Landon's Not So Excellent Adventure

Landon underwent surgery for a burst appendix

It was quite the ordeal.

They left his incision open for a few days.......



......before finally pulling it together. 
 Notice they went around his belly button :)



Some of his closest friends, Byron, Mikey, and Cody



Grandma Rich, and Grandpa and Grandma "D"

Clicky Clicky - Mikey helped administer the "self-dosing" pain meds :)

The Porter Family came to visit too.



Roger D -  hating his pic taken.



Young Love - just married a month ago !

About a month? after - healed pretty nicely.

“That which does not kill us ~ makes us stronger”

Thursday, September 4, 2003 – Landon first noticed pain after the Mtn. Crest football game. He had taken a helmet to the gut the day before in practice. When he felt the twinge of pain in his lower right belly, he attributed it to the hit. It bothered him for a few days, mostly when he was going up and down stairs, and at the beginning of football practice. We thought we had better get it checked out to make sure it wasn’t appendicitis.



Thursday, September 11, 2003 – In the morning we took Landon down to the South Ogden Clinic where Physician’s Assistant Alan Bybee examined him. After pressing and pushing on Landon’s stomach, he didn’t think it was appendicitis, but wanted blood drawn to check his white cell count just to be sure. The white cell count came back normal, so he said it was most probably a pulled muscle due to the football helmet, and to just take Ibuprofen as needed. Landon played a great game against Roy that afternoon.



The week of September 14th – 19th, Landon never complained about his stomach at all. I saw him take Ibuprofen a couple of times here and there, but he didn’t complain at all. He played another great game against Tooele on Thursday the 18th, and stood on the sidelines at Tooele on Friday night the 19th as we watched the Varsity football team play a spectacular game, winning in the final 20 seconds! We talked to Landon after the game, he was in good spirits, he was going to be riding the bus home with the other players, and then have a few of them over to spend the night. We went home and went to bed.



Saturday, September 20, 2003 – Landon woke me early this morning complaining of terrible pain in his stomach. It was not located in the lower right region, but rather all over. He was in pretty bad pain for an hour or so, then threw up and felt some better as far as the pain in his stomach. He said they had eaten at Carl’s Jr. the night before on the way home, and it was terrible. We thought it might be food poisoning. Landon also had really bad diarrhea throughout the day. He slept most of the day in the recliner, not throwing up again, but having terrible chills now and then. His face would feel cold and clammy, while his legs would be burning hot. All he would drink was water and Alka-Seltzer, and a spoonful or two of chicken noodle soup. His diarrhea was really bad, but he didn’t throw up again. We thought he maybe had a bad case of stomach flu. Later in the evening about 9 p.m. his stomach started hurting again, and he called me in the bedroom, and wanted me to call Scott Harris to come and give him a priesthood blessing. I was a little hesitant – a priesthood blessing for stomach flu?? But I did as he asked, and Scott and Jim Wiscombe were gracious enough to come down and administer to him. He felt a little better, and had a relatively good night, mostly sleeping and only getting up to go to the bathroom.



Sunday, September 21, 2003 – Today was our ward conference but Landon was much too sick to go. I did not want to leave him, and so stayed home also. I was sitting at the computer, and he walked in and sat down beside me. As I looked at him, he looked as though he had dipped his face in a basin of water. Cold sweat had literally broken out all over his face. I had read about this term before in books, but had never seen it personally.


I might mention at this point, that Landon is NEVER sick. I cannot remember the last time he had either a cold or flu. It has been years and years. He is just one healthy kid. You would think that I would maybe think that this was something serious at this point, but no, we still just thought it was the stomach flu – a really really bad case. He slept again most of the day, and it was basically a repeat of the day before. It didn’t appear he would be getting well anytime soon, so I planned to run him over to the clinic the next day.



