Lakshmi Tatma
Encyclopedia
Lakshmi Tatama is an India
n girl born in 2005 in a village in Araria district
, Bihar
, having "4 arms and 4 legs." She was actually one of a pair of ischiopagus conjoined twins
where one twin was headless due to its head atrophying and chest underdeveloping in the womb. The result looked like one child with four arms and four legs.
, the multi-limbed Hindu
goddess of wealth. She was sometimes an object of worship as an incarnation of the goddess Lakshmi; by the age of 2, she was known all over India. At one point, a circus
had offered the couple a sum of money to buy Lakshmi as a sideshow
, which forced them into hiding. At the time of being found by Dr. Sharan Patil
, she was suffering from an infected pressure ulcer at the neck end of the parasitic twin
and continuous fevers.
Lakshmi is the second child of the family. She has an older brother named Mitelesh, and a younger sister named Saraswati.
Poonam said in a television program that a few weeks before giving birth to Lakshmi, she had a dream which told her to build a temple to the goddess Lakshmi. Subsequently, Lakshmi was born during the "Festival of Lakshmi"
.
She was the subject of a surgery carried out by Dr. Sharan Patil
and 30 other physicians which included Chief Anesthetist Dr. Yohannan John at Sparsh Hospital in Bangalore
, Karnataka
.
The twins' two pelvises formed a single combined ring. Each twin had one working kidney
. Lakshmi had a second kidney which was necrotic
. The autosite
's feet were affected by clubfoot.
Her abdominal aorta
gave off iliac branches
to the autosite's legs and continued as a main trunk artery which gave off iliac branches to the parasite's legs and continued, and finally forked into the parasite's subclavian arteries.
The parasitic twin's spine and abdomen merged with Lakshmi's body. The twins' backbones were joined end-to-end and nerves were entangled. Lakshmi could not crawl normally or walk, but she could drag herself around somewhat. Doctors surmised early on that without the operation, she would not be able to live into her teens. The surgery began on Tuesday, 6 November 2007, at 7 am IST
(1:30 AM UTC
), and was planned to last 40 hours at the most. An estimated cost of over USD$
625,000 was paid entirely by the hospital's charitable wing http://www.sparshhospital.com/sparsh_foundation.php Sparsh Foundation. A team of more than 30 surgeons worked in shifts. The surgery lasted for 27 hours. The doctors gave Lakshmi a 75-80% chance of survival during the surgery
.
The steps of the operation were:
After the operation, the camera showed the amputated parasite and its legs laid out so that for a while they looked like a separate human form.
Lakshmi's recovery so far has been swift and satisfactory. Within a week after the surgery, the doctors held a press conference showing Lakshmi being carried by her father. Her feet were still bandaged. She was in the hospital for a month after the operation.
Afterwards, she and her family moved to Sucheta Kriplani Shiksha Niketan in Jodhpur
in Rajasthan
, where Lakshmi joined a school for disabled children and her father got a job on that school's farm.
As of February 2008, a later operation is planned to bring her legs closer together. Another operation may be needed to rebuild pelvic floor
muscles.
The last view of her in the first television program showed her making an effort to walk, with her thighs fastened together with a spacer to keep her pelvic ring in place while it heals, and casts on her shins and legs.
The second television program showed her recovering well. It was found that cutting the conjoined vertebral column in the separation operation did not cause paralysis
. She was operated on for clubfoot. X-ray showed that extra bone between the pubic symphysis
(parts of the parasitic twin's ischium and pubis
bones) had been absorbed, or were not ossified. Slight scoliosis
was found, but was correctable by a minor operation; her mother was unwilling for her to have to wear a spinal brace through all childhood. Later the villagers reacted quite angrily by protesting. One villager stated " You have killed Lakshmi incarnated, now you have invoked the wrath of Vishnu himself and shall be incarnated into the worm you are".
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
n girl born in 2005 in a village in Araria district
Araria District
Araria district is one of the thirty-eight districts of Bihar state, India, and Araria town is the administrative headquarters of this district. Araria district is a part of Purnia division. The district occupies an area of 2830 km².-Origin of name:...
