Peritonitis

Emergency Surgery

On the morning of 25 October 2016 Ryan was complaining that his PEG feeding tube was unbearably painful. He was due for a review anyway that day at Velindre Cancer Centre and a PEG specialist nurse came for to look at Ryan. She said the site was a bit weepy and raw, she thinks he possibly caught or pulled it in the night. She is confident that it is fine and she also gave it another good clean. 

A week on and we are back to square one. The district nurse came out on Monday 31 October 2016 to advance (turn) the PEG tube as is needed each week after the first month.

The nurse was unable to move the disc and caused Ryan an incredible amount of pain. We ended up having to go to the Teenage Cancer Trust ward in Cardiff, where two gastro nurses met us and spent the best part of an hour, torturing Ryan while they 'forced' the PEG to move, which they eventually did. Or so they thought.  The following week, 7 November 2016, the district Nurse came again to the house to do the 2nd advance. This time Ryan screamed a blood-curdling scream and said: "it has burst".

I managed to get him into the car, to take him to TCT, Cardiff again but had to stop on the hard shoulder of the M4 and ring the ward as he was in so much pain. They were reluctant for me to call an ambulance as we had no idea how long we would have to wait and we would have been taken to Carmarthen, not Cardiff as it was the closest hospital.  I eventually (driving at a snail's pace) got him to Cardiff hospital where the Gastro surgeon met us at the ward and scans were done. It took a long time to get through the scans as Ry was in so much pain. Gas and air all the way. Which he did enjoy (small positive).

The scans showed the PEG tube had ruptured his stomach, hence the pain and sickness, which is what we had guessed. The surgeons were frantically organising for him to go into surgery in the next couple of hours, we were just waiting for Anaesthetists to come to do their checks and give the okay that he is well enough to proceed.

Ryan was eventually taken into emergency surgery at 9:15pm. They had discussed several options with me before I signed consent, depending on what they found when they get the camera down. Hoping they would be able to perform keyhole through the bellybutton.

A laparotomy was possible, but hopefully not obviously. The Surgeon Mr D said it would be a least a couple of hours.  

Ryan was given 48 hours to live.

Over four hours later at 1:35am Tuesday 8 November 2016, the Surgeon Mr D came to see me. They had to do a full laparotomy. The disc that holds the PEG in place had eaten away his stomach lining and had migrated out of his stomach, causing a lot of internal infection, which ultimately was peritonitis.

They cleaned away the infection and inserted a different type of feeding tube a temporary one called a Malacott tube, but it could not be used for 5 days as Ryan's stomach needed time to heal and recover. 

The surgeon was brutally honest with me in those early hours, I had only had 1.5 hours sleep and had to process the news Mr D was giving me that he had never operated on a child with such low muscle mass and he was very doubtful that the sutures would hold. The next 48 hours were critical. Either Ryan would make it or he wouldn't. It was confirmed Ryan needed 2 days complete rest and sedation. Those 2 days, Tuesday and Wednesday worked and Ryan defied the odds once again. On the Wednesday at ward rounds we had: The Gastro Surgeon is Happy with Ryan's progress. Blood numbers and obs are as they should be. 

Dietitian: They may start with a little water on Friday to see how well his stomach tolerates, they may leave him till Saturday.

Physiotherapist: To help with moving about after Laparotomy, bed rest and sedation. This was to begin on the Friday with the target of sitting on the edge of the bed.  Gastro nurse: To explain in more detail the new feeding tube and care. 

Ryan's 15th Birthday

The morning of Thursday 10 November 2016 was Ryan's 15th birthday and he decided to celebrate by having a small lung aspiration which meant a frantic hour while medics got a mobile x-ray and started him on antibiotics. Once again their quick thinking and actions prevented any lung infection taking hold and although Ry had a really rough day. He was saved from a whole lot worse.   

Finally, after another 10-day spell in Children's Hospital for Wales Ryan was finally well enough to be ambulanced across Cardiff town to Velindre to finish his Radiotherapy Treatment and back to Cardiff Heath and we were ultimately discharged on Thursday 18 November for 2 weeks well deserved rest and relaxation before commencing chemotherapy which originally should have started on 21 November. 

So not content with his ultra-rare lymphoma diagnosis Ryan decides to go all out and add Sepsis and Peritonitis to his collection of troubles. 

It has also been confirmed that he needs to have a Hickman Line fitted as his veins are not big enough for a PICC line? That will be operation number 7.