Resilience

Resilience: “the ability to overcome serious hardship; toughness.”

One week ago, I got yet another call from the school nurse sharing that our little buddy was in her office. Theo had been a frequent visitor to the nurse’s office since the first week of school with perpetual tummy aches. We were chalking it up to pooping problems given that their water intake had been likely cut in half since the start of school. However, last Wednesday he was refusing to go back to the class. He didn’t have a fever but was unable to keep anything down so, a quick Google search told me he was either severely constipated, caught norovirus, or a different stomach bug. Unfortunately, water, miralax and a glycerin suppository didn’t produce the results we were expecting so we settled on a bad stomach bug. Then, Thursday evening we noted that his stomach had blown up like a water balloon and nothing could soothe him; Off to the ER we went.

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Obstructed portion of the small intestine

I was hesitant to jump to emergent care because Theo was showing these same symptoms back in February which didn’t show anything significant; this time was different. The abdominal x-ray didn’t demonstrate stool burden so we moved on to an MRI. Here we saw that Mr. Theo had a bowel obstruction. The next 2 hours flew by as an emergent surgery was organized. The best case scenario was that Theo’s small intestine was simply kinked like a garden hose… the worse case scenario was that the obstruction could be so bad that he would leave with an ostomy.

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Frank rushed to the hospital as we were moving to pre-op. Theo was cool, calm and collected. He simply wanted to know the facts. This young boy knows the word surgery and all that it entails far too well after 4 surgeries in his first 4 years of life, including a repair of a spontaneous bowel perforation (day 1), anastamosis (3 months), an epiplocele repair, and a tonsil-and adenoid-ectomy. We discussed two plans with the surgeon; Plan A which was a simpler laparoscopic procedure where they would enter through his belly button and two small sites on either side and Plan B where they would convert Plan A to an open procedure for more extensive repair.

The surgery took two hours and we were notified after 90 minutes that they were progressing through Plan A. To say that we were relieved would be an under-statement. Once Theo procedure had concluded, the surgeon came to visit us to explain that this obstruction was a spontaneous occurrence and had nothing to do with bowel habits, hydration or anything we or Theo could’ve caused. The obstruction was caused by the omentum.

The omentum is a fascinating apron of fat within the abdomen which not only keeps our organs in place but also plays an immunological role. The omentum’s central role is the abdominal defenseman, it adheres to sites of inflammation and provides leukocytes to combat infection. In Theo’s case the omentum had adhered to the sites of his previous bowel surgeries, stretching across a portion of his small intestine. This part of the small bowel proceded to push through the stretched omentum- creating a donut-like shape- and then curved back around and came back through the same hole.

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Kinked small intestine

This kink in the intestine had been developing since Theo’s first symptoms in February. During the procedure, the team trimmed back the omentum, releasing Theo’s small intestine. They then inspected most of small intestine to examine other sites of adhesion but felt no further alterations were necessary.  We found this pathophysiology to be fascinating, as did Theo. He even got surgical pictures as a keepsake. He enjoys retelling the story to his sisters with these graphic images.

Amazingly, Theo displayed his resilience by discharging from the hospital 1 day later and returning to school on Monday. His bravery, curiousity and recovery truly make him one of our five super heroes!

 

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