Juliet was in surgery for 4 1/2 hours last night. Shortly after 11:00pm, she returned to the NICU with her surgeon, Dr. Chahine. He explained when he opened her abdomen, it was filled with infection and bile. A portion of her intestine had several tiny tears and needed to be removed. He removed about 14 cm. of her small intestine (fairly close to her stomach). As a result, she has 2 stomas again. One that will go into an ostomy bag and one that he hopes to be able to feed her through. This way her entire remaining intestine can be fed and absorb nutrition, in hopes of preventing further liver damage. Her liver was enlarged and discolored, but still soft. Apparently, this means the damage is still reversible. However, the longer Juliet remains on her IV nutrition (TPN/lipids), the more damage her liver will sustain and the higher potential for permanent liver injury. If she can tolerate more feedings through the majority of her intestine, the TPN can be decreased.
Dr. Chahine's best possible explanation for all of this is that the intestine that was stuck in a hernia at her last surgery was the section that had perforated. They repaired the hernia the last time, but it had probably been damaged a little during the process. He suspects this happened fairly quickly after her last surgery (when she was the sickest) and Juliet has been managing the perforation and infection the last 6 weeks. He also suspects the infection was contributing to her chylothorax (excess fluid that is draining in her chest tubes) as it had spread up into her chest cavity as well.
The entire team is hopeful that this is what has been making Juliet sick over the past 6 weeks and now that it is repaired, she will start to improve. So, she has signed herself up for at least one more surgery to reconnect her intestines and take-down the ostomies. When this will happen will depend on her recovery from last night's procedure. Again, like her other surgeries, she is expected to get sicker over the next few days and then start to improve. Last night, she was relatively stable. Today's goals are to keep her comfortable and to closely watch her fluids. So, our little Juliet keeps on fighting. This child not only has the will to live, but the will to make an impact. She is one special baby.
Thanks to all who took care of her last night, through the surgery and beyond. We are eternally grateful. And I almost forgot, HAPPY 5 MONTH BIRTHDAY, JULIET!! XOXO