A two-year-old child suffering from Hirschsprung’s disease — a rare condition affecting 1 in 5,000 to 10,000 children and causing severe constipation — has become the first in Mumbai to be successfully treated using a scarless endoscopic procedure known as PREM, at Gleneagles Hospital.

In a groundbreaking milestone, Gleneagles Hospital has become the first in Mumbai to successfully perform a rare, scarless procedure — Per-Rectal Endoscopic Myotomy (PREM) — on a two-year-old boy who had been unable to pass stool naturally since birth due to a congenital condition. Dependent on daily enemas for over two years, the child is now living a normal life following the procedure, free from abdominal pain and swelling, with no external stitches and no further medical interventions required.

Mr and Mrs Vaidya (names changed), the parents of the child — Aryan (name changed) — were overjoyed at his birth. A cheerful and playful baby, Aryan brought joy into their lives. However, from the age of one month, they noticed he was struggling with severe constipation, often unable to pass stool for up to eight days. Despite several medications and daily enemas prescribed by their family doctor in Nashik, his condition showed no improvement. His abdomen was frequently swollen with gas, and he struggled to gain weight.

In December 2024, the family travelled from Nashik to Mumbai to consult Dr Vibhor Borkar, who suspected Hirschsprung’s disease. Diagnostic tests including a barium enema, endoscopic biopsy, and manometry conducted at Gleneagles Hospital, Parel, confirmed the diagnosis.

Dr Vibhor Borkar, Consultant Paediatric Gastroenterologist, explained, “Hirschsprung’s disease occurs when nerve cells (ganglion cells) fail to develop in the lower part of the large intestine, causing a blockage due to stool build-up. It affects around 1 in 5,000 to 10,000 children. Left untreated, it can become life-threatening due to infections. In newborns, a delayed passage of meconium (the first green stool) can be an early indicator. Older children typically suffer from a swollen abdomen, vomiting, poor weight gain, and chronic constipation.”

“The conventional treatment involves major surgery — either open or laparoscopic — to remove the affected part of the intestine. However, in this case, we performed a minimally invasive technique called Per-Rectal Endoscopic Myotomy (PREM), which leaves no external scars. The child is now symptom-free, eating well, and passing stools naturally, without the need for enemas. Early intervention was crucial to avoid complications such as enterocolitis, infection, and failure to thrive,” he added.

Dr Shankar Zanwar, Interventional Gastroenterologist, further elaborated, “When Aryan arrived in Mumbai, he was extremely uncomfortable — his stomach was distended, and he could not pass stool without enemas. After confirming the diagnosis through manometry and biopsy, we opted for an advanced endoscopic technique — PREM — under general anaesthesia, with assistance from Dr Aditya Prabhudesai and Dr Dhanashree Karkhanis.”

“In this procedure, a small incision is made internally, just inside the anus. A tunnel is then created within the intestinal wall, allowing us to cut the non-functioning, nerve-deficient section of the intestine from within. The entry point is then sealed with clips. As the entire procedure is performed endoscopically, there are no visible cuts or stitches. The patient was pain-free post-surgery, and the operation lasted three hours.”

“This marks the first time such a procedure has been performed in Mumbai, and globally, only 13 similar cases have been reported. The child was discharged within two days, no longer requiring enemas, and is now able to pass stools naturally. His stomach has returned to normal. This procedure has truly transformed his life.”

“My son Aryan was perfectly fine at birth. But after a year, he began suffering from severe constipation and was clearly in pain. Our family doctor referred us to Dr Vibhor. His biopsy confirmed Hirschsprung’s disease. After the successful treatment, he’s now doing well and passing stools without any difficulty. We’re deeply grateful to Dr Vibhor and Dr Shankar for their timely care,” said Aryan’s mother, Ms Usha (name changed).

“This case demonstrates our hospital’s ability to manage complex paediatric conditions with both clinical excellence and compassion,” said Dr Bipin Chevale, CEO of Gleneagles Hospital Mumbai. “The successful use of PREM — a minimally invasive and scarless procedure — highlights our commitment to innovation, patient comfort, and long-term outcomes. We are proud to have pioneered this life-changing intervention in Mumbai, offering new hope to families facing similar challenges. This sets a new benchmark in paediatric healthcare.”