Monday, September 22, 2003 - I made an appointment for 10:30 a.m., and Dr. Challburg looked Landon over. He had him give a urine sample, which turned out to have traces of blood in it. Dr. Challburg probed Landon’s abdomen quite a bit, and this was VERY painful for him. His stomach was swollen, hot, and hard. His temperature was 98.6 though – very weird. After doing this, he stood there with his chin in his hand, looking at Landon very seriously. He then said he wanted him taken to the hospital for an ultra-sound and lab work. Landon and I had to go home and switch the Metro for the truck. Every bump we would hit, hurt Landon’s stomach really bad. Landon asked me what I thought was going to happen, and I said that probably it would turn out to be nothing, and not to worry about it. I called Roger on the cell phone, and he arranged to meet us at McKay-Dee Hospital. As we were pulling out of town, Jason Lee the school cop saw us turn at the Chicken Inn. He could tell that something was wrong, and followed us for a ways, and flipped his lights on for us to stop, but I was busy talking on the cell phone, and Landon was too sick, and we didn’t even notice.


As we pulled into McKay’s parking lot, Roger had parked clear out in the boonies. I pulled up next to him, and said that Landon couldn’t walk that far, and for him to come down to the door and get the truck while I helped Landon in. As we pulled up in front of the main doors, Shirlee Wilkerson, CJ’s mom happened to see us pull up. At this point, Landon was having a really hard time walking because of the pain. Shirlee helped us in to the Lab, and every seat in the room was taken. We ended up sitting Landon in the main corridor of the hospital. It became obvious that we would be waiting a LONG time. Shirlee took matters in hand, and expedited our paperwork, and got us into radiology for the ultrasound in 20 minutes. Her friend Nancy was the one doing the procedure. As she rubbed the device over Landon’s stomach and the pictures came up on the monitor, it was hard to tell what was what. There were these BIG black areas, and I didn’t think anything of them, but when she stopped and started “mapping” them, I looked over at Roger and whispered, “Something’s wrong”. I didn’t think she would tell us anything, but I asked her anyway, “What are those black areas?” She said that it was blood and fluid, and that it shouldn’t be there. These black areas were located all around his liver, appendix, kidneys, spleen, bladder, and stomach. At this point she said she needed to talk to call Dr. Challburg, and she left the room.


Landon was lying very quietly. He was so sick that he didn’t talk much. When Nancy came back in, she said that Dr. Challburg wanted Landon admitted to the emergency room for a CAT Scan, and that the doctor there would take over his case. CAT SCAN (Computerized Axial Tomography Scan): A type of X-ray that yields a three-dimensional picture of the body that is about 100 times more sensitive than a standard X-ray. It can be given with or without contrast (medication given by drink or injection to enhance X-ray pictures). Landon’s CAT scan was given WITH contrast, by injection, which was Iodine. He turned out to be allergic to this, and developed a hive (which he was given Benedryl for). Landon was wheeled down to the ER on the table. Thank goodness he didn’t have to walk at this point. He was put in exactly the same cubicle that CJ was put in after the car crash, exactly a year ago to the day. The CAT scan showed the same thing as the ultrasound, but in more detail. Dr. Lane, the ER doctor said there was definitely something wrong, and they would be calling in the surgeon on call. At this point I requested Dr. Richard Alder. Shirlee had said that he would be the best one, and Stephanie, whom I work with and Gaylene Kimbal, our good friend had always spoken very highly of him. As it happened, Dr. Alder was just finishing up with surgery upstairs, and would be down shortly.


Dr. Richard Alder examined Landon, and said he definitely had a “surgical abdomen”. Landon was bleeding internally, and they would need to go in and take a look to see what was the matter. We had mentioned the football injury, and Dr. Alder wondered if he had a perforated bowel that was “not viable” at this point. Only surgery would tell. It would not be a “scope” surgery, but an OPEN incision. Landon was hooked up to two different IV’s as he was prepped for surgery. Shirlee came and found us in the ER, and we arranged for two men she knew and worked with, to give Landon a blessing. Dave Ferrin and Keith Johns did this, and we were very grateful.




Landon was lying very quietly, and didn’t have much to say. I remembered a couple of weeks ago on the way to the other doctor, him saying, “I’m NOT having surgery! – it will foul up my football season!” – but now he wasn’t saying anything at all, football was the last thing on his mind. At one point he pulled me down close and whispered in my ear, “Just make sure I’m asleep – I don’t want to feel anything!” I assured him that he would be OUT, and later expressed these same feelings to the anesthesiologist.


