Abington Pediatric Surgeon Solves
The school year had just begun, and Andrew Stenger, of Philadelphia, was attending a full day of classes, but he couldn’t seem to make after school soccer practice at Norwood Fontbonne Academy. His mother, Deb, explains, “He loves soccer, but started having stomachaches off and on.
“It wasn’t as if he came home and went to bed,” Deb adds. “He would end up going out to play with his younger twin brothers in the yard. We even started to wonder if it was psychosomatic—he was missing too many weekday practices.”
Finally the coach asked for a doctor’s note before Andrew could return to soccer. “We learned that when he did attend soccer practice, he would sit the bench with a stomachache. He never really complained,” Deb says.
“By about 2 o’clock I would have to just bend over because my stomach hurt,” Andrew, 14, remembers. “I couldn’t play by the time school ended.”
His parents took him to see his pediatrician, who examined him. Andrew didn’t exhibit signs of appendicitis, but seemed a little pale. The Stengers were told to watch him for the H1N1 virus, which was going around.
Then Andrew began to vomit. Over one weekend, he became sicker and sicker. It seemed to be a raging case of the flu. By Sunday night, Andrew was sitting up in a chair, very quietly. He didn’t volunteer, but when asked, admitted it hurt to lie down. His mother was startled to discover his abdomen had swollen significantly under his baggy shirt.
On Monday he was back at the pediatrician’s office. The doctor directed Deb and Tom Stenger to take Andrew to Abington’s Emergency Trauma Center right away.
“Abington is our hospital, and emergency specialist Dr. Drew Ball is one of Andrew’s soccer coaches,” Deb adds. “Dr. Ball knows our son’s personality, and he wasn’t seeing the Andrew that he knew.”
Dr. Ball and the Emergency Department physicians called in pediatric surgeon Ala Stanford Frey, M.D. to consult after Andrew’s lab results proved extremely abnormal. Dr. Frey is Director of Pediatric Surgical Services at Abington, and one of approximately 1,000 practicing pediatric surgeons in the country. She also has privileges at St. Christopher’s Hospital for Children.
Dr. Frey remembers, “Andrew was very sick when he arrived at Abington. His blood pressure was low, and his respirations and heart rate were far too high. He was slow to respond to simple commands. He was showing signs of sepsis (bacteria in his bloodstream, spreading through his body).
“He didn’t even flinch when we had to insert a nasogastric tube to decompress his stomach and intestines nor a catheter for urine,” the pediatric surgeon continues. “Initially I didn’t want to operate because of his poor lab values and dehydration. He needed to be resuscitated.”
Once Andrew’s blood work inched closer to normal, and fluids were being introduced through an IV, Dr. Frey took the teen to the operating suite. “When you see a young person with these symptoms, one of the most common causes is a ruptured appendix,” Dr. Frey notes.
She began less invasively, making a small incision near Andrew’s navel and inserting a 5 millimeter laparoscopic camera. Magnified images showed a healthy appendix.
What Dr. Frey discovered was far more disturbing.
Andrew’s abdominal cavity was filled with infection—pus and digestive waste that had leaked in from the intestine. Andrew had a Meckel’s diverticulum, a congenital abnormality that often causes no problems.
“Only 2% of the population has Meckel’s diverticulum,” Dr. Frey explains, “but this young man’s condition was rarer still.” The diverticulum, a pouch that protrudes from the intestine, had perforated, allowing waste to filter into the abdomen. His bowel was blocked, and an abscess had formed.
Worse yet, Andrew was going into renal failure.
“We were in a panic,” Deb remembers. “But everyone was so nice, explaining just what was happening and what Dr. Frey needed to do. We trusted the doctors at Abington with our son’s life.”
Dr. Frey and team suctioned the waste and infection from Andrew’s abdomen, cleansing it with a sterile wash. They quickly set about resectioning the boy’s intestine, removing the diseased part and sewing the healthy ends together.
His post-surgical condition was so serious that Dr. Frey wanted him placed in the adult intensive care unit. Because of the initial leakage, he continued to have an abscess form in his abdomen. Andrew needed a central venous catheter inserted for continuous nutrition and another drain from his abdomen to expel the infection.
Deb says, “The doctors and nurses were fantastic, helping to keep Andrew motivated during all these procedures. Everyone was trying to help him get better. They also realized that we were tag-teaming as parents, with one of us always at the hospital and the other home with our twins. Even the valet parking staff got to know us and had encouraging words.”
Two weeks and minus twenty pounds later, Andrew Stenger walked out of Abington Memorial Hospital. While the teen had to forego beloved sports like soccer, skiing, biking, and lacrosse for six weeks, he went on to prepare for eighth grade graduation.
No longer a man of mystery, Andrew is looking forward to summer league soccer. Deb says happily, “We are thrilled to have our son back.”