A Really Good Day

“Can I get sick again so I can go see Dr. Lanning?” 6-year-old Alex Snead asked his mom this spring.

Although Alex’s mom, Sylvia Pegram, said David A. Lanning, MD, PhD, Professor of Surgery and Pediatrics and Co-Surgeon-in-Chief, Children’s Hospital of Richmond at VCU (CHoR), “left a lifelong impression and will always be near and dear to us,” she would prefer a friendly get-together instead of the esophageal duplication cyst that caused Alex intense stomach pain and had to be surgically removed in April.

Tummy Troubles

Alex’s stomach issues began as a toddler when doctors believed his random stomach aches and vomiting were related to reflux or eating certain foods. In February, when Alex developed a fever and began screaming about stomach pain, Sylvia, an emergency room nurse, said she “knew something wasn’t right.” She rushed Alex to the hospital where she works, and he had a CT scan to rule out appendicitis.

Alex’s appendix was fine, but the scan found masses on his esophagus and liver. His pediatrician referred him to one of two pediatric surgeons, only one of whom practiced at CHoR.

“There was no question where we were going to take him,” Sylvia recalled of her decision to drive to CHoR from her Bon Air home. “Dealing with something that could be a big thing, I knew we were going to Children’s Hospital.”

Dr. Lanning diagnosed the kindergartener with an esophageal duplication cyst, a rare inherited lesion that develops in utero and has no known cause. He also referred Alex to CHoR’s gastroenterology and nutrition specialists to rule out underlying gastrointestinal (GI) problems. An endoscopy determined Alex’s symptoms were not related to GI issues.

“Esophageal duplication cysts are quite rare,” said Dr. Lanning, who has cared for a couple of patients with these cysts in 14 years. “They can cause difficulty swallowing and reflux symptoms, but the biggest concern is if [they get] infected, which can then be a significant problem [because they become] very difficult to remove.”

Surgical Intervention

Because Alex had been sedated during his endoscopy, Sylvia said he knew what to expect and was less anxious for his surgery. Although Dr. Lanning explained all possible scenarios for how Alex’s surgery could go, Sylvia said, “my nerves were a huge ball in my chest.”

Dr. Lanning told Sylvia and her husband, Levion, he hoped to perform a 90-minute minimally-invasive procedure to remove the cyst, which was growing close to Alex’s heart. Five minutes before the 90-minute mark, Sylvia said the recovery room doors opened, and Alex was wheeled past his parents.

“He had no chest tubes, only an oxygen mask,” Sylvia recalled. “Looking at the time and looking at Alex, all the worry I had was gone.”

In addition to taking less time to perform, the minimally-invasive procedure reduces pain, scarring and the length of the hospital stay. Alex had three small incisions in his chest and spent one night at CHoR.

“Everybody who had their hands on Alex that day was amazing,” said Sylvia of CHoR’s nurses, operating room staff, anesthesiologists and physicians. “It was the scariest day of my life but a really good day thanks to the staff.”

Homeward Bound

Alex recovered at home for a week before returning to school. Although he wasn’t able to start the soccer season with his team, his big brown eyes lit up as he flashed a toothless grin and talked about “learning a lot” at school including “clocks, patterns, colors, letters and counting coins.”

“The resilience of kids makes it hard to rest when you feel good,” said Levion of Alex’s desire to play with his three siblings after surgery. “He bounced back very quickly.”

When Dr. Lanning cleared Alex to return to the soccer field a week after surgery, Sylvia said he was so excited he jumped in the doctor’s lap. While the cyst on Alex’s esophagus shouldn’t grow back, Sylvia said doctors will continue to watch the spot on his liver.

“Alex has an excellent prognosis, and his symptoms have resolved completely,” said Dr. Lanning, who has seen CHoR’s pediatric surgery program expand thanks to $4.38 million in support from Children’s Hospital Foundation since 2010. “All in all, it was a great outcome for a very sweet kid and very nice family.”

Sylvia and Levion are thrilled for their son who loves sweet tea, coffee ice cream and spending time with family.

“There are no better hands than those at Children’s Hospital,” Sylvia said. “For my children, it’s the only option.”