 Landon was taken into surgery about 4 p.m. At about 4:30 p.m. they let us know that it definitely was a “burst” appendix. Another hour, and the surgery was complete. Landon was moved to recovery, and we were taken into a consultation room to wait for Dr. Alder. The first words out of the doctor’s mouth were, “What a mess!!” “I’m sorry to put it that way, …. But WHAT a mess!”


 He then proceeded to tell us that Landon had one of the worst cases of peritonitis that he had ever worked on. (Inflammation of the peritoneum (membrane) which lines the inside of the abdominal cavity and all of the internal organs) When he got in there, the appendix was no place to be found, apparently it had disintegrated and all that was left was a bloody mass where it was supposed to have been. The doctor stapled the bowel and cut off the mass, and proceeded to flush his intestines. The bowels were so very swollen and infected.


I was feeling really bad that we had waited to bring him into the hospital, and that the two days of lying at home had made this situation so much worse. Dr. Alder then said, “Oh, Mrs. Rich, this has been going on MUCH longer than two days. For it to be as bad as it was, it had to have been going on for 1-2 weeks!”


Then Dr. Alder told us about the many complications that might result from this “poisoning”. Multiple Organ Failure - which is when the major organs in the body shut down, Abdominal Compartment Syndrome – when the bowels swell and additional surgery is needed to relieve pressure, and also some other kind of Bowel Syndrome, where the bowels stick together and kink and become obstructed. We were speechless. Dr. Alder told us the first 48 hours were the most critical, and that Landon would be monitored very closely, and given strong antibiotics to combat the infection. Needless to say we were very concerned. Dr. Alder said that he had left Landon’s outer incision “open” so that any swelling that might occur would be able to have room to do so, and also that it would heal from the inside out. Landon was moved to Room 2210 on HOBBS (High Observation Unit) not ICU, and I was wishing he was in ICU, just so he would get more closely watched.


 Landon was closely monitored Monday night, and I (Gwen) stayed down at the hospital with him. He has a catheter (to keep his bladder drained), and an NG (Nasal/Gastric) tube down his nose to his stomach to drain his stomach, in order to provide room for his intestines to move, swell, etc. Stake President Bott and Bishop Fisher came down tonight (Monday) and a special prayer and blessing was offered. Landon was told that from this moment forward his internal organs would begin to heal and he would be made whole !! Also that he had a special mission to perform and that his work on this earth was not finished and that he would be a “comfort” to his parents and others. This word “comfort” and the aspect of “caring” is the same wording that was mentioned in my patriarchal blessing as it pertained to Landon. I do not think this is a coincidence. Landon has brought so much joy into our lives, there are no words to describe our life and relationship with him, maybe special, wonderful, fun, enjoyable, are some that come close.


Grandpa and Grandma Dickson were with temple friends up in the Uintahs since early this morning, and I tried to leave “non-worrying” messages on their answering machine to let them know what was going on. When they got home at about 11 p.m., they were pretty upset and concerned.





Tuesday, September 23rd - Landon is a very very special person. He has had so many people concerned about him. Adults, young adults, and kids alike. The football team, his young men group, friends, teachers, coaches, advisors, you name it !! Prayers and fasting have been offered in his behalf by so many people. Scott Harris, his old Teacher’s Quorum Advisor, who went through this same ordeal when he was 19 years old (in 1983) said it best when he said “Up until I met Landon, I could not say I had ever met a special valiant son of God, but I know that he is one of the Lord’s valiant sons – absolutely – sent down to earth to love and be an example to others. Landon has had so many visitors today, as the word got around about what had happened to him. He’s in pretty good spirits, considering.


Wednesday, September 24th - Matthius Rupp’s wife Michelle has been a good nurse and Big Al’s oldest brother Kenny Tucker is Landon’s CNA today. Landon’s fever, or lack there of has been good. It is now 39-40 hours since surgery, so we are doing okay. The tube in the back of his throat is bugging him most of all. His incision has not bothered him at all. Changing gears a little – football this season is over for Landon. He is feeling a little blue about this, but has resigned himself. He had members of the football team, including coaches and his close friends come down to visit last night. He is worn out today, and doesn’t seem as perky. Dr. Alder seems cautiously optimistic. He came in and said his bowel sounds were good, so the stomach draining tube and catheter could be removed. They came out okay, and Landon was trooper, but said afterwards that it hurt. He has slept a lot today. I don’t know of all the visitors wore him out or what. He’s pretty punk (my grandpa Dickson’s word) tonight, we had them put a sign on the door saying “check in with office” so he won’t be disturbed.


