Wednesday, May 25, 2016
Wednesday, May 25, 2016 - Post-Op
There is both good and bad news from the procedure today. Good news first. The surgeon placed the vascath in his neck without any issue, which was our biggest concern going into this. He should be good to go back onto dialysis at some point.
The bad news is that while they were removing the UVC, they found stool in his abdomen again. The surgeon proceeded to conduct an exploratory laporatomy to examine the abdomen and find out the origin. When they went into the abdomen, he said that he saw open bowel staring at him. Apparently his bowel had ruptured or torn during the procedure, most likely while the UVC was being removed. He attempted to reposition his bowels to examine the damage further, but his intestines were so unhealthy that they would tear as he tried to move them. The surgeon then tried to enter the abdomen from the incision where they conducted his last surgery, but the liver was stuck to the abdominal wall and blocked that access as well. Based off what he could see and the amount of damage any more exploration would cause, they decided to leave the bowel and place drains to ensure any further intestinal secretions are removed. They're leaving him off dialysis for the next 24 hours because running the machine requires Heparin, a blood thinner, and with the amount of damage to his abdomen they didn't want to start that back up until he'd recovered some.
There are numerous consequences from what happened today. Obviously he has some major trauma to his abdomen and large areas of unhealthy bowel which will effect his ability to recover. Long term, the surgeon said that his peritoneum was seriously damaged and that the likelihood of him ever being able to start peritoneal dialysis is very low. This means that he would have to remain in the hospital until he was able to receive a kidney transplant, sometime around his 2nd birthday.
Through all of this Ezekiel remained stable and didn't have any issues with the procedure. He waited to get back to the room for that. After he arrived back to his room in the NICU, he desatted and his oxygen saturation dropped to 19%. The nurses had to bag him to keep him stable. They found that his ventilator tube had pulled out and they had to reintubate him. Now that the nurses fixed that, he's been doing well. All of his stats are good and he's already come down a long ways on all of his vent settings (now at pressure of 29/6, respiratory rate of 32, and O2 concentration of 24%).
Back to the waiting game as we see how he recovers from the surgery and what our options are going to be to repair his damaged bowels. Typically the first 48-72 hours are the worst postop.