Corinna Smith is certain she owes her life - and an important body part - to a quick-thinking surgeon who used a new technique he'd just learned about at a conference to save her colon.
Smith, whose bowels were being ravaged by toxins as a result of a Clostridium difficile colitis infection, is believed to be the first B.C. patient to undergo the still-experimental procedure.
It involves diverting a loop of the colon, flushing the poisonous germs out of it, then injecting antibiotics directly into the diseased area. Months later, after rest and healing, the colon is reattached.
The conventional procedure in severe cases like hers would have been removal of most of her diseased colon, which would have meant wearing a bag to collect stool for the rest of her life.
Smith believes her brother's pleadings while she was on life support in the Langley hospital intensive care unit helped sway general surgeon Dr. Donald Shirley to use the new technique.
"When he learned that the plans were to remove my colon, my brother started to cry, telling Dr. Shirley that I was only 35 and single, and wasn't there anything else they could do?
"Apparently, there was this negotiation over how much of my colon the doctor was going to take out. Losing a large piece of my colon would mean that for the rest of my life, I would need to be very close to a bathroom," Smith said.
Shirley had just been to a surgical conference at the University of Toronto where he had heard about the generally positive results of a Pittsburgh study on the less-invasive technique in more than 60 patients.
"I don't know of anyone else in B.C. or in Canada who had been deviating from the standard, but I thought that in this case - a patient so young, and with a still viable colon - it was a reasonable opportunity to try to implement the technique," Shirley said in an interview.
"If unsuccessful, my plan was to then take the whole colon out. But fortunately, it all worked out," he said.
"Before I went into the OR, I chatted about my intentions with a colleague and he agreed it was reasonable to attempt," Shirley said.
The loop ileostomy surgery he performed decommissions the bowel to allow time for healing. It is also used in bowel cancer cases, so Shirley said there was nothing new for him about that. But it is not the standard for C. difficile cases, nor is the accompanying irrigation process in which massive amounts of saline fluid are flushed through the colon to dump out toxins.
After the procedures, Shirley attached a temporary bag (ostomy) to Smith's colon to divert bowel matter for the next four months. Smith recently had her re-connection surgery.
Because of the uniqueness of Smith's case, Dr. Kevin McDermid, the internist who cared for Smith while she was in an induced coma for 10 days after the operation, wrote a report he's hoping to have published in a medical journal.
"Call me the miracle patient," Smith said in an interview. "I cannot even begin to describe how grateful I am to my surgeon, the internist, and everyone else at Langley Hospital," she said in an interview.
Smith's near-death experience arose after she got a particularly severe C. difficile colitis infection.
C. difficile, often transmitted from contaminated hands to the mouth, is one of many types of bacteria found in feces. For those who are infected, antibiotics usually suffice, but in rare cases, it is a worst-case scenario.
Smith's was that worst case, but it was also unusual in that it wasn't hospital-acquired, as 80 per cent of C. difficile cases in the province are.
She got her infection from a bad reaction to antibiotics she was prescribed for a sinus infection. When her diarrhea and abdominal pain became unbearable, she ended up in the Langley emergency department, where it took a few days to pin down the cause of her problems.
She hadn't known it at the time, but she has a genetic variation that predisposed her to a severe response to certain broad-spectrum antibiotics.
Smith, who is still recovering from the latest operation to reconnect her colon after it was temporarily decommissioned, said she wants to share her experience, not only as an act of gratitude, but also so doctors and other patients know about the new procedure.
Other surgeons interviewed about the procedure used in the Smith case were intrigued, but cautious. Dr. Garth Warnock, a Vancouver surgeon and University of B.C. professor, said he heard the Pittsburgh presentation at an American Surgical Association meeting in Florida last year. He said he was impressed, but feels "a higher level of evidence" is still needed to indicate which patients are most suitable for the procedure.
- Pamela Fayerman is a reporter with the Vancouver Sun