They still haven’t “sewed’ him up completely, and I forgot to ask the doctor about it. The nurse says it is to let him heal from the inside out. Landon is on two different kids of antibiotics to fight the infection. Genamicin (given once a day) is very strong, and Landon’s blood must be drawn before and after the administration so that the toxin levels can be checked. He was also given Unasyn every 6 hours. Landon’s dressing is changed at 9 am and 9 pm (approximately) He is still on Morphine, self administered by the PCA pump (Patient controlled analgesic). He can press the button every second if he wants to, but the dose is only allowed and administered every 10-½ minutes. As his friend Mike Eddy would say…. Clicky clicky clicky !!!



Thursday, September 25th - Last night (Wednesday) was pretty good. Landon and I only woke up 2 times (1 a.m. and 4 a.m. when he had to urinate). His nurse for today is Cody and Caid Evans Uncle. Landon’s incision is hurting him because when he’s asleep he can’t remember to hit the PAC button; also his left IV is hurting and stinging, so they switched it to the right tube. Dr. Alder came in and you could tell he was pleased with Landon’s condition and said he was going “pretty good”. His blood count came back good and his temperature is good. The doctor said he would probably close the stitches tomorrow or Saturday. He also said that Landon might be moved to the general surgical floor (5th floor) today or tomorrow. Landon looks to be out of the woods as far as multiple organ failure and abdominal compartment syndrome. Roger asked how long it would take to recover from all of this, and the doctor said probably 3 months until he was completely over it. After 6 weeks he’ll feel pretty good, but still be tender, etc. Wrestling looks to be in jeopardy. Oh well, we hope he will just be okay. Sports can wait !!!


Landon was moved to room 5207 on the 5th floor pediatric surgery unit at 11:30 a.m. today. He is sleeping a lot. It has me worried. We’ve got his room all decorated up with his cards and posters and balloons and gifts. Kresta is his RN for this afternoon. Landon has been very very sleepy. About 5 p.m. they hooked up a play station, but the games were so stupid he didn’t even play them. Back to sleep he goes. Brenda Crossley brought us prime rib from the Timbermine for dinner tonight. It was great !! Of course Landon only gets ice chips, so we go out in the hall so we won’t have to eat in front of him. He’s sleeping again, and doesn’t seem to mind. Tonight ended up not going so good. I had been worried about Landon sleeping so much, and not walking around, and then he developed a rattle and a cough and I was worried about pneumonia setting in, and I asked the nurse to check him, and sure enough, he has diminished lung capacity. So now they have the Respiratory Department involved, and he is doing breathing exercises. I was pretty upset. Also, the Junior Varity football team got creamed by Bear River, and the Sophomore team ended up playing a whole game and won 31-30 with Jared Olsen kicking a game winning field goal in the last 20 seconds.. All the kids started chanting Landon, Landon, Landon, afterwards. I think they all miss him.



Friday, September 26th - Today is better but I’m still so worried. My emotions are really high. I worry so. They sewed him up this morning, or I should say “closed” his wound with sutures that were already in place. It is quite the scar, or will be, I guess. Rog has been here all day and I went home for 2-3 hours. Rog made him cough and suck air though the respirator thing and walk a bunch to help his lungs and get his bowels going. His lungs have much improved, thank goodness !!, but his lower bowel still is not making very many sounds. This is so worrying to me. Landon has been without food for a week now (Last meal was Carl Jr’s, last Friday night).


September 27th - Dr. Alder came in this morning and in the course of our conversation said that Landon was progressing about where he thought he would be. He wasn’t surprised that his bowels hadn’t woken up yet, and that with the trauma they had sustained, that it might take up to a week, so still nothing more than ice chips. He also said the Landon was not behind schedule. That made me feel ALOT better. He ordered some Pro-Cal (Protein and Calories) for Landon’s IV. Today was a good day for the most part. Landon walked 5-6 times and was awake more, playing X-box with Roger. He had a bunch of visitors, and Brittney Brown came down and sat with us for 3-4 hours and watched “Holes”. The “boyos” and girls came in during their Homecoming date, dressed in all their finery. What a bunch of good lookin’ kids.



