Surgeons team up to treat boy with rare traumatic injury

Patient Stories |

01/06/2020

Guthrie Web

A car crash left Connor Guthrie with a ruptured stomach and esophagus, an “exceedingly rare” and complex injury, but a year later, the teen is healed and playing basketball again.

By Maureen Gilmer, IU Health senior journalist, mgilmer1@iuhealth.org

Connor Guthrie doesn’t remember much about the accident. He saw the remnants of the vanilla shake that had been tossed around the car and thought for a moment he had vomited.

What he does remember is the pain – searing, excruciating pain that left him terrified of being touched, much less moved from the mangled car.

It was one year ago this past Sunday that Connor, now 13, his older brother and his mom were involved in a crash in Bloomington that left Connor with traumatic injuries to his abdomen, stomach and esophagus.

The injuries were so severe they required the combined skills of surgeons at Riley Hospital for Children and IU Health University Hospital to repair.

When the trauma team at IU Health Bloomington Hospital – where the boys were transported after the accident – got a look at Connor, they put in a call to Riley’s trauma department. Dr. Matthew Landman, associate trauma medical director, answered the call.

The injury was something they’d never seen outside of a textbook, they told the surgeon. The boy’s esophagus has ruptured where it connects to the stomach, tearing a hole and spilling the contents of the stomach into his abdomen, where infection would soon set in.

“I admit when they told me the injury they thought Connor had, I honestly didn’t believe it because it’s just something you never hear about it,” Dr. Landman said.

“EXCEEDINGLY RARE”

Connor was LifeLined to Riley, while his brother was treated for less serious injuries in Bloomington. Their mother, Amber Hattabaugh, refused treatment until she arrived at Riley to see Connor, then was checked out in the emergency department at Eskenazi Health.

“We were all at different hospitals overnight,” Hattabaugh said. “I didn’t sleep at all.”

Meanwhile, Dr. Landman and his team reviewed the CT scans while Connor was en route to Riley and determined their colleagues in Bloomington were likely right.

“When Connor got here, he was awake but was in a lot of pain, and it was very clear immediately that he would need an operation to correct this,” Dr. Landman said.

“We took him to the operating room urgently and found a very unusual perforation of his stomach as the esophagus comes from the chest into the abdomen. It’s exceedingly rare.”

So rare, in fact, that Dr. Landman had never seen it in an actual patient.

“It’s one of those things you read about, you learn how to take care of it, then you never see it. And here it was on our doorstep.”

Connor was in bad shape, Dr. Landman recalls.

“He had a tear right where the esophagus attaches to the stomach. He had recently had a meal, and all that stuff blew out everywhere,” he said. “The way I chose to correct it (initially) was to staple off the esophagus to prevent more contamination in the abdomen.”

He underwent multiple surgeries after the accident, beginning that first day, Jan. 5, 2019, and didn’t fully wake up until Jan. 24. His first stay at Riley lasted 45 days. He was then cared for at home until it was time for reconstruction surgery under the skillful hands of Dr. Landman and University Hospital’s Dr. Ken Kesler, “the absolute best of thoracic surgeons,” Dr. Landman said.

The duo performed a complex reconstruction rarely used on a child that involved turning the stomach into a tube and bringing it up to connect it to the repaired esophagus.

“ONE OF THE MORE COMPLEX INJURIES”

“In terms of a traumatically injured child, it was definitely one of the more complex injuries that I’ve ever seen,” Dr. Landman said. “Complex in how it first presented and how we had to think about it immediately after the injury and then how we had to proceed with a reconstruction.”

He gives credit to the entire Riley team for not only saving Connor’s life but restoring his quality of life.

“The nice thing about having this group and having colleagues that do pretty complex esophageal work, I picked the brain of every one of my partners, and Dr. Kesler was key, particularly to the reconstruction. Here we have at IU a guy who has written the technique paper on how to do this type of reconstruction … he brought with him his paper that he published. It was incredible. He’s a great surgeon.”

What was also incredible was seeing Connor move from “near death’s door” when he came into the hospital to being stabilized within a matter of hours and days, Dr. Landman said. Not that his medical journey was over, by any means.

“It was a very long process,” Dr. Landman said. “This isn’t the type of injury that you open the textbook to Page 15 and do A, B and C. We had to be a little creative surgically to address his injury.”

LEARNING HOW TO EAT AGAIN

Fast forward one year and Connor looks good. After enduring months of surgeries and hospitalizations, the quiet seventh-grader had to learn how to eat again – smaller portions now because his stomach can’t handle large amounts of food.

That’s a hard adjustment for a teen boy who still loves to eat – tacos are a favorite. He works with Riley gastrointestinal Dr. Girish Rao on adjusting to a new type of diet and avoiding unpleasant side effects like “dumping syndrome,” caused by eating too much too fast.

It’s something he’ll have to get used to, Dr. Landman said, explaining that the reconstruction surgery he and Dr. Kesler performed on the boy left him with a tube that leads from the esophagus to the intestinal tract, bypassing what used to be his stomach where food could be processed before it moved into the intestines.

Though the tube will grow with Connor, he will always have to be careful how much he eats at one time.

At 5-foot-3 and barely 90 pounds, Connor is thin but healthy. He tried out for the basketball team at school but was cut after the second round, mostly he believes, because his stamina is not what it needs to be yet.

His mom is proud nonetheless.

“For him to even be able to try out was a big deal,” she said. “For him to push himself like he did … they didn’t know what he had been through.”

When his mom describes the accident and the surgeries and the tubes that came in and out of him for months, Connor sits quietly.

Asked if it’s hard for him to listen to, Connor shakes his head. “I’m used to it now.”

“AN INCREDIBLE HONOR”

Connor was dangerously ill, Dr. Landman said, but he tips his hat to the Riley team.

“One of the nice things about practicing here at Riley is we have all these incredible specialists here at a moment’s notice. I certainly did not do all of this myself. It was a huge team of people – ICU, OR, anesthesia, rehab – everyone played a huge role in this. He was cared for by a lot of folks.”

Hattabaugh is grateful for that care but struggles with guilt that her son had to endure such a horrendous injury and rehabilitation.

“That was the hardest thing to go through,” she said. “That should have been me, not him. He shouldn’t have had to go through that.”

Sitting in the lobby of Simon Family Tower recently, Connor said he was a little nervous coming back to Riley, “but it’s a good place.”

While he might not have made the basketball team this year, he plans to try again. It’s his favorite sport, and Golden State Warriors point guard Stephen Curry is his favorite player. Giving up on life or basketball is not an option.

Dr. Landman said seeing Connor today offers no hint of what he has been through.

“I got to see him go from super sick, banged up and bruised to being a normal kid again. Seeing someone come from near death to living a productive life again, that’s an incredible honor to be a part of.”

Photos provided and by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org