There once was a boy named Grey.... Grey Nolan Maurer to be exact. He was born to give his parents a run for their money from day one!
About 3 days after birth Grey stopped having bowel movements, and had upon looking at the xrays of his belly large intestine that was inflammed and distended. On June 22nd, they did a barium enema, which is a test that looks at the intestine with xray after the contrast barium is injected per his rectum. It showed that something wasn't right in his intestine, and needed to go to surgery. He was, on that day, 1lb 13 oz (he lost wt after birth).
Once in surgery they found that he had a small hole in his mesentary. Mesentary is the tissue that holds the large intestine in place in the abdomen. It was just a freak thing, that many newborns may be born with, however.... his small intestine (jejunum) had gotten looped into it, and had started to cut off the circulation to his small intestine.
There are 3 parts to the small intestine. The duodenum, jejunum, and illeum. After the ileum, there is a valve called the ileocecal valve, and that leads into the large intestine (colon)... which is broken up into the asending, desending and transverse colon.
SO, long story short, they took 1 cm of his jejunum out because it was damaged. That is a short amount that was resected (or taken out). When he was brought back up from this surgery, they said that just proximal (before) to this area, the jejunum looked "ugly". Meaning it didn't have very good blood flow. But, as the surgery went on, it looked ok, and they were going to give it a chance to get better.
On July 23rd, it declared... it wasn't going to get better. It died. Making Grey septic, and near death himself. So 10 more cm of the jejunum was removed. After both surgeries Grey was left with an ostomy.
About 3 days after birth Grey stopped having bowel movements, and had upon looking at the xrays of his belly large intestine that was inflammed and distended. On June 22nd, they did a barium enema, which is a test that looks at the intestine with xray after the contrast barium is injected per his rectum. It showed that something wasn't right in his intestine, and needed to go to surgery. He was, on that day, 1lb 13 oz (he lost wt after birth).
Once in surgery they found that he had a small hole in his mesentary. Mesentary is the tissue that holds the large intestine in place in the abdomen. It was just a freak thing, that many newborns may be born with, however.... his small intestine (jejunum) had gotten looped into it, and had started to cut off the circulation to his small intestine.
There are 3 parts to the small intestine. The duodenum, jejunum, and illeum. After the ileum, there is a valve called the ileocecal valve, and that leads into the large intestine (colon)... which is broken up into the asending, desending and transverse colon.
SO, long story short, they took 1 cm of his jejunum out because it was damaged. That is a short amount that was resected (or taken out). When he was brought back up from this surgery, they said that just proximal (before) to this area, the jejunum looked "ugly". Meaning it didn't have very good blood flow. But, as the surgery went on, it looked ok, and they were going to give it a chance to get better.
On July 23rd, it declared... it wasn't going to get better. It died. Making Grey septic, and near death himself. So 10 more cm of the jejunum was removed. After both surgeries Grey was left with an ostomy.
After parts of the intestine are removed, a lot of times patients are left with stomas and ostomies. This means that if part of the intestine was removed at the jejunum, it is cut there, and the healthy portion is brought to the surface of the skin and a bag is put on it. So food goes from the mouth, then stomach, then duodenum, then the jejunum.... and out into the bag. The reason they do that is usually DISTAL to the injured area (in Grey's case the ileum, and the whole colon) gets inflamed due to restricted blood flow etc. At that time, the part of the intestine that is no longer connected together(remember the bag is now where it would be connected)... that portion is brought up to the skin too. Usually this is to rest the portion of the intestine that was damaged because the intestine proximal, or before it had alot of problems.
SO, after all of this rests, and 6-8 weeks later most of the time it can be re-anastomosed. Meaning he is put back together. The two portions of the intestines that are brought up t
o the skin, are just now put back together to allow the food to go from the mouth, stomach, duodenum, jejunum, ileum, to the colon... and of course out. This is a picture of almost what it looks like, but with bags on both of the pieces of intestine that are brought up to the skin.
Some of the issues with this surgery are scar tissue. Scar tissue forms because of the manipulation and previous surgeries. This can cause injury to the bowel, or accidental injury during surgery. Also, since Grey hasn't eaten really.... he has to learn to bottle feed and his intestine that hasn't been used for a long period of time has to get used to be active, and has to move like it's supposed to, to expell feces.
In the meantime, the liver has been injured because of the IV nutrition. It is high in calories and fat. Which doesn't make the liver happy. So, slowly but surely that will recover once Grey gets to take more and more nutrition by mouth, and using his intestine to absorb it, instead of having it thru his IV.
I think I explained this as layman as I can..... email or comment if you have questions. The date is set for WEDNESDAY!!!! I can't wait to hold my little man without his little bags hanging off of him!
Holy crap - great summary. Can I use it when I precept? And you are slipping into medical mode- which polishes over the drama of this all, but I tear up just thinking about that whole day waiting for surgery number two. Grey is the toughest little fart alive! Hell - yesterday he beat the tuna salad (leonardo the terrible monster) out of me while I was trying to give him his bath. But he can dance to Billy Jean like no other.
ReplyDelete