Daphne’s last liver biopsy did show some signs of rejection. Her doctors increased her anti-rejection drugs. Although rejection is very serious, the solution seemed pretty straight forward, as she had been on the lowest level of anti-rejection drugs at the time.
Sunday she was given another CT scan because her abdomen was getting bigger. She was given contrast and it didn’t show a leak, but they could tell there was more air in her tummy since the last CT. This air had to come from somewhere, but without the contrast leaking through the bowels in the scan it wasn’t clear what was going on. There was a very strong difference of opinion on the issue. The intensivists were certain there was a perforation in the bowels regardless of what the CT said. The transplant surgeons didn’t agree.
Monday the transplant surgeons did decide to take Daphne to the OR for a wash-out and to look at her bowels. They did find a small perforation! They closed up the perforation, did the wash-out and removed her dying spleen. After all of that there was so much room inside of Daphne’s abdomen they decided to close her up completely, skin and fascia (muscle). This might sound like an obvious thing to do next, but sometimes it can take a very long time before they close up the muscles as well, some transplant kids are sent home without that done. As for the explanation as to why this perforation never showed on any of the CT scans was that the hole was in the length of bowel off of her liver not her stomach. If you have studied anatomy and that sounds strange to you it should be; Daphne’s anatomy is very unique at this point. The rest of us have a hepatic duct coming off of our livers not a length of bowel. This perforation was what was keeping her WBC high, but because of the location of the perforation she wasn’t getting seriously ill like most people do when there is a hole in their bowels.
We feel like this is a major turning point. Her WBC is down now. She has been doing well off of dialysis. They even took out the dialysis line in her neck. We are now waiting for her lungs to get stronger. Being on the ventilator so long has made them weak. Weaning her off the ventilator will be a slow process. We will just need to be patient. Today Daphne had a minor surgery to get a broviac. It’s a more long term way of getting IV meds and blood work. Her PICC line needed to be removed. Getting a broviac seems like a very positive step forward, like we are preparing for life at home post-transplant. The broviac will be used for all the frequent blood work she will need even after we are sent home.
One more thing, this week Daphne has also been moved to a new PICU unit. We have a window and it is spacious and quiet.