Thursday, July 24, 2008

Emergency Surgery

Kaitlyn woke up moving her legs this morning and waving her arms! She had an OK night, pretty fussy and awake from 3:30am until 4:30am, and every time the nurse was in, but overall a pretty good night. They kept a close eye on Kaitlyn's leg all night. Her right leg was definitely cooler than the left one, but seemed to warm up a bit towards morning. It still looks slightly blue to me. Surgery was in around 8:30am and said that they were trying to get Kaitlyn down ASAP this morning for her new J-tube; they just had to wait for the radiographer to get in. Hopefully Kaitlyn won't have to wait much longer.

The resident wants to have somebody come in this morning and do an ultrasound on Kaitlyn's leg just to be safe. She has also called our nutritionist in to figure out Kaitlyn's TPN as it will be ordered just in case there are any complications with her J-tube reinsertion. It's probably more likely that we would have more trouble restarting her feeds. We had to fight hard to get the TPN ordered, they said that she would be getting her J-tube anyway. My husband and I said that we wanted to cover all our bases and she was not to be starved because we didn't request the TPN soon enough!

Kaitlyn went down to ultrasound at 9:00am to look at her leg. She does have some clotting but it looks chronic not something that was done yesterday(trying to place the central line) by our General Surgeon, but perhaps exacerbated by it. I don't think that they will be doing anything proactive about the clot, it seems like other pathways have already been formed for the blood to get through.

Then Kaitlyn went to radiography for her J-tube reinsertion. There were two radiographers present in the room. One was a Dr. we have had in the past, the other a woman who didn't seem that confidant about placing the new tube!! She advanced the new tube really fast, the tube took a funny turn and the primary radiographer said "whoa... it shouldn't look like that" and decided to inject some contrast fluid to see were the bowel was going with regards to the end of the J-tube. When the contrast reached the end of the J-tube it didn't continue on down the bowel it dispersed and flowed out into the stomach cavity.

The primary radiographer said that he felt that the old J-tube had erroded the wall of the bowel causing a perferation in the bowel. The new tube was a GOOD six inches away from the last J-tube end point so I believe that they perferated the bowel when they inserted the new J-tube!
Kaitlyn had to go for immediate surgery to fix the hole in her bowel. Her platelets and haemoglobin were both low so they may have to do infusions during surgery. She is currently on TPN as of 2:15pm so she was 27+ hours without proper nutrition. Our General Surgeon is performing her surgery and is going to try to do so laporascopically. He also suggested that we think about another way in which to feed our daughter from now on. He will try to do a laporascopic fundiplocation, but if he has to open her up for the bowel surgery he may end up doing her fundo open chest as well. Her perferation is at the back of the stomach wall and appears fixed. Kaitlyn will go to PICU after surgery and is not likely to be extubated tonight. Dr. Macmanus (PICU Intensivist) will be in charge of Kaitlyn's care when in PICU.

Kaitlyn was in surgery until 9:30pm. Dr. Brisseau fixed a tear in Kaitlyn's bowel (he thinks from the guide wire) and a small puncture from the J-tube. He said that the wound looked fresh that there was no indication that her bowel had been open for very long at all. He suspects that the bowel was perferated in flouroscopy when she was having her new J-tube placed. He was able to do the bowel repair laporascopically and took more time doing it because he was trying to be thorough in checking for any more leaks using a flourescent dye. When Dr.Brisseau was done with the bowel surgery Kaitlyn was stable and he knew that she would not come off of the ventilator until the next day, at least, so he decided to go ahead with the laporascopic fundiplication. The Fundo went well but took forever as her stomach is very small having had no feeds since last October. He had a difficult time getting a proper 360 degree wrap and making sure that it wasn't too tight! He placed an NG-tube attached to suction to better vent and drain her stomach. He placed a drain at the bowel site.

We got to see Kaitlyn at 10:20pm. She looked very swollen but otherwise very good. Her sats were 100%, her lungs were sounding clear, and she was at 30% O2. Thank goodness My husband and I pushed hard for the TPN otherwise she would have been without food for an incredibly long time.

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