Toddler Luke Tan was six months old when his father noticed that the whites of his eyes were too yellow for comfort.
'That was when we noticed his skin was also yellowish. We took him to KK Women's and Children's Hospital (KKH) for a blood test, which showed that Luke was suffering from jaundice,' his mother, Madam Lotus Ho, 37, said.
Jaundice occurs when the blood contains an excess of the pigment called bilirubin. This pigment is produced when red blood cells are broken up and excreted in the bile through the liver.
Further tests using an ultrasound scan found the reason for the bilirubin build-up: Luke had an 8cm choledochal cyst in his bile duct, which obstructed the passage of the bilirubin and was also damaging his liver.
Choledochal cysts are congenital, that is, present at birth. In infants, they usually lead to obstruction of the bile ducts and retention of bile, resulting in jaundice and an enlarged liver.
If the obstruction is not cleared, permanent liver damage may occur, such as scarring and cirrhosis, increasing the risk of cancer.
Dr Low Yee, who heads the department of paediatric surgery at KKH, said cysts are often diagnosed antenatally during routine tests.
'Otherwise, they are diagnosed symptomatically, that is, when there is fever and abdominal pain. In some cases, the obstruction results in jaundice.'
In Luke's case, the operation had to be done almost immediately as there was already some liver damage.
'His condition could not be reversed. Through surgery, we could only stop it from progressing further,' Dr Low said.
Madam Ho, a housewife, said: 'The doctor told us that if the surgery was not carried out, Luke's life would be in danger so his father and I decided to go ahead.'
The treatment of choice for a choledochal cyst is to remove it completely. The procedure to restore continuity with the gastrointestines by reconstructing the tract using another part of the intestines is called a Roux-en-Y reconstruction, Dr Low explained. (See graphics below).
One option is to adopt the conventional open surgery method to remove the cyst. However, in Luke's case, Dr Low opted for keyhole surgery.
'The operation is carried out through the belly button with two other tiny holes made on either side for other surgical equipment.
'Although the procedure takes twice as long to carry out than the conventional one, recovery is much faster especially for a child as young as Luke,' Dr Low said.
The open surgery method would have meant that Luke's post-operative stay at the hospital would take up to 20 days, instead of the six he spent at both the intensive care unit and the general ward as a result of the keyhole method.
Baby Luke's operation took seven hours and, at six months old, he was the youngest patient in Singapore to have undergone keyhole surgery for a choledochal cyst.
It has been eight months since his surgery and Luke is an active little one-year-old despite being a little thin, his mother said. 'He is now much healthier and we are relieved we caught the condition early. Otherwise, who knows what the consequences might have been,' she said.
