Emergency Surgery for Declan

After all the serious posts I have posted over the past months I wanted to have something fun and light to post... I promise I will have something in the next few days.  But, alas I am going to put that off until next time because we have been through more than we thought we could ever handle.  But, we are here we have made it so far and I just wanted to share some additional news of the past couple months.

Last month, on September 16th, in the early morning hours Declan woke with violent vomiting.  The weeks prior to this Declan had not been quite himself and we just blamed it on a cold.  I felt terrible that now Declan had come down with a stomach bug, after already having been sick on top of everything else his poor little body has been through in his short life so far.  Scott and I took turns through the night caring for our very sick little boy.  As it was a Sunday morning and had been up all night and all feeling a little under the weather decided not to attend church that morning.  I told Scott to get some sleep because he would be working a 12 hour shift later that evening and knew he needed some rest, I took the kids downstairs.  And tried to calm Declan, but he was restless and would only sleep for moments at a time. I could tell he was starving so I continued to try and nurse him but he wouldn't eat.  I finally prepared him a bottle with only 2 ounces and to my relief he gulped it down!  As I sat him up to burp him there was a terrible sound in his tummy and then he had a very forceful bowel movement.  So, I took him upstairs to change him.  As I pulled down his diaper, it was full of bright red blood.  I immediately yelled for Scott to wake up and told him that we needed to take Declan to the ER.  As Scott ran into the room I sat Declan up and he began vomiting bright green bile.  If the blood wasn't scary enough, the green vomit was a sure sign of trouble.  We had been warned to watch for these signs and to take him immediately to the ER.  We rushed him in and 2 hours later we were in emergency surgery.  

On the way to the ER, I was trying to contact someone to come get Paige.  Thankfully we are lucky enough to have wonderful friends who came within minutes after arriving at the ER to come get her and even assist in giving Declan a blessing.  Thank you Mike and Barb for being there for us when we were in such desperate need.  We cannot say thank you enough!

So, after some testing they discovered that Declan had something called Intussusception.  Basically, it is when your intestines telescope in on themselves.  And apparently, as far as we were told, this was not related to his previous 3 diagnosis'.  


*I've included a detailed description at the end of the post for those that are interested in more information...



Most of the time intussusception can be treated with an air enema.  Unfortunately, Declan's was severe enough that they could not correct it this way and we were told that he would need to go in for surgery to correct the problem.  If we did not act quickly and have emergency surgery he would die.  

What a terrifying day!  We truly thought that we were going to lose him.  At one point I remember asking Scott if Declan was going to be ok, I felt that he knew more of what was going on.  All he did was look at me and didn't respond.  I was so scared, I asked him again, and he told me (not very convincingly) that he would be fine.  We thought that after the last surgery for Declan that we would never have to go back in for surgery.  Little did we know that just a few short months after his first surgery we would be going back in for a second.

Since it was a Sunday, they had to call a surgical team to come in.  With Scott being a nurse and working in the medical field we are very familiar with being on call and Scott needing to go into work when called.  Which I now hate to admit, it was irritating I wanted to keep him at home with us, I was selfish.  I truly had never appreciated in the same capacity as I do now for those who accept a career that involves their lives being interrupted and put on hold for their career until that day.  Wow, what we take for granted!  How grateful we were that Sunday morning that there was a surgical team willing to come away from their own family to save ours!  I cannot say thank you enough.  We told the surgical team multiple times thank you for being there.  I have come away from this experience with a greater appreciation and gratitude for those who are in the medical field and sometimes have to work on Sundays.

I thought that the last time sending my baby in for surgery was hard.  But I wasn't prepared this time.  Watching them take my baby out of my arms and walk down that hall to the surgery room was terrifying.  Not knowing if that was the last time I would ever see Declan, my sweet baby, alive.  I was scared for his life.  How thankful I was that Scott and I were there together and there for each other.  He was my rock and strength through this difficult trial.

Going into surgery the surgeon told us that she was hoping that she could do the surgery laparoscopically.  But once in surgery we were called and she told us that they were unable to reduce the intussusception and needed to open the abdomen and manually massage the intestine to free it.  So Declan now has a nice very visible scar below his belly button.  The count is now at 7 total scars.  Most of which you can barely see.


They were able to get a few good pictures of the surgery that show the extreme blockage:

In the lower right of this picture you can see part of the intestines at regular size, the smaller pink tubular shape.  The purplish pink mass in the center left is the portion of his intestine that was telescoped.  As you can see: it was at least double, if not more, than the size that it should have been.  And very inflamed and bulging.  They were worried at the sight of it that he might lose some of his bowel from lack of blood flow, but thankfully we were lucky that it pinked right up within minutes of reducing the intussusception and they did not have to remove any of the strangulated bowel.

