Mackenzie’s team of doctors came through early. Same old, same old…they said she was still draining too much stuff and that we would just keep watching her today. I think I asked them about the x-ray but again, I was half asleep and don’t remember their exact words. One of the doctors said that he hadn’t seen them but the other doctor said that he had and that they took it to know where to readjust the tube. It didn’t sound like anything had changed otherwise.
Then we got a visit from the ortho resident, who is very easy on the eyes :), by the way! He made sure her back looked okay and told us that whenever she does get to start eating that they will take it very slow…first ice chips and water and then progress from there.
Around 9:30am a whole team of doctors came in our room. I knew it couldn’t be good when about 10 doctors filed in. They are finally going to do the CT scan with the contrast dye. The main surgeon is getting more worried the farther we get out from her original surgery date and since she is still producing green stuff (even after moving the tube up yesterday). I got excited because I thought the same canister has been there since yesterday, but there was a new one this morning and right now (10am) it has filled up to 500ml over the past 8 hours or so. He said that since we are now 10 days post-op, he is less and less convinced that this is an Ileus. He said that they will put the contrast dye into her NG tube and try to let it sit in her stomach for about 2 hours, and then they will do the CT scan. He wants to make sure that her intestines just still haven’t started working yet, if there is an obstruction, if it was something related to the surgery, or if it’s something completely unrelated to the surgery. He said it may be something to where we can change her position or it could turn out to be something that they can go ahead and fix to make her get better. We won’t know until after the scan.
They started putting the dye down her NG tube around 10:30 and said that it will run over the course of two hours. Then they will do the CT scan. We finally got transported downstairs to the CT section around 1:30pm and got back to our room around 2:30pm. I was worried that she would get sick and throw up all the dye that they pumped into her stomach, but she did good. As soon as we got hooked up to the suction, most of it came back out.
Around 4pm, I asked the nurse if she knew if the radiologist had gotten a chance to read the scan yet. She said that she saw it pop up on her computer and would see if Mackenzie’s team of doctors were notified. A little before 5pm the nurse said that the doctors would be in soon to talk to us. I had just had a feeling all day that something was wrong. It’s the same bad gut feeling I get when I know something is wrong, no matter how much I try to shake it. It hasn’t let me down yet.
Around 5:15pm, two doctors come in our room and introduce themselves and kind of look around the room for the whiteboard. They ask if we have a dry-erase marker that they can use. At this point, I know for sure that there is something wrong because they’re having to draw it out! The doctor says that radiologist reviewed the x-ray and called him directly with the result, which clearly showed something they call SMA syndrome. I recognized the name immediately (not because I knew what it was but because the ER doctor on Thursday night mentioned that this could be a possibility). Back in the ER, they kind of brushed it off because it was really rare and the symptoms between that and the post-op Ileus were very similar. So after we left the ER room, none of the doctors mentioned anything else about SMA syndrome. So, anyway, the doctor starts drawing on the board. Here is what he drew:
I’ll try to relay what he explained to us. So, there is an abdominal aorta that runs along the length of your spine, and there are places that it branches off (the picture on the right side above is a side view that shows where it branches off into two places – the squares are vertebrae). The SMA (Superior mesenteric artery) branches off and part of the small intestine runs right underneath that artery. There is supposedly fatty acids or some kind of body fat that surrounds this small intestine to kind of cushion it underneath the SMA. During spinal fusion where the spine is being moved so much, it can sometimes decrease the space where that small intestine was originally lying underneath the SMA. This is what happened to Mackenzie.
Here is the drawing for that example:
The drawing on the left represents what her small intestine looked like before the surgery and the one on the right shows what it is now (it’s pinched in there).
He said that when this normally happens it is seen mostly in people who have lost a lot of fat at once (like after gastric bypass surgery) and the fat doesn’t cushion that artery anymore, therefore pinching it and causing blockage. In this case, it’s more of an anatomical issue where her spine was moved around and changed the space that was available for that part of the intestine.
The doctor said that there are really two options…to wait and try to build fat on her and hope that the artery basically gains fat in that area. This didn’t really sound like a valid option because she is 12 and the issue was caused by moving her spine, not losing a lot of fat.
The other option was surgery to cut the small intestine before the spot where it is caught and then sew it back to a place below the blockage to just bypass where the issue is. The doctor said that this will most likely be the route to take. He said that it’s done through laparoscopic surgery and that the tube would remain in her for about 1-2 days…enough to make sure that everything is flowing through like it should. Then she would start eating clear liquids and progress from there.
He said that since this is so rare, he was going to talk to the head surgeon and then would talk to us about everything in the morning when they do their rounds. When the doctors came in, Mackenzie was awake, but during the course of their explanation, Mackenzie just turned her head and closed her eyes. She had had enough and was just trying to block it out.
After the doctors had left, I asked our nurse if she had ever seen anyone with this and she said no. She said that after the doctors talked to them, her and some other nurses were looking up stuff online…I thought that was pretty funny…that they’re Googling stuff just like I am.
So, that’s how today went. Fun stuff.