Sunday, September 28th - Happy Birthday to Zac. 22 years old !! It was a year ago that we were down here with he and CJ and their accident. Now they are just an old married couple !! CJ works at the hospital, and it’s been great having her around everyday to pop in for a visit. We love them both so much !! Last night at the hospital went well, Landon was just up two times to urinate. Still no bowel sounds. I’m praying that they’ll start. Today is Fast Sunday in our ward. I hope people will be fasting and praying for Landon. This morning we walked at 7:30 a.m. and noticed his IV in the right arm had failed. The nurse is putting in a new one right now. It didn’t go too easy. They say he has really tough veins and it took 2-3 times of poking and he didn’t like it one little bit. The Elders from the church stopped by and they’ll be bringing us the sacrament later. It makes me so emotional, and I’m really looking forward to this. Landon will only be able to partake of the water, as he is still on ice chips only, poor kid. We are so…….. tired of this place. Landon has had SO many visitors tonight, and it is really wearing on him - and us. Landon’s attitude and demeanor is low.


Monday, September 29th - One week, and still no passing gas. The doctor has not been in because of surgery. Landon took a shower this morning and the IV dressing got wet and when the nurse tried to change it the IV accidentally pulled out. Putting in a new one was pure hell. Finally in……thank goodness! Rog came over from work and after a few games of X-box baseball, Landon was smiling and believe it or not, trying NOT to laugh because it hurts his stitches! Rog went and got a couple of movies.


Hurray !! - The doctor just called and Landon can go on Clear Liquids. After 10 days – finally !! Even though he has not passed gas yet, we’ll proceed and hope that all works out well !! Roger has gone to Megan Porter and Johnny Wilkinson’s wedding dinner up Hardscrabble tonight. My mom and dad came down and we put Landon in a wheel chair and walked him outside and around the pond. It was a LONG HOT walk. Landon “ate” orange jello, chicken broth, and apple juice tonight for supper. He savored them !! Lisa and Clay Carrigan are coming down tonight for family home evening. Also Mark and Sherrie Rich and kids. Landon is very special to them.


Tuesday, September 30th - Rog came down at 7 a.m. so I could leave and go home and go to work for a little while. The doctor came in at mid morning, and still no passing of gas. He said to put Landon on a FULL liquid diet, which is tomato soup, milk, and pudding. He also said to take him off the morphine and put him on Lortab “tablets’ and also get a suppository in him. I asked Landon if he knew what that was, and he said NO. I explained it, and he said he’d insert it HIMSELF !!! He’s a goof. I love him. Rog and Landon are watching 2 Fast 2 Furious. Rog will go back home to Johnny and Megan’s wedding ceremony this afternoon. I think both Rog and I will skip the reception. Landon’s spirits are good !! The suppository worked !! Three times !!! Yahoo!! During the night he was “tootin’” up a storm. Hallelujah!!


Wednesday, October 1st - Happy Day !!! Dr. Alder came in about 7:30 a.m. and said that Landon was free to go home after breakfast !!! The smile on Landon’s face was worth a million dollars. He immediately wanted the IV out that had been hurting him (he hadn’t mentioned it because he didn’t want to get poked again). He is now “unhooked’ from all of the tubes for the first time in 10 days. Roger is to work this morning until about noon. Then he’ll come and get us. I have a prescription for Lortab that I need to get filled and we need to run by Walmart and pick up one those “ear’ thermometers. Dr. Alder said the things we need to watch for are fever and pain. “Pain”, not from the incision, but from his bowels, which would indicate an obstruction. This is something he is going to have to be aware of, for the rest of his life, because there will be TONS of pelvic adhesions going on inside of him that “could” cause bowel obstructions. Dr. Alder said there is nothing that can be done to “fix” this, nothing he can eat, etc. It’s something he’ll have to live with, and hopefully it won’t give him problems.


