Hi:

My son had ulcerative colitis and after several years of steroids and
trying other medications we decided to proceed with a pull-through.
He's 11 years old. The first surgery was completed recently. The
surgeon decided to perform it laporoscopically with our consent on
the morning of the surgery (despite the fact that the GI had
indicated previously that laporoscopic would not be appropriate for
my son). Damage was done to the duodenum during the colectomy and
the surgeon made a larger incision to make repairs. My son was
discharged a couple of weeks ago. But he started getting high fevers
and vomiting. We visited the ER after about a week out of the
hospital and they decided it was a stomach virus. The fevers and
vomiting continued for another week and we returned to the ER a
couple of days ago. They decided that there was an infection and
following a CatScan identified an abcess near where the incision had
been made to repair the duodenum. Yesterday they proceeded to place
a drain in the abcess but missed on the first attempt and put a 1.5
mm puncture in the duodenum. (They did ultimately succeed in placing
the drain) Because of the recentness of the colectomy, they are
reluctant to perform additional surgery to repair the new puncture.
They have him on intravenous feeding and an NG tube for at least a
week in the "hope" that the duodenum will repair itself. If it does
not, he faces further surgery to effect the repair in about a month
when he is sufficiently recovered from the colectomy (I assume he
would stay on the NG tube and intravenous feeding until that time).
He is also on intravenous antibiotics to address the infection. He
is also on the equivalent of 6.25 mg prednisone and we have stopped
the weaning until the damage to the duodenum is healed.

My questions are -

Are these complications common? This feels like we are slipping out
of control with each procedure causing more damage than previously
existed.

Is there anything else that anyone knows of that we should be doing
to try to resolve this issue?

Would it be crazy to change the hospital and surgeon to perform the
2nd and 3rd phases of the pull-through? We would of course wait
until my son was stable before changing. My fear is that we have had
this hospital perform surgical procedures on my son twice and on both
occasions they damaged the duodenum. I understand that the 2nd phase
of the procedure can be more sensitive than the first with a
potential for causing more significant damage (e.g., to the
reporductive system). On the other hand, the first surgeon has first
hand knowledge of what was done previously and so may be the best
person to "go in" again. If we were to change - any recommendations
on how to find an appropriate surgeon? We are in the Boston area -
though of course travel to get this done "right" would be acceptable.

Any advice would be helpful.

Al