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Lisa and DJ Pier, of Erie, PA, are the kind of people who take adversity in stride and know how to keep their priorities straight—and their four-year-old son, Bradley, seems to have inherited their strong character. The family's ability to find joy despite serious challenges is a foundation that serves them well.
Bradley had been living with chronic idiopathic constipation for over two years, which wasn't easy. "He was on Miralax for so long," Lisa remembers. "It just wasn't working." Bradley had his first surgery, a colostomy, in April 2013. (A colostomy is a surgical procedure that brings one end of the large intestine out through an opening, called a stoma, made in the abdominal wall. Stools moving through the intestine drain through the stoma into a bag attached to the abdomen.) Unfortunately, the efficacy of this intervention didn't last; by July, Bradley was having trouble passing stool through the stoma. His parents worked together with his doctors to flush his colon every day, but because Bradley was growing so quickly, he became impacted quite frequently. The Piers decided to visit UPMC Children's Hospital of Pittsburgh, home of the Colorectal Center for Children.
Chronic idiopathic constipation often responds to bowel management, so the team at the Colorectal Center decided to try that approach first. The Center's Bowel Management Program has a long history of excellent outcomes, but it was not the right answer for Bradley. He remained unable to pass stool through the stoma.
Dr. Luis De la Torre knew that something was amiss and took a closer look. In January 2014, he discovered that the opening had narrowed—the stoma was no longer large enough to allow the passage of stool. He and Bradley's parents decided to close the stoma and try a relatively new procedure: a cecostomy.
Cecostomy is the surgical clearance of the bowel. It is different from a traditional enema in that it occurs through a catheter connected directly to the cecum, or first part of the large intestine. (An enema is given through the rectum.) A cecostomy is sometimes called an antegrade enema, because it proceeds towards the front, in the normal direction of movement. The enema, therefore, is administered through the cecostomy tube to bring about elimination through the rectum.
Clearance of the bowel through a cecostomy tube requires time and effort, but the Piers were up to it. "DJ and I worked as a team to handle everything that needed to happen," Lisa says cheerfully. Even so, the cecostomy also seemed to be ineffective. Dr. De la Torre realized that Bradley's rectum was incapable of releasing stool even with the cecostomy.
In May 2014, the Piers and Dr. De la Torre decided to try an ileostomy—the creation of an opening at the end of the ileum, in the small intestine. Dr. De la Torre brought Bradley's intestine through the abdominal wall to end in a stoma, and Bradley is able to pass waste through this stoma into a pouch. The procedure is reversible, but the Piers are in no hurry to rush things.
Since the ileostomy, Bradley has thrived. He has gained weight, and he is as happy and high-spirited as any other kid his age. "This condition doesn't slow Bradley down one bit," says Lisa. "He was up the day after the surgery, playing Wii. He's still the same kid we brought home from the hospital—we just have to handle this one physical need, and we do that as a team." The Piers worried a bit about how Bradley's friends would react, but they did hope that the other parents would set a good example and model appropriate behavior for their children.
They needn't have worried—Bradley and his buddies recently visited the pumpkin patch, and they continue to treat him like any other kid. Someday, Bradley may have his ileostomy reversed, but not yet. "There's no sign of stopping him," says Lisa. "We're in no hurry; we are happy now."
For more information, contact the Colorectal Center for Children at UPMC Children’s Hospital of Pittsburgh.
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