A seemingly simple problem with which a 12-year-old boy was brought to the Institute of Child Health here on Wednesday posed a challenge to paediatricians and anaesthetists.

The boy, Mohammed Mustafa, had swallowed a bone along with a piece of mutton on Wednesday evening and began choking. A resident of Vanagaram, Madhuravoyal, he was brought to the ICH around 7 p.m. after being referred by a private ENT hospital.

At the ICH, doctors were confronted with the morbidly obese boy, who weighed 103 kg. “We generally anaesthetise the patient and remove the foreign object but in this case it was difficult to find a vein to start intravenous fluids. Obese patients do not breathe well and when they are laid flat on the table could suffer from breathlessness and result in death,” explained K. Balachandran, who led the team of doctors that treated Mustafa.

Anaesthetist K. Srinivasan said: “The next challenge was using instruments to remove the bone lodged in the food pipe. The child was fully fed and obese. Transporting him to the theatre and stabilising him was a problem. He was dozing off even as he was on his feet. We had to keep him awake throughout the procedure.”

Around 9.30 p.m, the bone was removed and the boy began breathing normally.

His mother Zeenat Basera said he had recently been diagnosed as having Prader-Willi syndrome. It is a genetic disorder that has not affected any of her other five children.

According to ICH Director P. Ramachandran, Prader-Willi syndrome is found in one in 25,000 children in which some genes are not expressed properly.

Geneticist Kalpana Gowrishankar of Kanchi Kamakoti CHILDS Trust, who sent Mohammed's sample for testing to New Delhi, said such children are stubborn, steal and hoard food and need therapy to correct behavioural problems.