USF surgeon Dr. Charles Paidas reconstructed Kaitlin Smith’s intestines, fixing a problem that had haunted the teen her entire life
Kaitlin Smith earned great grades and awards in middle school and was at the top of her class – all signs of a smart and driven teen.
Kaitlin Smith, 16
But friends and family of this 16-year-old didn’t realize she managed this success while feeling constantly nauseous, frequently throwing up and, in essence, starving because of an unknown blockage in her intestines.
Stronger clues began to appear as she entered high school – fatigue that bordered on exhaustion and her already-thin body began to look emaciated. With Kaitlin’s struggle intensifying, her family took action.
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Nearly 16 years ago Kaitlin was born with a blockage in the first portion of her intestine just beyond her stomach. For her first 10 days after being born, she constantly vomited. Using an endoscope, doctors discovered that liquid would not go beyond her stomach – it stayed in her stomach until newborn Kaitlin threw it up. Two emergency surgeries were required to open the blockage (called an atresia), allowing her to keep food down.
Since that neonatal series of operations, Kaitlin’s family watched her grow, thinking that her digestive problems were gone. Across her childhood, Kaitlin thought the same. Sure she still felt nauseous and was always tired. But she didn’t realize that was abnormal – she thought everyone felt that way, too. And she never complained, so her family didn’t realize just how much she was struggling. Turns out that, despite two attempts at reconstruction as newborn, the opening in her intestine continued to narrow.
How could her mental state stay so strong? That’s the question Kaitlin’s grandmother asks now, looking back.
“It was amazing she was able to survive like this for so long,” said Nita Wombles. “But she’s not a quitter. She never complained of being nauseated and she ate like a bird. She was very thin, but so is her mom and dad.”
As Kaitlin started high school, it became obvious to those around her that her health was deteriorating rapidly. A family doctor in their hometown of Lakeland referred her to a specialist in Tampa, who then directed her to Dr. Charles Paidas, chief of the Division of Pediatric Surgery for the USF Health Morsani College of Medicine.
USF Health pediatric surgeon Dr. Charles Paidas with Kaitlin, who is thriving following the reconstruction of her digestive tract.
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Kaitlin’s third operation was in June of 2014. She was exhausted but had tremendous hope – the problem that had haunted her for her entire life was very likely fixable. She knew she was in the right place with the right surgeon.
Just before the operation, she told Dr. Paidas how much she believed in him.
“What a great way to go into the operating room,” Dr. Paidas said.
The operative plan was fairly straightforward but, like many procedures, the plan going in isn’t always what ends up playing out.
“Every endoscope and image using a contrast agent had us all convinced she had a dilated stomach and that everything beyond the stomach was fine, that maybe it was residual scar tissue from her previous surgery creating an additional blockage,” Dr. Paidas said.
“But once we were in, we saw that not only was the stomach dilated but also the entire loop of intestine beyond the stomach, called the duodenum, specifically the first and second portions of the duodenum that borders the pancreas. There was only a pinhole for any food and nutrition to pass through and, as a result, the redundant dilated duodenum and stomach was the root cause of her problems.”
According to Dr. Paidas, the procedure involved tapering the enlarged duodenum, narrowing the section that leaves the stomach and re-opening a pathway to the rest of her intestinal tract. The reconstruction required careful navigation to prevent blockage of bile into the intestinal tract from the nearby pancreas and liver ducts that open right where the problem originated.
Dr. Paidas helps explain Kaitlin’s digestive problem with a sketch on examination table paper.
“Once we dissected all the intestine and scar tissue and assessed normal and abnormal organs, we carefully tapered and reconnected,” he said. “The result is that the stomach and duodenum are now the correct size, functioning properly, and in continuity to pass early digested food on to the intestines, like normal children, giving Kaitlin a working digestive tract for the first time in her life.”
Kaitlin’s condition affects one in 4,000 live births and is part of a spectrum of duodenal anomalies that occur in the first 8 to 10 weeks in-utero.
“During pregnancy a classic double-bubble is suspicious for duodenal atresia but we typically do not do any in-utero reconstruction, but rather wait until the baby is born because there may be associated anomalies,” Dr. Paidas said.
So while Kaitlin’s condition is fairly common in neonates, being treated in her teens places her in a very rare category, a point that likely drew added attention from the teams of health care providers making rounds at TGH during Kaitlin’s two-week stay following surgery.
“After a while, we built a bond with everyone,” Wombles said. “We understand it’s a learning process so we didn’t care who they brought around. We want others to have the knowledge, especially because she was a rare case.”
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Nearly two years now has passed since the procedure. Kaitlin has thrived, is in her junior year of high school, and is getting great grades and awards.
“There are no words to express how thankful we are to Dr. Paidas and his entire surgical team for their professionalism,” Wombles said. “How does one say ‘thank you’ to someone who gave you back your granddaughter?”
And her gratitude goes beyond this one surgeon.
“We are also grateful to Tampa General Hospital, the entire staff, nurses, Kristyn our Pediatric Surgery nurse practitioner, Intensive Care Unit team, everyone!,” Wombles said. “I spent a great deal of time there, day and night, and I was so impressed with the staff. They are very professional and at the same time so thoughtful, considerate and kind. USF and TGH are so very fortunate to have Dr. Paidas here in the Tampa area. May God continue to bless him and his entire team as they strive to save our children and grandchildren.”
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Throughout interviews Kaitlin remained fairly quiet. Somewhat shy or just a low-key teen, she would offer only a few words, letting her grandmother help tell her story.
But gratitude poured out in a letter from Kaitlin describing her thanks to Dr. Paidas and the USF Health and Tampa General teams:
Before the surgery, it was difficult to function. Hardly a day would go by that I did not get extremely fatigued. Though I maintained “highest honors,” academically it was hard to focus. However, a few weeks after the surgery, the days passed easier. I could think more clearly and did not get fatigued as easily. To my surprise, on most days I wasn’t even fatigued at all. I am now able to pursue interests that would not have been possible before.
Dr. Paidas, his team, and the staff at Tampa General Hospital were extraordinary throughout the entire surgical process. My expectation was that the experience would be impersonal because of the medical staff’s hectic schedules and the amount of patients that are seen on a daily basis. However, my expectation could not have been further from the truth. I felt a personal connection with Dr. Paidas and his staff and I felt as though they cared, and still do care deeply about my wellbeing.
Sometimes people do things for you that make it hard to think of a way to say “thank you” properly. Before the surgery my goal was to be a psychologist. I am now directing my attention to surgery or in forensic pathology so I can help people regain their health or to find out why things go wrong and be a part of the solution. I am currently an intern at the Polk County Medical Examiner’s office.
Thank you Dr. Paidas!
Kaitlin Cierra Smith
Photos and multimedia by Eric Younghans, USF Health Office of Communications
