Myelomenigocele. It is a neurosurgically treated birth disorder that is largely preventable by Folic acid (vitamin) taken during pregnancy. I had not seen a case in decades until I worked in Saudi Arabia. I lived in a walled compound with guards. The poverty rate? The government hides its data but estimates of 30% unemployment are noted.
Needless to say it was shockingly sad to be treating a condition that was preventable by simple measures taken early in pregnancy.
In this land knowledge mixed with ignorance. I lived in a walled compound separated from the very people I treated in so many ways more than the mere presence of a wall. Yes, it came with a pool. My hospital was no clinic. It was an upscale hospital in busy downtown with a well to do patient population. It meant the general population had poor health care knowledge.
This is a birth defect. Once in a while you have a run of cases that are interesting. In Jeddah everyone is wary of surgery. The reasons are myriad but mostly people are just plain afraid. I had some recent successes so for a few days I’ll post up some medical things.
This child was born with a failure of the spine to close over into a proper canal. So the lump is a combination of nerves and skin exposed to the air. The spinal cord begins as a plate which rolls into a tube which is surrounded by the muscle bone and skin. Failure of the tube to roll up results in this defect. It is largely unseen in the US for many years. Prenatal vitamins has pretty much made this so rare that I have not cared for such a patient in many years.
You can see that the nerve sac is incomplete and sticking out through the spine at its lower end.
Fortunately the defect may be low enough that the child will walk. His bowel bladder function may be incomplete. The repair is shown.
The wound is several days after surgery so there is a lot of swelling and bruising but the defect is covered and repaired now. Many more problems will face this child as he grows. This is the first step. The biggest challenge now was to make a proper closure and to prevent infection.