#Medical Case: 7-year old with Limbs Growing Out of his Chest

           A 7-year-old boy Deepak Kumar Paswaan, who lives in Buxar, Bihar, India, was born with extra arms, legs and buttocks of a parasitic twin protruding from his chest, which looks similar to the Indian man’s extra body.

• This case is similar to how conjoined twins are formed, except there is a malformation of one of those twins.As a result, the twin never fully develops and has caused the boy to live with extra arms and legs.The worst part is, the legs are growing at the same rate as the boy, adding to the weight the boy must carry.
  

• As “usual,” he was worshipped as an incarnation of Lakshmi, the multi-limbed Hindu goddess of wealth and prosperity but there are also people who cast stones to him to driveout the “demon” in his body. 

When Deepak was born with the parasitic twin growing out of his abdomen the doctors in the village warned he wouldn’t have lived for more than a few days. However little Deepak fought through all the odds and survived as a healthy child though he was much behind his peers and led a socially restricted life. The contrasting ways in which he led is life is best exemplified by the fact that Deepak was treated as a religious icon and was worshipped by a set of villagers as God, while a few took him as a devil born to the village that would cast bad luck and attacked him with stones which left the little boy petrified and restricted his movement out of his home, mingling with his peers or even going to school with his brothers.

• “It is heart wrenching for a parent to see his child suffer like this, though many people come from distant villages to worship him, offer money, sweets, flowers etc but I never had any intention of earning money through my child. I wanted to see my son like any other normal child being accepted by the society and so I decided to go for the surgery and get rid of the abnormal part of his body” says Viresh Paswan, Deepak’s father a construction worker at Bhelhari, a village 125 kilometers away from Patna.

Dr. Ramcharan Thiagarajan the lead surgeon of Deepak’s case felt that  the boy and the parasitic twin shared the chest wall and the abdomen. “I was concerned that there may be sharing of the thoracic organs such as heart or lungs in addition to the abdominal organs“. We were confident about providing care to this boy as we have an outstanding cardiac and liver unit at Fortis Hospitals Bangalore. The MRI scans which were sent to us showed that the parasitic twin was protruding from his lower chest and abdomen and was fused to Deepak with sharing of liver, intestine and possibly other structures. On clinical examination, the parasite was attached to the lower part of the chest and the most of the upper abdomen and it looked as if he was carrying a baby. It had two legs, a pelvis, abdomen and two poorly formed upper arms.

• Once Deepak was brought into the hospital a CT scan was performed and it revealed that the sharing of the intestine, had vascular anomalies, a huge hernia and possible involvement of the liver. After an intensive discussion amongst the team of specialists which comprised of the liver and digestive surgical team, radiologist, anesthesiologist, neonatologist and child psychologist they concluded that the parasite can be safely removed without Deepak compromising his life. However there is always a possibility of complication after surgery either from excessive bleeding or from sharing of organs. The involvement of a neonatologist and a child psychologist was important because the physical disability affected Deepak’s social behavior; he seemed to have suffered from neurological imbalance and was mal nourished to a large extent as the parasite was taking most of the nutrition from his body.

• According to Dr. Murali Chakravarthy, Chief Anesthesiologist “Anesthetizing parasitic twins is always a challenge. Deepak was no exception. We were not worried about gaining control of blood pressure fluctuations; because continuous monitoring of the hemodynamic parameters began from the word go. Grossly hypertrophied artery from the chest was supplying the parasitic twin. We had concerns about the management of the subsequent clamp of this while separating the twin. Thanks to the preparations, we could handle them without causing any danger to Deepak. Pain relief after a major surgery requiring a long surgical incision was yet another challenge, which was adequately taken care by insertion of the thoracic epidural catheter. Overall the job was well planned and executed. A beaming Deepak is a testimony to that.

“We were well prepared and started the surgery with an incision on the parasite to save skin and muscle to use for Deepak at the time of closure. We went into the parasites body and found that there were loops of intestine, piece of urinary bladder densely adhered to Deepak’s liver which was enlarged and also creating a huge hernia coming out through Deepak’s abdominal wall little bit below the fusion. The parasitic content was meticulous dissected off from liver and excised without compromising Deepak’s internal organs. The skin, muscle and the fascia (fused muscle providing strength) of the parasite was used to reconstruct Deepak’s abdominal wall” explained Dr. Ramcharan Thiagarajan. “What was originally seen as a sharing of the liver was found to an enlarged liver Deepak’s recovery has been quite fast, and he was moved out of the PICU on the first post op day and he started walking on his own on the 2nd post op day. He will be able to lead a normal life with pride and dignity like any other child without any physical difficulty in further”.

• An emotionally charged Indu, Deepak’s mother says “I was initially not sure with the decision of Deepak’s surgery and was upset with my husband as I thought it would put my son’s life at risk. Though I wanted Deepak to have a normal life but as a mother my heart wept constantly with the fear of losing him in the process as I was scared by the villagers saying no surgery in this world can correct Deepak’s condition. But now when I see him smiling and playing with our 3 year old daughter just after two days of the surgery, my faith has strengthened and I believe that medical science has progressed so much that anything is possible if there is enough conviction”.

• “I was confident that my child will fight a way out of this however an unknown fear was always there. I am eagerly waiting to go back to our village and show to all those people who considered my child as a devil, that my son is one of the luckiest and the bravest child in our village. I want to give him a good life and education so that he doesn’t remain a prey to society’s superstitious thoughts. The hospital and doctors have not only given my child a new life, they have restored his dignity” said Viresh.

Dr. Ramcharan added “Deepak has recovered very well and our entire team of doctors feels highly gratified that we have helped this child get back to a normal life just like any other boy of his age. It is sad that he could have been fixed long time back and not go through physical and emotional trauma all these years. He is also lucky that this one surgery will completely fix him and he would not require any more surgery contrary to other such where these children go through multiple remedial procedures.”

• “At Fortis Hospitals our commitment in contributing towards clinical procedures which are truly life changing has always reflected in all our medical marvels. To us this case reflects the contribution that modern medicine can make in healing lives. Through our clinical expertise and our passion to be relevant to society we are glad to have given this little child from Bihar a new lease of life and free him of the social stigma. Deepak is a real hero for us who has fought the social and medical battle, he has won over the hearts of all the employees at hospital with his spark and brilliance. We wish him a good life and a great future ahead” said Mr. Vishal Bali, Chief Executive Officer, Fortis Hospitals.

Source:
http://www.dailymail.co.uk
http://www.telegraph.co.uk