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The life of 3-year-old Agam has been saved twice, the first time in utero and the second time just after she celebrated her third birthday.
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The little girl was born with a Type IV choledochal cyst, a rare and dangerous bile duct defect whose incidence is one in two million. Even before her birth, the defect was diagnosed at one of the hospitals in the North. Physicians there advised her parents to terminate the pregnancy. “The doctors explained to us that she could expect a life shadowed by health complications and a very high risk of developing cancer of the bile duct and liver,” Shlomo, the father, relates. “But we chose to continue the pregnancy.”
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From right to left- Shlomo, Agam’s father, little Agam and Dr. Arcady Vachyan
Pioter Fliter-RHCC |
From her birth, Agam’s parents monitored the cyst with ultrasound scans every six months. For the first nearly three years of Agam's life, the cyst’s diameter held steady at 2 cm. Two months ago, however, the toddler complained of ongoing stomach pain. The health clinic pediatrician diagnosed a virus. After a few days, a second symptom appeared – a rash all over Agam’s body – and the family immediately rushed to the Emergency Room. “Agam has always been a healthy child, but periodic ultrasound scans, and the knowledge that we accumulated, have made us experts,” Shlomo says. “We knew that a rash can be a symptom connected to liver function.”
Tests performed at Rambam revealed that the cyst had ballooned to 8 cm in diameter and was blocking the bile duct. Explains senior pediatric surgeon Dr. Arcady Vachyan, "We are speaking of a defect so rare that we have almost no experience in treating it. Before I operated on Agam, I had operated on only one other such patient, a seven-year-old girl who came here from Russia three years ago for treatment.”
The delicate, complicated surgery to excise the cyst lasted seven-and-a-half hours. Dr. Vachyan and colleague Dr. Lili Hayari, Acting Director of the Pediatric Surgery Department, employed the laparoscopic surgical method – entering the abdominal cavity via a number of tiny incisions and using a camera-equipped fiber optic tube. “It wasn’t easy for us to agree to such surgery,” Shlomo recalls, “but we trusted Dr. Vachyan to do everything in his power. We stood outside the Operating Room and lost years of our lives to stress. When the doctor exited the OR, he was simply wrung out.”
Two weeks after surgery, the child was released from hospital in good condition. “We have been compelled twice to make choices that could have cost Agam her life,” Shlomo sums up as he watches his daughter playing with her dolls and laughing. “We took a chance twice and are glad we did.”
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