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Surgery to help 4-legged boy stand on two feet

Most parents would want their kids to stand out in a crowd. But parents of the infant Raj cherish just one simple dream — that their 10-month-old bundle of joy will one day blend in with other kids his age, and stop being the object of curious stares. This Friday, a team of surgeons will try and give shape to the Yavatmal couple’s dream, when they perform a difficult surgery to rid the infant of his many extra organs, including two extra feet and an extra set of genitals.

‘Two’ much
For the past few days, doctors, nurses, ward boys, as well as patients and their kin have been frequenting the paediatric ward at KEM hospital, to catch a glimpse of the common object of interest, the ‘four-legged-baby’ admitted in the ward. But its not just a case of two legs too many. The unusual looking child suffers from a rare congenital defect called caudal duplication, an anomaly that has led him to have double of each of the organs below his waist, both internal and external.


Worried father: Ravindra Janardhan Manohar, who works as a labourer in the farms in Yavatmal, is finding it difficult to make ends meet in the expensive city of Mumbai

Born to 28-year-old Ravindra Janardhan Manohar and his wife Vaishali (25) in Yavatmal, Raj, in his few months, has already become the subject of great and disbelief and mythmaking. “When he was first born, everyone came to gawk at him. We don’t believe in myths and superstitions surrounding such births, and doctors at the hospital had explained to us that the extra legs and organs were owing to a medical defect that can be corrected through surgery. We took him regularly to the hospital, where doctors assured us that he would be operated upon, once he grew a bit,” said Manohar.

Ten months after his birth, the doctors at the government-run rural hospital in Yavatmal referred Raj’s case to the civic-run KEM hospital, which has a well-equipped paediatric surgery department. “For the past few months, doctors from the rural hospital have been intimating us with details of the case, through the telemedicine facility,” said a source from the hospital. Since his admission, Raj has undergone a battery of tests and investigations in the run-up to this major surgery. On Friday, Raj will be operated upon by a team of the best paediatric surgeons KEM has to offer. The hospital’s dean, Dr Sanjay Oak, who is also head of the paediatric surgery department, will be leading the team of surgeons and anaesthesiologists. Dr Oak said, “We are going to operate on him this Friday, only after which we can discuss the case.”

Less is more
While surgeons are in a huddle working out their strategies for a surgery that is sure to put all their skills to the test, Raj’s parents are hoping that the surgery will divest the child of the organs and allow him to blend in with other tots his age. “He has a pretty face, and his abnormal looks are very disturbing for us. We always wanted a child, but we want him to be like other children. We want him to be able to play and walk like other children,” said Vaishali.

Future tense
Ravindra, who works as a labourer in the farms, is finding it difficult to make ends meet in the expensive city of Mumbai. “The hospital hasn’t told us about the expenses involved yet, but we are worried. After the surgery he will require a lot of care, and we need money to support his medical treatment and his education in future,” appealed Ravindra. The cost of such operations ranges between Rs 1.5-5 lakh in private hospitals.

Did you know?
Experts suggest that in order to rule out any such anomaly, pregnant women should undergo pre-natal testing on a regular basis during gestation.  

Expert speak
Dr Nitin Dhende,

Head of the paediatric surgery department at JJ hospital “These are sporadic cases, and till date there has been no research on the genes responsible for such congenital defects. About six years ago, we had operated on a female child who had two vaginas and four legs. In such cases, all the organs are one, and then reconstruction has to be done, which is a complicated surgery in itself.” Speaking of the complications that could arise if the condition was left without rectification, Dr Dhende said, “This swelling can go to the spinal cord and lead to complications. The child whom we had operated upon is now growing normally, though she still has difficulty defecating, owing to the organs.” 

Dr Santosh Karmarkar, 
Senior paediatric surgeon at Lilavati hospital “In such cases, abnormalities are not just limited to the physical duplication of visible organs. The child also has duplication of internal organs, including the urethra and intestine, which lead to internal complications. We had operated on a case of parasitic twinning, in which the lower half of a baby was sticking out from the chest of another baby. But this is a case of caudal duplication with hindgut duplication, which is very rare, as both the genitals and the legs are doubled. The operations can be scheduled depending on the anatomy. A series of operations can be performed, or the defects can be corrected stepwise. Usually, if planned well, these cases can be corrected.”

8-limbed Lakshmi
Lakshmi Tatma from Jodhpur, born with 8 limbs and an extra torso fused at the hips, was two years old when doctors performed a 27 hour operation on her to separate her from her parasitic twin. The operation was a success, and she now leads a normal life. 

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