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Patient’s freak pancreas injury spurs rapid response

Posted by on Wednesday, February 28, 2018 in Around the Medical Center, Winter 2018 .

Patient Macie Glover poses with Dai Chung, MD, during a recent follow-up appointment. Photo by Susan Urmy.

Macie Glover sprinted across the gym floor at school, tripped and crashed into a wall. In a bizarre sequence of events, she hit her head and arm and scraped her knees as the force of the crash propelled her whole body arching backward into a crescent shape.

“I hit the ground. I couldn’t breathe. Whenever people asked what was hurting me, I said it was my stomach and my elbow. Everyone was worried about my head. My head never hurt, even to this day,” said Macie, a 13-year-old freshman at Lawrence County High School.

CT scans of her head at a local hospital were clear. After persistent pain in her abdomen in the hours that followed, doctors performed another CT, this time of her stomach. The images revealed her pancreas had split in half. Macie was a ticking time bomb. What the Glover family thought would be an ambulance trip to Monroe Carell Jr. Children’s Hospital at Vanderbilt quickly turned into a helicopter ride.

Vanderbilt LifeFlight arrived on that March 2017 morning to take her from Lawrenceburg to Children’s Hospital, where the pediatric trauma team was awaiting her arrival. Her mother, Annette Glover, tearfully recalls the fear she felt as LifeFlight took off.

“When that helicopter lifted and they took off with her, that was the worst feeling of my life,” Annette said. “From a past experience, we knew they would do everything they could for her.”

In cases likes Macie’s, the Children’s Hospital Pediatric Trauma team is ready and waiting in the Emergency Department to treat pediatric trauma patients who have suffered a wide range of injuries resulting from various mechanisms. Injuries run the gamut, including all-terrain vehicle accidents, motor vehicle crashes, falls, gunshot wounds and bicycle wrecks, among others.

As a regional comprehensive pediatric facility, Children’s Hospital is the only Level I Pediatric Trauma Center within 150 miles, providing specialty services for children from Alabama to Kentucky and across Tennessee.

Dai Chung, MD, director of Pediatric Trauma and chair of the Department of Pediatric Surgery, said the symptoms Macie experienced — severe abdominal pain and the inability to stand up straight — were classic signs of peritonitis (inflammation of tissue lining the abdomen) and a severe intra-abdominal injury.

“The clock was ticking. Her pancreas was completely torn in half,” said Chung, the Janie Robinson and John Moore Lee Professor of Pediatrics. “It was getting close to 24 hours (post injury), a time when things can get unsettling, with a lot of edema and inflammation, and her internal organs start reacting. By 24 hours post injury, operating on the pancreas becomes tricky, and thereafter, it becomes more difficult by the hour, to a point where you run out of operative options.”

As inflammation begins to set in and reactive enzymes release with the injury, blood pressure and other vitals become unstable and deteriorate.

The Trauma team had to quickly assess, stabilize and rule out that Macie didn’t have any other unknown injuries before entering emergency surgery to remove part of her pancreas. Prior to surgery, the team also casted Macie’s arm, which was fractured and had been splinted in Lawrenceburg.

“Knowing she had plenty of pancreas left, we made the decision to resect the distal part of the pancreas while avoiding any injury to the spleen. It requires very carefully teasing off of the blood vessels and tying them off,” said Chung.

Four hours later, Chung met Annette and Keith Glover, pulling up a screen on his computer to detail Macie’s injury and the surgery.

“We knew Macie was in bad shape when she went in, but the extent of her injury was unbelievable,” Annette Glover said. “He talked us through all of it. He answered any questions we had. He was just awesome.”

Macie was able to go home about a week after her surgery. While she has had to mend and deal with drainage issues with the pancreas, she has been able to start back with sports, and even made the high school basketball and softball teams.

“It’s been a long journey, but we’ve had a good leader through this journey,” Keith Glover said, referring to Chung.

Annette agreed. “We can never ever repay what he has done for her. He was so caring to her from the very beginning. Every time he has come in the room, he has been so good to her. He has treated her like his own.”