Surgical fix sought for Pitre’s complications
Jonathan Pitre will undergo gallbladder surgery Wednesday in an effort to relieve his persistent fevers and debilitating nausea.
Pitre, 17, will have his gallbladder removed at the University of Minnesota Masonic Children’s Hospital, where he had a stem cell transplant last April to halt the advance of his blistering skin disease, epidermolysis bullosa (EB).
Pitre’s surgery is also complicated by his EB.
Doctors are hoping they’ll be able to use keyhole incisions and laparoscopic tools to remove Pitre’s gallbladder, a small, pouchlike organ that stores bile produced by the nearby liver. But the non-invasive approach may not be possible since Pitre’s liver is swollen and might make it difficult for surgeons to access the gallbladder.
Open surgery is also a possibility, but it heightens concerns about infection and bleeding. He’ll be transfused with platelets before and after surgery to promote blood clotting and wound healing.
Pitre will also have to be intubated during the surgery, which is again an issue for someone with recessive dystrophic EB since his throat and mouth are prone to blistering.
The Russell teenager has endured a complicated and painful series of medical issues in the aftermath of his stem cell transplant, which was preceded by intense chemotherapy and radiation. Gallbladder problems are a common complication of high-dose chemotherapy.
“Let’s just say, lately, it’s not been very good,” Pitre said last week.
Doctors have been aware for months that Pitre’s gallbladder was not functioning well but were hoping to manage the condition without surgery. In recent weeks, however, Pitre has been in and out of hospital with headaches, fever and nausea. Whenever he stopped using antibiotics, he would get another infection.
Pitre’s skin has improved significantly since the transplant, but the medical complications have prevented him from returning home to Russell.
During April’s transplant — his second — Pitre received stem cells donated by his mother. The stem cells successfully took root in Pitre’s bone marrow and began making new blood cells.
Pitre’s transplant is an experimental treatment. It’s based on the theory that a stem cell transplant can offer EB patients a “systemic” approach to skin healing by manufacturing the key protein that their bodies lack — a protein essential to the development of collagen. Collagen holds the body’s outer layer of skin together with its inner layers.
Pediatric transplant specialist Dr. Jakub Tolar pioneered the treatment at the University of Minnesota Masonic Children’s Hospital, which is the only health centre in the world that offers it.