Edward Corsello Jr., 1, inches around the couch, trying out steps, and then he’s on the floor playing with his sister Maria, 2. He laughs often, an eye-crinkling, full laugh. His favorite thing to do, according to his mother, Luciana, is to point at what he wants or loves and say, “That!” A banana, a Peppa Pig toy, his big yard outside. “That! That! That!”
But one Thursday morning in mid-March when Eddie woke up, there was no laughing, no pointing, no “That!” He didn’t climb up into his mother’s lap or burrow his light brown curls into her shoulder. “He’s a cuddler and he didn’t want to be held,” she said. “He didn’t want to nurse. I could tell he was in pain.” Luciana called their pediatrician, who told her a bad stomach flu was going around and to call if Eddie got worse. By late afternoon, he was vomiting and his eyes weren’t focusing. The doctor told her to take him to the emergency room. They left their Trumbull home for Bridgeport Hospital because of its affiliation to Yale.
At first. Luciana said, the emergency room doctors thought Eddie had a really bad flu or was constipated but when they saw his stool was a color that could signal a bowel obstruction, they sent him by ambulance to Yale-New Haven Children’s Hospital. Early Friday morning, a team in the Pediatric Intensive Care Unit assessed him, gave him IV fluids, and took X-rays and an ultrasound. When those tests weren’t definitive and he still wasn’t responding well, they called in Michael Caty M.D., chief of pediatric surgery for Yale Medical Group and surgeon-in-chief at Yale-New Haven Children’s Hospital, who began his own kind of detective work.
“For a child this age, how he feels is interpreted through his parents. Does he play? Does he interact?” Dr. Caty asked Luciana and her husband, Edward, Sr. “It’s mother knows best, fathers too. Moms don’t tell you medical things, they tell you the most important things, like he’s not interested in his bottle now.”
Watching and waiting
Dr. Caty said he and the pediatric team would wait and watch Eddie closely. The pediatricians tried different treatments to determine whether Eddie had gastroenteritis or another condition that would not require surgery. Dr. Caty still came in each day that weekend to check on Eddie. His calming and continued presence, and the way he answered all of their questions, eased the family’s worries, Luciana said.
Edward Sr. went back and forth between home and the hospital. Luciana’s mother came in from New York; extended family did too, to help with Eddie’s two sisters back home and to see Eddie—who seemed nothing like his wide-eyed, cheery self. None of the three Corsello children had ever been this sick. “I was so scared,” said Luciana, who never left the hospital. “But the nurses and the volunteers were wonderful, so attentive to him.” They gave him warm baths to soothe him, brought in books and even a therapy dog that stood by the door warmly wagging his tail, making Eddie smile.
By early Monday morning, Eddie’s condition had worsened. Dr. Caty talked with the Corsellos and ordered a CT scan, to be read by a pediatric radiologist who helped with the diagnosis. They could see his intestine was malformed, but they would have to operate to determine whether there was a blockage and to fix it. “We got him right up to the OR where a pediatric anesthesiologist managed him in the operating room,” Dr. Caty said.
“It was the longest hour of our lives,” Luciana said.
Dr. Caty discovered Eddie did, indeed, have a very rare congenital malformation of the intestine, which affects about 2 percent of all children, and a blockage, which affects an even smaller number of children. He made a small incision at Eddie’s belly button and removed a small part of the small intestine, which had been compressed by the blockage. He then connected the intestine and removed the scar tissue that caused the blockage.
Choosing the best surgery
Yale’s pediatric surgeons opt for minimally invasive surgery whenever possible. “So many of our parents have dual incomes or dual careers to support their families so by getting their children home and functioning faster not only do children recover faster and reduce their hospital stays, but parents can get back to work faster,” Dr. Caty said.
Yale’s pediatric surgeons perform an array of minimally invasive surgeries including;
- Minimally invasive chest surgery for a lung malformation. Surgeons remove a lobe of the lung through three tiny incisions and the child can go home in one to two days.
- Minimally invasive repair of pectus excavatum, a chest deformity in children where the chest appears caved-in, which is repaired by placing a small concave steel bar in the chest.
- Laparoscopic surgery on patients with Hirschsprung’s disease which affects the colon and causes problems with passing stool. “It used to involve three operations and a 30-day stay in the hospital,” Dr. Caty said. “Now we do one operation and they stay in the hospital for a day or two.”
Dr. Caty is quick to point out that minimally invasive surgery doesn’t just mean laparoscopic surgery, a technique that is less invasive than open abdominal surgery in that the surgeon inserts a fiber-optic instrument through the abdominal wall and views the organs on a monitor. “We do a lot of operations through the belly button, which is largely where we did Edward’s, to minimize scarring and help the recovery,” he said. “Surgeons need to know the difference and not spending the time trying an approach that doesn’t yield success just for sake of doing it.”
Two days after surgery, Luciana was brushing her teeth in Eddie’s room when he woke from a nap. “He stood right up and he was smiling,” she said. “That’s when I knew he was back to himself again.” Dr. Caty said she had been right to trust her instincts. Eddie had just two postoperative doctor visits and will require no other care related to the surgery.
“When I think of what could have happened if I had waited, if we hadn’t made it to Yale, he could have died, but he’s here now with us because of Dr. Caty,” she said. ‘I’m so grateful.”
At home, Luciana shares the picture she took of Eddie when he stood right up so soon after surgery. Maria asks to see it. “That’s when Eddie got better,” Luciana said. “All better,” Maria said. She kisses her little brother on the forehead and dashes off to play and Eddie crawls off fast after her.
To learn more about Yale Pediatric Surgery, call 203-785-2701 or visit https://medicine.yale.edu/surgery/pediatric.