Another really good picture of the strangulated bowel.

In recovery waking up.  After all the stress and worry this was a moment that lifted our spirits... with his binkie just hanging out.  Sure made us smile :)

Here is a picture of Declan hooked up to the monitoring equipment and IV.  He kept trying to pull everything out so we had to tape his hand really well so that he couldn't tear out his IV.

He was pretty swollen from all the fluid.  Sure didn't look like Declan, but still cute :)

Video I sent to Scott.  He had to go home and work on some school assignments.  We were excited to see him acting a little more like himself and responding to us.

We had called my parents when we arrived at the Emergency Room to let them know what was going on and within a few hours they were there to help care and support us.  My mom stayed with us for a few weeks to help out and stay with Paige while we were going to and from the hospital that week, allowing us to lay by our sweet baby boy day and night, every moment while he was recovering.  Thank you Mom and Dad!  I am so grateful to have you as parents, you have come to our aid in the very desperate of times and we are so thankful!  Thank you for always being there for us.  We are so very grateful for all the many friends and ward members who brought us meals, visited, and prayed for us.  We have felt them!  THANK YOU!!!

I am happy to report that we are all doing well, and hoping that life stays that way for a while.  We are aware that we will experience many more moments in our lives that are difficult and we know that we will make it through as long as we rely on the strength of our Savior, Jesus Christ.  He not only suffered for our sins, but our pain and sorrows as well!  And with his help we can overcome all things.  We have learned from strong faith in the gospel that this is true and we need only lean on our loving Heavenly Father and his son, Jesus Christ.   

Again... Thank you all for your love and support!



*Additional information:


DESCRIPTION:
An intussusception is a medical condition in which a part of the intestine has invaginated into another section of intestine, similar to the way in which the parts of a collapsible telescope slide into one another.^[1] This can often result in an obstruction. The part that prolapses into the other is called the intussusceptum, and the part that receives it is called the intussuscipiens.

Early symptoms can include nausea, vomiting (sometimes bile stained (green color)), pulling legs to the chest area, and intermittent moderate to severe cramping abdominal pain. Pain is intermittent not because the intussusception temporarily resolves, but because the intussuscepted bowel segment transiently stops contracting. Later signs include rectal bleeding, often with "red currant jelly" stool (stool mixed with blood and mucus), and lethargy. Physical examination may reveal a "sausage-shaped" mass felt upon palpation of the abdomen.

In children or those too young to communicate their symptoms verbally, they may cry, draw their knees up to their chest or experience dyspnea (difficult or painful breathing) with paroxysms of pain.

Fever is not a symptom of intussusception. However, intussusception can cause a loop of bowel to becomenecrotic, secondary to ischemia due to compression to arterial blood supply. This leads to perforation and sepsis, which causes fever.

In some institutions, air enema is used for diagnosis as the same procedure can be used for treatment. (THIS IS HOW THEY DIAGNOSED DECLAN)  An air enema is 

TREATMENT:

The condition is not usually immediately life-threatening. The intussusception can be treated with either a barium or water-soluble contrast enema or an air-contrast enema, which both confirms the diagnosis of intussusception, and in most cases successfully reduces it. The success rate is over 80%. However, approximately 5–10% of these recur within 24 hours.^{[citation needed]}

If it cannot be reduced by an enema or if the intestine is damaged, then a surgical reduction is necessary. In a surgical reduction, the abdomen is opened and the part that has telescoped in is squeezed out (rather than pulled out) manually by the surgeon or if the surgeon is unable to successfully reduce it or the bowel is damaged, the affected section will be resected. More often, the intussusception can be reduced by laparoscopy, whereby the segments of intestine are pulled apart by forceps.^{[citation needed]}

Intussusception may become a medical emergency (in our case it was) if not treated early, as it will eventually cause death if not reduced. In developing countries where medical hospitals are not easily accessible, especially when the occurrence of intussusception is complicated with other problems, death becomes almost inevitable. When intussusception or any other severe medical problem is suspected, the person must be taken to a hospital immediately.^{[citation needed]}

The outlook for intussusception is excellent when treated quickly, but when untreated it can lead to death within 2–5 days. Fast treatment is a necessity, because the longer the intestine segment is prolapsed the longer it goes without bloodflow, and the less effective a non-surgical reduction will be. Prolonged intussusception also increases the likelihood of bowel ischemia and necrosis, requiring surgical resection.