Imagine oral feed leading to infection and abscess in a two-year-old child. Ashish underwent three MRIs and five surgeries that did not reveal the ailment that had been troubling him for a year.
It was only recently that the medical investigations revealed he was afflicted by an abnormal communication between the food passage and the neck. It was a congenital anomaly. Only 30 cases of fourth branchial cleft fistulas have been reported in the world medical literature so far.
The problem started when Ashish turned one, said Venkat Rao, his father. “He had some water retention near his neck as a result it had swollen on the left side. After a few days, he had difficulty swallowing and used to get restless. We had to rush him to a hospital every time it happened,” said Rao.
The three MRIs that were done over the past year couldn’t identify the problem. An open dye test was finally done to identify fourth branchial cleft fistula.
A team of two surgeons — Dr Kumaresh Krishnamuthy, ENT surgeon and Dr Anand Alladi, paediatric surgeon from Apollo Hospital did a surgery on Ashish that continued for six hours.
“After opening the neck, the tract of the fistula was followed up to the region of the thyroid and cricoid cartilage. A urinary catheter was passed into the internal opening through the mouth. The opening in neck was in the posterior part (near the spinal column). The tract was completely removed and the fistulous opening closed,” explained Dr Krishnamurthy.
It was a high-risk surgery, especially because it was done on a two-year-old. However, post surgery, little Ashish is doing well. He will be followed up for two months every two weeks and then only when necessary.
“The challenge in this surgery was that since Ashish is just two, the space on the neck region was extremely small. Thus, chances of injuring important structures like the nerve to the voice box, was high. Any injury to the area of attachment to the voice box could have led to a change of voice. Also the main artery was part of the tract and had to be preserved. A small mistake would have injured the artery,” explained Dr Krishnamurthy.
