Today’s procedure itself did not go exactly as we had hoped. More details later but…
1. The lower stricture had closed down to 8 mm again. In other words, no progress the last two times. If this continues, they will abort the entire plan and move to resection. I think that this discussion will happen if there is no progress next week.
2. Biopsies taken last week from the lower stricture showed mostly fibromuscular thickening but also very small pieces of tracheobronchial remnants. We are hoping this will not stop the dilatations from being successful, but we don’t yet know, this is uncharted territory.
3. Dr Manfredi was more aggressive this time because of the lack of progress. This caused what he called a “controlled leak.” This is not ideal, but is better than a full blown perforation. It means that his esophagus and inner muscular layer are cut through and leaking, but it did not perforate the outer muscular layer or connective tissue, so it does not leak into his chest. However, Lucas is on antibiotics now and we will be watching for fevers and pneumonia etc. The antibiotics pretty much destroy any benefits of the FMT (ie. Stool transplant to cure the C. Diff infection). Lucas is not allowed to eat today. May be allowed to eat tomorrow depending on how he’s doing, and will have a swallow study on Wednesday to check the status of the controlled leak. He could get discharged after that if everything goes well.
4. Next surgery is the end of next week if everything goes well.
So let’s end this blog with some good news…
1. The upper stricture looked really good. Was very open and needed very little work. He did do some stuff on it, but it wasn’t critical. He dilated the upper to 17 mm.
2. He dilated the lower to 15 mm which is what caused the “out pouching” and controlled leak. The good news is that Dr Manfredi thinks this may have been NECESSARY to make the progress we want to make. It is what happened with all the other kids with this issue, and with Lucas he may have just been “too careful.” The controlled leak could/should force his lower stricture to heal more open.
3. I think the antibiotics could put us on the fast track for another FMT, which I think Lucas needs.
4. We did allergy testing bloodwork today – so those results will be interesting.