 We will be going back to see Dr. Alder in one week – then if everything has gone good up to that point, Dr. Alder said he’ll (Dr. Alder) feel good. He says that in 6 weeks Landon should be able to resume all activities, including sports, etc. Thank you Heavenly Father for our many many blessings. Aunt Lynette Hartman, who was down for Megan’s wedding came in this morning on her way back to Idaho Falls. She just barely caught us, as we were just ready to leave the hospital. She brought Landon a BIG Tweety Bird Balloon and some candy – she’s the best !!



Friday, January 02, 2004 – As of this date, things are going well. Landon has resumed wrestling, and other than not regaining the 18-20 pounds he lost during his ordeal, he is doing okay. His strength and endurance needs to be built back up, and he is working with trainers at Weber State College and the Human Performance Center to help with this. He still has a couple of stitches that haven’t dissolved yet, and they tend to “weep”, but they don’t pain him. After wrestling if they are still giving him problems we’ll have to take him back to Dr. Alder and he’ll be given a local, and they will have to be cut out. We’ll cross that bridge if and when we have to. We are so thankful for everyone’s prayers in our behalf.



Ultrasound Technician Notes There are large loculated (divided into compartments) fluid collections throughout the abdomen. The largest is present in the left lower quadrant measuring 7.5 cm in greatest dimension. Multiples of these fluids collections demonstrate a strandy echogenic material which is consistent with prior hemorrhage Fluid is seen surrounding the liver and spleen. A large collection in the pelvis measures 10.9 x 5.6 cm in size. The liver and spleen demonstrate a homogeneous (normal) echotexture. There is no evidence of hydronephrosis (abnormal enlargement). Kidneys are grossly intact. There are no blind-ending loops of bowel within the right lower quadrant to suggest appendicitis.


Impression: Given the patients history of a football injury, injury to a solid abdominal viscera (any large organ in the abdomen) is suspected. A CAT scan may be helpful in further evaluation. CAT Scan notes Axial CT performed through the abdomen, from above the diaphragm (thin muscle below the lungs which separates the chest from the abdomen), to the pubic symphysis. The base of the lungs are clear. The visualized portion of the heart and pericardium appears normal. There are large fluid collections throughout the abdomen. These fluid collections are loculated and demonstrate mild rim enhancement. There is fluid surrounding the inferior aspect of the liver and spleen, also loculated in appearance. The small bowel demonstrates increased enhancement and is fluid filled throughout a majority of the loops. Multiple air-fluid levels are present throughout numerous small bowel loops. These findings are consistent with severe ileus or obstruction. No definite transition point is identified. The liver, spleen, pancreas, and adrenal glands appear normal. Impression: Multiple loculated fluid collections throughout the abdomen and pelvis. No solid abdominal injury can be identified. This raises the possibility of a mesenteric or bowel injury.
 

Doctor’s notes (from emergency room) The patient is a 15 year old healthy white male who on about the 4th of September while playing football was struck on the right side with a helmet in the abdomen. He had pain and discomfort at that point, but it seemed to get somewhat better. He was seen somewhere around the 11th of September with a normal white count (of blood) and from that point on he seemed to do fairly well until the last two days when he became ill with increasing pain, some vomiting, and general malaise (bodily discomfort). He was brought into the emergency room and was noted to have an ultrasound with fluid and a CT scan showed marked fluid in the abdomen, some of which was loculated (divided into compartments). There was not any specific inflammatory mass that could be picked out, however. I was asked to see the patient at this point. Past medical history: Medical in unremarkable. Surgical is none. Medication: He takes no medications


Physical Examination General: This is a very ill young man, lying very quietly with flushed cheeks , with his hips flexed and knees flexed. Vital signs: Normal Lung: Clear Heart: Regular rhythm Abdomen: Rigid and diffusely (not localized) tender, clearly a surgical abdomen.


Impression: Acute surgical abdomen, etiology (cause) unknown. Possibilities include: 1. Trauma with delayed injury to bowel, resulting in a questionable bowel viability (being alive; functioning, working, etc.) 2. Perforated (pierced with holes) appendicitis with generalized peritonitis. Disposition: The patient clearly has an acute surgical abdomen and needs urgent exploration. We started him on IV’s and he will receive some antibiotics and we will go to the operating room as soon as one is available.


