171 Ashley Ave.
Charleston, SC 29425
843-792-1414
800-424-MUSC
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Major Big Trouble
It’s easy to see why people gravitate to 5-year-old Savannah Williams. Not only is she Cover Girl adorable, she’s got spunk – a topsy turvy, beyond-her-years way of being that lights up a room.
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| Savannah Williams |
A year ago, Savannah got sick. Or, in Savannah’s words,“I was in major big trouble.” Fever, diarrhea, listlessness replaced her usual playful energy. The symptoms didn’t go away.
On her parents’ second trip to the emergency department, Savannah was admitted to MUSC Children’s Hospital. Her fever was causing convulsions. But the fever wasn’t the root cause of her problem. What she had is a condition known by pediatric specialists as “the great masquerader.” A generalized pain in the stomach, fever, no appetite and gastrointestinal distress. These are symptoms of many things.
Edward Tagge, M.D., a board certified, fellowship-trained pediatric surgeon, knows what to look for. All his training and expertise is about the care of sick children. What Savannah had cannot be identified through a blood test. It took a combination of things, the most important of which was experienced observation (position in bed, sensitivity to movement and something doctors call rebound tenderness) of a pediatric surgeon. Savannah had a ruptured appendicitis.
“When Dr. Tagge told us what it was,” says Nicole, her mother, “I immediately thought it would mean emergency surgery.” The traditional approach would be exactly that – a large incision to remove the perforated appendix and associated inflammation.
“While immediate surgery for ruptured appendicitis through large incisions is a common practice,” says Dr. Tagge, “the results can be less than ideal.” Dr. Tagge explained to the family that, frequently, immediate surgery can actually make the patient temporarily sicker and increase the risk of postoperative abscesses. The big incisions also can get infected or develop hernias. The most important thing to do was control the infection, which could be done through antibiotics dispensed directly into Savannah’s bloodstream.
“We get rid of the infection and then, a few months later, when the child is healthy, we remove the appendix,” says Dr. Tagge. “It’s far better to operate on a healthy child than a sick child, if one has the option.”
Nicole describes Savannah’s care at Children’s Hospital as “phenomenal. The staff and Dr. Tagge were great. It makes a huge difference that they choose to work exclusively with children. They know exactly how to care for them. Everyone was just great with Savannah.”
Nicole describes the measures the staff took to make Savannah feel comfortable about being in the hospital. To help prepare her for the IV, for example, a child life specialist introduced the idea to Savannah by demonstrating on a doll and then having Savannah do it as well. As she felt better, Savannah was able to visit the child life atrium, a huge colorful playroom on the seventh floor of the hospital. “It made her feel less sick and more like a regular kid,” says her mom.
Savannah was in the hospital for a week. The abscess that had formed around the appendix was drained, and the infection controlled. She was able to go home. Three months later, a healthy and happy Savannah returned to Children’s Hospital to have her appendix removed. “Before Savannah’s operation,” says Nicole, “Dr. Tagge did a cheer for her. It made us all laugh!”
Dr. Tagge used a minimally invasive approach. Rather than one long incision, he made three tiny incisions and used a laparoscope (a long camera that visualizes instruments as they enter the area that needs to be worked on). Carbon dioxide flows through a special instrument to inflate the belly so it can be navigated by the surgeon’s instruments.
“Taking this approach means less pain for the patient,” says Dr. Tagge. “Kids get over the operation easier. They have tiny scars.” Savannah was discharged home the day after surgery, and was playing the following day.
It’s been a little more than a year since Savannah’s operation. The three tiny incisions on her tummy are already so faint they can hardly be seen.
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