, Bihar
Bihar
Bihar is a state in eastern India. It is the 12th largest state in terms of geographical size at and 3rd largest by population. Almost 58% of Biharis are below the age of 25, which is the highest proportion in India....
, having "4 arms and 4 legs." She was actually one of a pair of ischiopagus conjoined twins
Conjoined twins
Conjoined twins are identical twins whose bodies are joined in utero. A rare phenomenon, the occurrence is estimated to range from 1 in 50,000 births to 1 in 100,000 births, with a somewhat higher incidence in Southwest Asia and Africa. Approximately half are stillborn, and a smaller fraction of...
where one twin was headless due to its head atrophying and chest underdeveloping in the womb. The result looked like one child with four arms and four legs.
Background
Her father, Shambhu, and mother, Poonam, were day laborers who earned less than 40 rupees per day, and were unable to afford a separation surgery for their daughter. The daughter was named after LakshmiLakshmi
Lakshmi or Lakumi is the Hindu goddess of wealth, prosperity , light, wisdom, fortune, fertility, generosity and courage; and the embodiment of beauty, grace and charm. Representations of Lakshmi are also found in Jain monuments...
, the multi-limbed Hindu
Hinduism
Hinduism is the predominant and indigenous religious tradition of the Indian Subcontinent. Hinduism is known to its followers as , amongst many other expressions...
goddess of wealth. She was sometimes an object of worship as an incarnation of the goddess Lakshmi; by the age of 2, she was known all over India. At one point, a circus
Circus
A circus is commonly a travelling company of performers that may include clowns, acrobats, trained animals, trapeze acts, musicians, hoopers, tightrope walkers, jugglers, unicyclists and other stunt-oriented artists...
had offered the couple a sum of money to buy Lakshmi as a sideshow
Sideshow
In America, a sideshow is an extra, secondary production associated with a circus, carnival, fair or other such attraction.- Types of attractions :There are four main types of classic sideshow attractions:...
, which forced them into hiding. At the time of being found by Dr. Sharan Patil
Sharan Patil
Sharan Shivraj Patil is an Indian philanthropist and orthopaedic surgeon.-Life and career:Dr. Sharan Shivraj Patil was born in the district of Raichur in the state of Karnataka, India. His early education took place in Gulbarga at Sharana Basaveshwara Samsthana...
, she was suffering from an infected pressure ulcer at the neck end of the parasitic twin
Parasitic twin
A parasitic twin is the result of the processes that produce vanishing twins and conjoined twins, and may represent a continuum between the two...
and continuous fevers.
Lakshmi is the second child of the family. She has an older brother named Mitelesh, and a younger sister named Saraswati.
Poonam said in a television program that a few weeks before giving birth to Lakshmi, she had a dream which told her to build a temple to the goddess Lakshmi. Subsequently, Lakshmi was born during the "Festival of Lakshmi"
Diwali
Diwali or DeepavaliThe name of the festival in various regional languages include:, , , , , , , , , , , , , popularly known as the "festival of lights," is a festival celebrated between mid-October and mid-December for different reasons...
.
Surgery
Before the operation, while being treated for the ulcer and the fever, she was again sometimes an object of worship as an incarnation of the goddess Lakshmi. She could drag herself around, although impeded by the trailing parasitic twin.She was the subject of a surgery carried out by Dr. Sharan Patil
Sharan Patil
Sharan Shivraj Patil is an Indian philanthropist and orthopaedic surgeon.-Life and career:Dr. Sharan Shivraj Patil was born in the district of Raichur in the state of Karnataka, India. His early education took place in Gulbarga at Sharana Basaveshwara Samsthana...
and 30 other physicians which included Chief Anesthetist Dr. Yohannan John at Sparsh Hospital in Bangalore
Bangalore
Bengaluru , formerly called Bengaluru is the capital of the Indian state of Karnataka. Bangalore is nicknamed the Garden City and was once called a pensioner's paradise. Located on the Deccan Plateau in the south-eastern part of Karnataka, Bangalore is India's third most populous city and...
, Karnataka
Karnataka
Karnataka , the land of the Kannadigas, is a state in South West India. It was created on 1 November 1956, with the passing of the States Reorganisation Act and this day is annually celebrated as Karnataka Rajyotsava...