Doctor’s surgical notes The patient was placed on the operating table, general anesthesia was induced, the operative site was prepped and draped sterilely and a midline incision extending two fingerbreadths above the umbilicus (belly button) down to the pubis symphysis (cartilage) was made and the abdomen was entered in the midline. All bleeding points were controlled with cauterization (heat). Upon entrance into the abdomen, there was a large amount of purulent (puss) fluid, which was cultured for aerobes and anaerobes (types of organisms). The majority of the reaction appeared to be in the pelvis. The loops (intestinal) were stuck together and multiple inter-loop abscesses. I began my surgery by removing the loops of small bowel stuck down to the pelvis, and then tracing back to the terminal ileum (the last portion of the small intestine which communicates with the large intestine). At the point there was an inflammatory (irritated) mass, which was stuck to the right abdominal wall, just at the lateral (side) pelvis area. I was able to bluntly break that down and then free up the cecum (a pouch at the end of the small intestine – the appendix extends off of the cecum) by dividing the lateral peritoneal attachment. After having done this it became apparent that we were dealing with a ruptured appendicitis of some time in happening, as manifested by the marked amount of inflammatory peel. The omentum (a free fold of the peritoneum) was stuck and it was impossible to get off the appendix, hence, I clamped, divided, and ligated (tied) that omentum which was stuck to the appendix. I took down whatever mesentery (membrane that connects intestines to the back wall of the abdomen) there was there, freed up the cecum so I could mobilize it, and once I had done that, I was able to get the TA-30 stapling device across the tip of the cecum and I stapled and then amputated (cut out) the appendix and tip of the cecum. I then checked the staple line and it was intact and in good shape. I then from the terminal ileum, traced the small bowel all the way back to the ligament of Treitz (a flat band of muscle attached to the right side of the diaphragm), debriding the fibrinous exudates (removing the blood clots), which covered many sections of the bowel. The intestine, other than being beefy red and inflamed, was otherwise uninvolved. The colon likewise was the same as the small intestine. There did not appear to be any reaction going on in the upper abdomen. We then copiously (profusely) irrigated (washed/flushed) with liters (quarts) of saline (salt water) and debrided off the fibrinous exudates as mention. I then aspirated (sucked out) all the free fluid and placed the bowel back within the abdominal cavity. We then closed the abdominal wall with a single layer of double stranded #1 PDS. I placed a few 3-0 Vicryl sutures (stitches) over the PDS knot, and then loosely approximated the skin edges with interrupted 3-0 Nurolon. I placed several (12) Nurolon stitches in, but did not tie them and will treat the wound with a wet-to-dry dressing change.


The patient was then transported to the recovery room in stable, but very serious condition.


 

Doctor’s Notes - final This young man presented to the emergency room extremely ill with probably a week to maybe even two weeks history of abdominal pain, which was difficult to sort out, but on exam he clearly had an acute (severe) surgical abdomen. He was explored, feeling that he most likely had ruptured appendicitis. Indeed, that is what he had with extensive peritoneal fibrinous exudates (blood clots), multiple inter-loop abscesses (localized collections of pus). I removed his appendix, and broke down all of the adhesions between the loops of small bowel and drained those abscesses and irrigated copiously (washed out thoroughly). The patients postoperative course was surprisingly not complicated. It took him several days to resolve his ileus (obstruction in intestine), which is not unusual, but he did not have a picture of real sepsis (presence of infectious organisms in the blood) after the first day or two. Once his bowels worked, he was started on liquids and advanced to a regular diet, which he is tolerating at discharge. I closed his wound secondarily, placing sutures at the time of the operation and then closing them when the wound looked good. At discharge the wound is healing without any evidence of suppuration (formation of pus). I will see him in my office in a week. We will make disposition at that point in time as to when he can return to school. The mother is to call if there are any problems between now and then.



Charges associated with Landon’s appendectomy Hospital Bill $26,493 Surgery – Dr. Alder $ 1,885 ER physician $ 336 Anesthesia $ 1,604 Dr. Challburg $ 113 Xrays $ 393 Totals $30,922 All we had to pay was the $1,500 co-pay. Thank goodness for good insurance!!