Liliana finished her surgery around 4. She’s fast asleep and still has an epidural connected, so it’s keeping her comfortable. We saw the incision in the recovery room; it’s straight down her stomach next to her belly button and she has the g-tube right above the belly button.

Our surgeon said that the surgery causes the bowels to seize up, so she won’t be able to do any feeding for a couple of days. He also said that the removal of the appendix was a routine procedure due to the fixing of the stomach malrotation. If the stomach malrotation was fixed without removing the appendix, the appendix would move from Liliana’s right side to her left and would cause confusion if she ever got appendicitis.

So…this cyst that they found is apparently something she was born with and should have been detected via ultrasound (either prenatally or when she’s had abdominal ultrasounds herself). The cyst is also rare; it occurs 1 in 100,000-150,000 births, while CDH occurs about 1 in 200,000. This condition is also more prevalent in females, and is also more common amongst Asians (and more commonly in Japanese).

So the gist of the cyst is this. Normally, there is a bile duct that comes out of the liver (that the gallbladder also is attached to) that leads to the duodenum (small intestine). There is a duct coming from the pancreas that also leads to the duodenum, and this duct sort of makes a fork with the bile duct so that they both empty into the duodenum separately at the same location. Liliana’s pancreatic duct doesn’t make a fork with the bile duct, but rather makes an intersection. One of the enzymes the pancreas produces goes up into the bile duct (when it shouldn’t) and causes it to get bigger.

Liliana hasn’t displayed the common symptoms of this anomaly, which Children’s Hospital Boston lists are:

  • Right upper quadrant pain
  • Jaundice
  • Abdominal mass
  • Nausea
  • Fever
  • Pancreatitis

However, stones can be created by this (I’m not sure if it’s caused her gallstones, because those were inside her gallbladder) and jaundice is associated with increased bilirubin in the blood. Liliana’s bilirubin was high when she was born.

Since leaving the cyst alone could cause complications in the future (e.g. pancreatitis, inflammation, and even cancer) and our surgeon is well versed in the repair of this cyst, Liliana had the cyst removed. This involved taking out the bile duct entirely and attaching a part of the small intestine to the liver so that the bile can still go through the small intestine.

Alright, it’s time for me to rest. I’ve only had 2-3 hours of sleep and I should prepare myself for whatever tomorrow brings!