Dr Mukewar performs novel procdure PREM

The patient was a 19-year old girl who presented with severe constipation since she was born. She would have one bowel movement per week. She tried various medications for constipation but had no relief of symptoms. She was diagnosed to have “Hirchsprung’s disease” after undergoing thorough evaluation at Midas. Hirchsprung’s disease is a rare condition usually presenting in childhood with severe constipation. There is a loss of nerve supply to the lower part of the colon. This results in inability of the muscles to relax and therefore the stool cannot pass across this segment – resulting in blockage of stool in colon. Typically, management of this disease requires a surgery with one or two settings.

“Per Rectal Endoscopic Myotomy (PREM)” is a novel endoscopic procedure which is an “incisionless”, “scarless” and “painless”. This was initially performed and described by Dr. Amol Bapaye in Pune. Midas is the third center in the world to perform this challenging procedure. This involves creating a tunnel in the wall of the colon with flexible endoscope and cutting the affected muscle. Following this, the stool can easily pass across the affected segment and patient is relieved of the constipation. In this particular patient, 25 cms of the affected muscle in the lower part of colon had to be incised – longest reported till date in the world.