By Halson Kagure & Dr Oriokot Francis
The Surgeons at Mbarara Regional Referral Hospital (MRRH) have yet made another milestone in the history of the Hospital. After two operations performed on Samuel Akamumpa, a nine-year old boy, the surgeons recovered 50 sewing needles and about ten pieces of objects that looked like broken glass pieces of the barrel of a BIC Biro pen, from his stomach and intestines.
The child who hails from Rweibare Kashenshero in Mitooma District in western Uganda has been recovering under the hospital’s pediatric surgical care.
Akamumpa was referred to MRRH from Ishaka Seventh Day Adventist Hospital after the health workers at Gava Imaging in Bushenyi scanned him and detected foreign bodies in his abdomen. An X-ray done on him at Ishaka Seventh Day Adventist Hospital confirmed the presence of metallic needle-looking objects in his stomach and intestines, hence triggering the referral.
According to Akamumpa’s aunt, Eunice Birungi, who has been the prime caretaker Akamumpa had been experiencing recurrent abdominal pains for over eight months, and had been receiving medical treatment for what was thought to be ulcers from several clinics. She said that she intervened when the child’s condition worsened and took him to the hospital.
During the initial six-hour operation, surgeons located and recovered 43 needles, some tied in bundles with sewing thread, others with thin strings, and also with pieces of thin cloths, and about ten pieces of glass fragments. The needles were located mainly in the stomach, the first part of the small intestine (duodenum). Other needles were recovered from the rest of the small intestine and the large intestine.
“Most of the needles were rusted, suggesting they had been present for some time. The fact that they were multiple and some were wrapped makes the whole case unusual and extraordinary,” said Dr. Eden Tilahun, a pediatric surgeon on the operating team.
Clearing medical suspicion
A follow-up X-ray was done the following day after operation and revealed a remaining needle in the intestines. A second operation was carried out and two needles stuck together were successfully removed.
Plain X-rays showed multiple linear and bent bright white structures, consistent with needles, according to Jonas Agaba, MRRH’s radiographer. Several areas of the first part of the patient’s intestines were inflamed due to the ingestion of foreign bodies which could have caused injury to vital abdominal organs if left untreated.
Surgeons note that while foreign body ingestion is not uncommon in young children who explore by putting objects in their mouths, this case was an extreme case.
Genesis
Akamumpa is a Primary One pupil at St Luke Primary School in Mitooma District, who has been living with his stepmother, Juliet Tushabomwe. His father, Simon Twinomugisha, separated from the mother, Mellon Natuhwera, when the child was one year old. The victim is the only child from his father’s marriage to his mother and there are three other children from the current wife to the father (Akamumpa’s step mother).
The child was moved from his grandmother’s care to the stepmother about eight years ago. The mother who last saw the son about six month ago says she requested custody of the child, but was denied custody. She alleged that the child faced torture, overworking, and inadequate food.
Earlier reports indicated the boy was allegedly forced by the mother to swallow needles wrapped in paper each morning, for reasons not yet confirmed. The stepmother is said to have bought needles from a nearby shop and told others they were for sewing clothes, a matter under police investigation.
The boy is recovering under Paediatric Surgery team. After being assessed as medically fit, he has been discharged and will return for scheduled follow-up appointments with the Paediatric Surgical team.
“I thank the health workers at Mbarara Regional Referral Hospital very much. People I am telling you I have never seen a hospital like this,” said Birungi, Akamumpa’s caretaker.
“We didn’t know the child could survive but, he is now in high spirit. The health workers provided constant care from the day we were admitted. We are thankful to be returning home with our child in good health.”
Why early precision was critical
Dr. Deus Twesigye, the Acting Senior Executive Consultant who doubles as a Senior Consultant General Surgeon closely monitored the operation and described it as spectacular. It lasted about eight hours, and the length of time needles had been in the stomach added complexity.
Some may have shifted from their original position or become embedded in surrounding tissue. This is why, even after an initial procedure, a follow up scan detected one more but during the surgery the team removed an additional needle.
To Dr Twesigye, delayed operation could lead needles piercing the intestines, leading to leakage of intestinal contents and severe infection that affects vital organs. Furthermore, the needles could also pause a risk of obstructing the bowel, which would have made it difficult for stool to pass.
For the hospital, this is one of many complex procedures the facility undertakes to provide as it takes pride in delivering a wide range of specialized, super specialized, and safe patient care.
Halson Kagure is the Communications Specialist with a broad interest in healthcare and environmental issues, while Dr Francis Oriokot is Senior Paediatric and Child Health Consultant experienced in research training, mentorship, health administration, and scholarly writing and editorial works.