.
The twins' two pelvises formed a single combined ring. Each twin had one working kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
. Lakshmi had a second kidney which was necrotic
Necrosis
Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...
. The autosite
Autosite
Autosite can mean:*the independent twin of a pair of conjoined twins where the other twin is a parasitic twin.*a Website about cars...
's feet were affected by clubfoot.
Her abdominal aorta
Abdominal aorta
The abdominal aorta is the largest artery in the abdominal cavity. As part of the aorta, it is a direct continuation of the descending aorta .-Path:...
gave off iliac branches
Iliac artery
In human anatomy, iliac artery refers to several anatomical structures located in the pelvis:*Common iliac artery - forms at terminus of the aorta...
to the autosite's legs and continued as a main trunk artery which gave off iliac branches to the parasite's legs and continued, and finally forked into the parasite's subclavian arteries.
The parasitic twin's spine and abdomen merged with Lakshmi's body. The twins' backbones were joined end-to-end and nerves were entangled. Lakshmi could not crawl normally or walk, but she could drag herself around somewhat. Doctors surmised early on that without the operation, she would not be able to live into her teens. The surgery began on Tuesday, 6 November 2007, at 7 am IST
Indian Standard Time
Indian Standard Time is the time observed throughout India and Sri Lanka, with a time offset of UTC+05:30. India does not observe daylight saving time or other seasonal adjustments, although DST was used briefly during the Sino–Indian War of 1962 and the Indo–Pakistani Wars of 1965 and 1971...
(1:30 AM UTC
Coordinated Universal Time
Coordinated Universal Time is the primary time standard by which the world regulates clocks and time. It is one of several closely related successors to Greenwich Mean Time. Computer servers, online services and other entities that rely on having a universally accepted time use UTC for that purpose...
), and was planned to last 40 hours at the most. An estimated cost of over USD$
United States dollar
The United States dollar , also referred to as the American dollar, is the official currency of the United States of America. It is divided into 100 smaller units called cents or pennies....
625,000 was paid entirely by the hospital's charitable wing http://www.sparshhospital.com/sparsh_foundation.php Sparsh Foundation. A team of more than 30 surgeons worked in shifts. The surgery lasted for 27 hours. The doctors gave Lakshmi a 75-80% chance of survival during the surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
.
The steps of the operation were:
- (8 hours): Abdominal operation: remove the parasite's abdominal organs.
- Remove the autosite's necrotic kidney and replace it with the parasite's kidney. Tie off the blood vessels that supplied the parasite.
- Move the reproductive systemFemale reproductive system (human)The female reproductive system contains two main parts: the uterus, which hosts the developing fetus, produces vaginal and uterine secretions, and passes the anatomically male person's sperm through to the fallopian tubes; and the ovaries, which produce the anatomically female person's egg cells...
and the urinary bladderUrinary bladderThe urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
into the autosite. - (6 to 8 hours) Amputate the parasite's legs at the hip joints: this caused heavy bleeding. Cut the joined backbone: the nervous system around the join was found to be extremely chaotic, and care had to be taken to avoid causing paralysisParalysisParalysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
. - Separation, at 12.30 am on 7 November 2007. The combined pelvic ring was divided through or near the parasite's hip joints and not at the pubic symphysesPubic symphysisThe pubic symphysis or symphysis pubis is the midline cartilaginous joint uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis...
. The remaining incomplete pelvic ring was cut and bent to make the ends meet, and not left as an open part-circle. - External fixationExternal FixationExternal fixation is a surgical treatment used to set bone fractures in which a cast would not allow proper alignment of the fracture.-Method:...
to hold the parts of the pelvis in place. This caused the pelvis to close in 3 weeks to the normal position. - (4 hours): Suturing. Operation completed at 10 am on 7 November 2007.
After the operation, the camera showed the amputated parasite and its legs laid out so that for a while they looked like a separate human form.
Lakshmi's recovery so far has been swift and satisfactory. Within a week after the surgery, the doctors held a press conference showing Lakshmi being carried by her father. Her feet were still bandaged. She was in the hospital for a month after the operation.
