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Dr. Makinde Akinlemibola, the Chairman of the Association of Nigerian Private Medical Practitioners in Lagos State, discussed the controversy surrounding the missing intestine of a boy named Adebola Akin-Bright, who tragically passed away on September 19, 2023.

The case revolves around a member of our association who practiced at the Obitoks hospital. The patient, may he rest in peace, had a long history of utilizing this hospital for medical care. Earlier this year, on March 6, 2023, the patient sought treatment at Obitoks. Prior to arriving there, it was reported that he had taken some medications, possibly outside of a medical facility. Upon examination, a scan revealed the presence of an abscess (a pocket of pus) in the vicinity of the appendix.

To address this condition, a surgical procedure was performed to alleviate the abscess, which provided relief to the boy. During this procedure, it was determined that the appendix could not be removed due to the presence of the abscess. In medical terms, this is a known situation, and attempting to remove the appendix under these circumstances could lead to further harm. Instead, a confirmative approach was taken, involving treatment with medication.

Fortunately, the young patient’s health improved, and he was subsequently discharged from the hospital.

Three months later, the young boy returned to the hospital complaining of abdominal pain. After a thorough evaluation, it was determined that he had developed intestinal obstruction, which required surgical intervention. During the surgery, it was not only the appendix, which had been challenging to remove previously, that was extracted, but also a section of the duodenum, a small portion of the intestine. This removal was necessary due to the duodenum’s condition, which had become gangrenous, indicating tissue decay due to insufficient blood flow. All of these procedures were undertaken to address his medical condition, with the hope that the surgical connections made within the small intestine would heal.

The family was indeed informed about all these medical procedures. They were provided with explanations, and the mother, in particular, was kept informed. Approximately five days after the surgery, it was noticed that there might have been a breakdown in the surgical connection, referred to as an anastomosis, resulting in what’s known as a fistula. This condition allowed some particles to emerge through the wound. Given this development, the doctor discussed the possibility of involving a physician from Lagos State University Teaching Hospital (LASUTH) to assess the situation and take necessary actions.

However, while considering this option, the mother decided to transfer the boy to LASUTH herself instead of having a LASUTH doctor come to them. Once at LASUTH, for reasons not entirely clear, there was no surgical intervention during the initial 28 days of the boy’s stay. Eventually, they conducted surgery and provided an explanation to the mother. Subsequently, concerns were raised regarding the loss of the intestine, but without being present during the transfer, we cannot definitively comment on what occurred. What we can confirm is that the private hospital, where he initially received treatment, possesses evidence indicating the presence and viability of the intestine before the transfer.

What evidence do you have that the small intestine remained intact when the patient left the private facility?

It’s important to clarify that we cannot assert that the small intestine was entirely intact, as a portion of it had been removed due to medical necessity. However, what we can affirm is that a significant portion of the small intestine remained intact, and this was confirmed through a scan conducted upon the patient’s arrival at LASUTH. Regarding the reasons for the 28-day delay before surgical intervention at LASUTH, I wasn’t part of the team responsible, so I cannot provide specific details. Nevertheless, the situation prompted discussions that raised concerns about the integrity of the doctor at Obitoks, which we find unjust. To address this, we’ve documented the events surrounding the patient’s treatment, surgery, referral, and subsequent developments.

You mentioned in a press statement from your association that a scan was conducted at LASUTH, confirming intestinal movements. How did you obtain and verify this information?

From the outset, I mentioned that the doctor at Obitoks had been the patient’s family doctor. Even after the patient’s transfer to LASUTH, this doctor continued to follow up on the case, inquiring about the surgery’s status. During this time, they sent the scan test results conducted at LASUTH to the family doctor at Obitoks. Upon reviewing the scan, it was evident that there were bowel movements, which indicated a positive medical sign. Thus, there was no further action needed.

The mother of the patient reportedly told Lagos State Governor Babajide Sanwo-Olu during his visit to LASUTH that neither the private hospital nor LASUTH acknowledged the removal of the small intestine, despite the evidence you claim to have. What do you believe might have caused this confusion?

I cannot provide a definitive answer to what may have caused the confusion. It’s possible that there was a gap in communication or miscommunication between parties involved. Whether she mentioned it or not, what is unequivocal is that when the patient arrived at LASUTH and underwent a scan, it confirmed the presence of bowel movements. Any misunderstandings or miscommunications that may have arisen should be addressed by the LASUTH doctors who were directly involved. If there was a discrepancy in what was communicated to the mother and what she understood, that could have contributed to the situation. Nevertheless, the essential point remains that when a patient’s intestine is removed, it cannot be used for transplantation or any other purpose. The removal of an intestine, whether at the private hospital or LASUTH, would only occur if something went wrong with it, rendering it nonviable.

How long can a patient survive without the small intestine?

