Mile 92

For the parents of Xinovia Lewis, residents of Jasper, Florida, about an hour outside of Gainesville, finding a specialist to treat the sudden gastroenterological problems their two-yearold was experiencing, would not be easy. When her persistent  stomach aches progressed to vomiting, and she would no longer eat, she was taken to a local hospital. An MRI revealed an anatomical problem that the ultrasound hadn’t shown. Bile was backing up into her stomach, and meanwhile her right lung had collapsed. They needed to find a hospital to do an ERCP, a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the pancreatic ductal systems.

This would require a very specialized pediatric gastroenterologist, and there wasn’t one in Orlando, or Jacksonville who could handle this case. With only 15 specialists in the whole country with advanced endoscopy training, one of them happened to be at Manning Family Children’s – Dr. Russel Zwiener – and he had treated very small children before. Xinovia was immediately airlifted and arrived in a life-threatening situation. Her bile duct had perforated from the pressure and backflow. The perforation was inside the liver, and bile was leaking outside into her body. It could have been days to a week before acute sepsis, and she would have died. Acting immediately, interventional radiologist Dr. Richard Marshall inserted a needle into her belly to drain the fluid that was causing the infection. Then, Dr. David Yu surgically drained all the fluid to have room to do the ERCP procedure. With the problematic area lit up from below, doctors saw a lot of inflammation in her bile and pancreatic ducts. She was born, it seemed, with a congenital malformation of her pancreatic duct, called APBJ. By inserting stents, doctors were able to redirect the bile and bypass the problem. Later, the stents were removed, and there was no more leaking as the problematic area had been closed off. To prevent the future possibility of problems, her gallbladder was removed.

Xinovia, now three years old, is back home with her older and younger sisters, and is doing well! She continues to follow up with the Children’s team for appointments and has nothing but good results!