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Children's Hospital Surgeon Tames 'Angry Organ'

By John Kelly
Tuesday, November 25, 2008

Not every organ in your body has a personality. The pancreas does. Unfortunately, it's not a very nice personality. Surgeons call the pancreas the "angry organ." One surgery textbook I saw said that most surgeons avoid even palpating (that is, touching) the pancreas unless absolutely necessary.

Like a snifter full of nitroglycerin, the pancreas is something you don't want to mess with.

And yet sometimes you must. When he was 12, Vienna's Justin Murphy tackled another boy during a pre-season football game. In the process, Justin took a cleated boot to the abdomen. He lay on the ground thinking he'd gotten the wind knocked out of him, but when the pain didn't go away, Justin and his dad, Harry, realized that something else was going on.

Doctors initially thought that Justin might have cracked a rib. Then they thought he might have bruised his pancreas. In fact, Justin had fractured the angry organ. When he fell on the other boy's foot, the foot pushed Justin's pancreas against his spine, nearly severing a portion as neatly as if he'd rocked a carving knife against a cutting board.

Doctors at the first hospital that examined Justin missed the severity of his injury. It was the doctors at Children's National Medical Center who realized that Justin's pancreas had gone from the angry organ to the psychopathic organ intent on going out in a blaze of glory -- and taking Justin with it.

"It's a bad injury, that's the problem," said Dr. Martin Eichelberger, the Children's Hospital surgeon whose job it was to tame Justin's outraged pancreas. "It's not like fracturing your bone, where it's healed in six weeks. You've got all sorts of physiological consequences to the pancreas being injured."

The pancreas is a thin organ that produces enzymes -- amylase, lipase -- that help break up sugars and carbohydrates in our food. In essence, it's a little acid factory, and nature positioned it just where you'd want such a volatile establishment: well at the back of the abdomen, protected. But Justin's freak injury had severed the pancreas near a duct through which enzymes travel to the duodenum. The pancreas went into overdrive, spilling enzymes through the breach, which then started digesting everything in their path.

Removing the organ completely isn't ideal, because the pancreas also produces vital insulin. But unless it is repaired, an injured pancreas will go on spewing fluid until the kidneys shut down and the body lurches toward multi-organ failure.

Dr. Eichelberger cut a six-inch incision straight up from Justin's bellybutton. A damaged pancreas can start to saponify, literally turn to a mushy soap. Justin's mom, Kim Murphy, remembers Dr. Eichelberger telling her that the tissue was similar to cottage cheese. But the surgeon was able to remove the tail of the pancreas, taking care not to damage the nearby spleen.

During Justin's four days in intensive care, and the three weeks in a recovery ward, the team at Children's monitored his enzymes and tended to drains in his abdomen. He went home weakened and with months of healing in front of him, but go home he did.

Justin's 16 now, a sophomore at the Landon School, where he's on the wrestling and lacrosse teams. He loved football but was just fine with walking away from it. "When I was in the hospital, my dad said, 'We're not going to let you play football anymore.' I was hoping that they'd say that."

Eminently understandable.

The Happy Hospital

Children's saw what others had missed because they've seen this sort of injury before. It's sometimes called a "handlebar injury," since slamming the abdomen into a bike's handlebars can crack the pancreas. Basically, if a kid can break it, burn it, bruise it or cut it, Children's has seen it -- many times. That's why we're so fortunate to have the hospital here.

Justin's family had insurance, but many around here don't. Your gift of $100 will help pay the bills of poor children and help us toward our fundraising goal of $500,000. To donate, write a check or money order payable to "Children's Hospital" and mail it to Washington Post Campaign, P.O. Box 17390, Baltimore, Md. 21297-1390.

To donate online using a credit card, go to http://www.washingtonpost.com/childrenshospital.

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There's more online at "John Kelly's Commons," my daily blog: http://voices.washingtonpost.com/commons.

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