The ability of a patient to survive without the small intestine depends on several factors. The small intestine plays a vital role in digesting most of the food we consume and absorbing nutrients essential for the body. Surviving without a small intestine is challenging, and the primary means of sustenance would involve a medical procedure known as total parenteral nutrition. This entails administering nutrients intravenously, similar to a drip. It’s a costly and complex process, where all the nutrients the body would typically absorb through the small intestine are combined in a drip format and provided to the patient to support their continued survival.

And how long can that go?

The survival of a patient without a small intestine is indeed possible, as long as all the essential requirements for the patient’s well-being are properly managed, including providing adequate nutrition through alternative means such as intravenous feeding.

Regarding the boy’s appearance of malnourishment before his passing, it’s important to note that keeping a patient alive and ensuring they receive adequate nutrition are distinct aspects of medical care. While it’s true that there might have been concerns that the nutrition provided to the boy was insufficient for him to gain weight and recover, we must consider the cost factor. The economic situation in Nigeria often limits the resources available for comprehensive medical care. It’s conceivable that cost constraints played a role in the nutrition provided to the patient. The financial burden may have affected the quality and quantity of nutrition the boy received.

You also inquired about the possibility of an intestine transplant if the boy had been taken abroad for treatment. As far as my knowledge goes, intestine transplants are performed in specific countries like the United States and India. However, it’s important to understand that preserving a removed intestine is highly challenging. Once the blood supply to the intestine is disrupted, it becomes nonviable within approximately five hours. Therefore, if a doctor removes a section of the intestine, it’s typically because that portion is no longer functioning and has no medical benefit.

Regarding the removal of a part of the small intestine during surgery, yes, it’s a procedure that may be necessary under various medical conditions. The alimentary canal, which starts from the mouth and runs through the digestive system, including the small intestine, can encounter issues that necessitate the removal of a damaged or non-functioning portion. This procedure is performed to maintain the continuity of the digestive tract. When a section of the intestine is compromised and no longer effectively transports its contents, it can lead to serious complications. During surgery, the surgeon assesses the condition of the intestine, looking at factors like movement, color, and texture. If a portion is found to be damaged, it is removed, and the remaining healthy segments are joined to ensure the continuity of the digestive process. The absence of this continuity can be life-threatening.

As for the specific events at the private hospital, it’s important to clarify that while a damaged portion of the intestine was removed, the doctor had already joined the remaining healthy segments together. However, there is a possibility of breakdown or complications in such cases, which is why careful monitoring and management are crucial. If issues arise, they may be managed conservatively or require further surgical intervention.

Regarding the process of intestine transplantation, it is indeed a complex and relatively new procedure in the field of medicine. The viability of any material introduced into the intestine is critical, and the process involves intricate and specialized steps.

What is your association’s reaction to the call on the House of Assembly ad-hoc committee for the arrest of the doctor who performed the procedure on the boy at the private hospital?

Yes, we have already said in our press release that it is unfair. You know that there are times when people quickly speak out of emotions, out of what they feel. I’m not blaming the Speaker (of the House of Assembly). The Speaker felt for the child but emotions are different from the law. If there are infringements, then you must ascertain that infringement before you can order someone to go and arrest or whatsoever, but we believe that it was out of emotion that he did that and that is one of the things we are trying to correct from our (press) release.

What do you think would have been the right step to take at that time?

I would have expected that they set up a panel of inquiry to know the real cause of the issue and to find out where the faults came from, and it is when the result of the panel is brought out that they can make pronouncements. If that had not been done and two parties were disagreeing over what had been done and what had not been done, and they are asking for the arrest of one of the parties and leaving the other party out, I don’t think that is fair. Well, I don’t think it is right. If you have not confirmed exactly what happened, then you cannot apportion blame, that would be unfair.

Why do you think the ad-hoc committee’s action is witch-hunting on private medical practice?

That is what we will perceive it to be because if you really look at it, the House of Assembly has to do with the government, and the Lagos State University Teaching Hospital is also funded by the government. For the fact that they are both funded by the (state) government, if they make such a pronouncement and we know that it is wrong, we will assume that it is witch-hunting. I think it is more of ignorance. They do not have enough knowledge of how to analyse whatever statement they must have gathered. I think it is more of that rather than witch-hunting.

You also claimed, in your statement, that a large mass of black tissue was removed at LASUTH and handed over to the patient’s mother to take to the histopathology laboratory by the team that operated on the patient at LASUTH. How did you confirm that?

That information came from the mother and she didn’t know it was significant. She just said what transpired but such information is very vital to us because it connotes some things which are not necessary for me to divulge. So, if we have such information and it is significant; we let them know that we are in custody of such information.

The Medical and Dental Council of Nigeria is not the mother body but the regulatory body for medicine and in the MDCN, you have doctors that are knowledgeable that will sit on the panel and they are not biased and that’s the essence of the MDCN and it will be good if we have the MDCN on the case, at least, that will be fairer than using an arm of the government to investigate another arm of the government against a private arm.