Afterwards, she and her family moved to Sucheta Kriplani Shiksha Niketan in Jodhpur
Jodhpur
Jodhpur , is the second largest city in the Indian state of Rajasthan. It is located west from the state capital, Jaipur and from the city of Ajmer. It was formerly the seat of a princely state of the same name, the capital of the kingdom known as Marwar...
in Rajasthan
Rajasthan
Rājasthān the land of Rajasthanis, , is the largest state of the Republic of India by area. It is located in the northwest of India. It encompasses most of the area of the large, inhospitable Great Indian Desert , which has an edge paralleling the Sutlej-Indus river valley along its border with...
, where Lakshmi joined a school for disabled children and her father got a job on that school's farm.
As of February 2008, a later operation is planned to bring her legs closer together. Another operation may be needed to rebuild pelvic floor
Pelvic floor
The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the...
muscles.
The last view of her in the first television program showed her making an effort to walk, with her thighs fastened together with a spacer to keep her pelvic ring in place while it heals, and casts on her shins and legs.
The second television program showed her recovering well. It was found that cutting the conjoined vertebral column in the separation operation did not cause paralysis
Paralysis
Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
. She was operated on for clubfoot. X-ray showed that extra bone between the pubic symphysis
Pubic symphysis
The pubic symphysis or symphysis pubis is the midline cartilaginous joint uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis...
(parts of the parasitic twin's ischium and pubis
Pubis
Pubis may refer to:* Pubis * Mons pubis, a padding of fat that protects the pubis bone...
bones) had been absorbed, or were not ossified. Slight scoliosis
Scoliosis
Scoliosis is a medical condition in which a person's spine is curved from side to side. Although it is a complex three-dimensional deformity, on an X-ray, viewed from the rear, the spine of an individual with scoliosis may look more like an "S" or a "C" than a straight line...
was found, but was correctable by a minor operation; her mother was unwilling for her to have to wear a spinal brace through all childhood. Later the villagers reacted quite angrily by protesting. One villager stated " You have killed Lakshmi incarnated, now you have invoked the wrath of Vishnu himself and shall be incarnated into the worm you are".
External links
- Smile of Lakshmi : Rarest of Rare Case report from Sparsh Hospital in India where the operation was performed.
- Spines of 2-year-old Lakshmi separated: Doctors Times of India 2007-11-06
- Many-limbed India girl in surgery BBC NewsBBC NewsBBC News is the department of the British Broadcasting Corporation responsible for the gathering and broadcasting of news and current affairs. The department is the world's largest broadcast news organisation and generates about 120 hours of radio and television output each day, as well as online...
2007-11-06 - Girl born with four arms and four legs undergoes surgery in India CBC NewsCBC NewsCBC News is the department within the Canadian Broadcasting Corporation responsible for the news gathering and production of news programs on CBC television, radio and online services...
2007-11-06 - Surgery for girl with eight limbs is going smoothly doctors say (video) CNNCNNCable News Network is a U.S. cable news channel founded in 1980 by Ted Turner. Upon its launch, CNN was the first channel to provide 24-hour television news coverage, and the first all-news television channel in the United States...
2007-11-06 - Surgery On Multi-Limbed Girl A Success (with video and photographs) CBS NewsCBS NewsCBS News is the news division of American television and radio network CBS. The current chairman is Jeff Fager who is also the executive producer of 60 Minutes, while the current president of CBS News is David Rhodes. CBS News' flagship program is the CBS Evening News, hosted by the network's main...
2007-11-07 - Girl Born With 4 Arms, 4 Legs Has Successful Surgery (with photographs) ABC NewsABC NewsABC News is the news gathering and broadcasting division of American broadcast television network ABC, a subsidiary of The Walt Disney Company...
2007-11-07 - Girl separation surgery a success (with video) BBC NewsBBC NewsBBC News is the department of the British Broadcasting Corporation responsible for the gathering and broadcasting of news and current affairs. The department is the world's largest broadcast news organisation and generates about 120 hours of radio and television output each day, as well as online...
2007-11-07 - New beginnings for the Tatmas in the land of the Maharajas!