the chest.
A six hour operation was performed by the Kind Cuts for Kids team, working with the doctors and nurses from Papua New Guinea, to remove the lump. The abdominal operation removed a huge tumour known as a benign teratoma, which was adherent to the pericardium (membrane around the heart) and the oesophagus.
Gloria made a spectacular recovery, seen in the picture below on day 2 (eating a banana), and went home with her family on the 5 th post operative day.
Rachel is a 13 year old girl who had a massive lump protruding from the left side of the neck. She became reclusive and afraid to go out without friends, spending her life hiding away under a bandana in the highlands of Papua New Guinea. After a number of years the word had spread deep into the highlands that children could have surgery to fix even such grotesque problems. Rachel?s family lived on a dirt floor, and only spoke one of the over 900 languages in Papua New Guinea.
The huge mass on her neck was a benign tumour that could easily be removed by doctors in the western world. However Rachel?s problem was that it had never been seen by the PNG surgeons and was far different to the usual situation encountered by the visiting Australian team. Like Gloria, the operation took around six hours. Despite the discomfort of the surgery, Rachel was easily able to smile when given a mirror to see the difference in her appearance the following day, something she had not wanted to do for many years. Interestingly, children with such a life-changing operation don?t seem to need much pain relief!
Yeshni is a beautiful three year old little girl who was born with an abnormal connection of her bowel to her perineum and a very dilated segment of bowel in the pelvis. This resulted in problems with constipation and soiling as she was unable to control her bowel action. She needed both repair of the abnormal anatomy to make her look normal and to enable her to be continent of faeces.
A barium enema, (a test where contrast/dye is placed in the lower bowel and x-rays are taken) confirmed the huge size of her rectum, which was also confirmed during the initial part of her surgery. The dilated bowel (below right) was removed through the second part of the operation, designed to establish continence and restore normal anatomy. The normal part of the bowel was sutured to the skin, without the formation of a colostomy.
Yeshni had benefited from the Kind Cuts for Kids team?s experience with complex cases of such ano-rectal anomalies. Therefore she was spared the formation of a colostomy and the ongoing problem of constipation and soiling that is seen when the dilated segment is retained. The lessons learnt by the Kind Cuts for Kids surgical team have also been applied to Australian children and the knowledge shared through publication in the international surgical journals.
Yeshni can now lead a normal life, fully continent and healthy. She can attend school and do all the activities that her friends can.
Manuel is a four year old boy who lives in Havana, Cuba with his brothers and sisters. He had only one kidney. His other kidney had been removed as part of surgery to save his life because of a tumour known as a Wilms? tumour, He had an ultrasound scan to check that his only remaining kidney was still OK. Unfortunately, the pictures showed that he had a large lump that looked like he had developed a second cancer in his remaining kidney. Manuel needed a second major operation to remove the tumour as without an operation, his life was at risk.
The removal of such a cancer is a complex procedure with high risk of major complications, and a major risk of loss of the kidney. The Kind cuts for Kids team worked with the surgeons in Cuba to successfully remove the tumour. Apart from a return trip to theatre to remove a clot in the ureter, the boy made a very good recovery, and was home six days later, much to his family?s delight. The pathology examination of the specimen indicated that Manuel was likely to be cured of the cancer.
The pale portion in the x-ray shows the poor blood supply of the cancer, in the middle of the kidney. Demonstrating the technique of removal of the tumour to the local Cuban surgeons will greatly benefit other children in Cuba in the future, and was excellent experience for the visiting medical team as well.
Yanebi, was a 13 year old girl who was born with her bladder exposed to the surface of her abdomen, a condition known as ?bladder exstrophy?. Her bladder was wide open, resulting in her being constantly wet with urine, giving her an awfully offensive body odour. She was unhappy at school and constantly teased by her school mates and as a result, became depressed. Any trip outside the home was an ordeal for her. And on top of this, she had previously had a major operation to try to fix her abnormality but it had been unsuccessful. This put great strain on her family who were finding the situation difficult to cope with. And so when we met her she was shy and embarrassed about her problem and had become withdrawn.
At operation, she was also found to have a blocked left ureteric opening, further complicating the complex surgery, and making a structural rearrangement also a lifesaving operation. The procedure involved fracturing the pelvis in four places, the incisions for which are shown below (left). The bladder was separated from the perineum and enlarged with bowel, after which a continent stoma and umbilicus were formed, so that she could drain her urine from the new bladder. Her urine from the right kidney was diverted through the left ureter and her perineum was made much more normal. This is a major undertaking, and a technique the surgeons in Cuba were happy to learn and use on future patients.
The final outcome was a well girl post operatively who had catheters in her bladder for three weeks (right) and plaster for six weeks (below - bottom right). Yanebi can look forward to a life that requires artificial emptying of her bladder, but with the prospect of being continent without the degrading isolating odour of her childhood. She will be able to go out and enjoy life and social activities like any other teenager.
Permission of families obtained in relation to display of patient and surgical images