A Survivor's Spirit.
Cassi Sorrells thought her infant son had put the worst days behind him, having undergone surgery hours after his birth. She felt that way until two weeks later, when she sat him up to burp him after a feeding.
That's when she found a lump on his back.
At 16 weeks into her pregnancy, an ultrasound led to a diagnosis that initially frightened Cassi. Her unborn son had gastroschisis, a condition in which his small intestines and much of his stomach and colon had developed outside his body.
"It was a scary thing to hear, but I wanted to know as much information as possible," Cassi recalls.
She came to Children's Hospital & Medical Center to meet with pediatric surgeon Shahab Abdessalam, M.D., one of only two surgeons in the country formally trained in pediatric surgery and surgical oncology.
"Gastroschisis results from a defect of the abdominal wall," Dr. Abdessalam says. "We see about 25 to 30 such cases a year, each with a varying degree of difficulty and management."
He told Cassi that her son would need surgery as soon after his birth as possible. If the gastroschisis was not corrected and the intestines not placed inside the infant's body right away, there would be a risk of dehydration and contamination.
"Dr. Abdessalam sat down and explained everything," Cassi says. "And it played out exactly as he said it would."
Her son, Corey Hulett, was delivered by Caesarian section on April 14, 2008. The attending obstetrician and neonatal team put the boy up to his shoulders into a "bowel bag" to protect the exposed organs and keep contamination to a minimum.
Taken first to the Newborn Intensive Care Unit, within an hour Corey was undergoing surgery with Dr. Abdessalam, who placed the exposed organs into the baby's body through an incision at the navel. Three hours later, the infant was back in the NICU.
Corey was fed through a central line for about 10 days, "until his intestines woke up," Cassi says. "We started with 5 milliliters of milk. I put the bottle to his lips and he sucked it down in like two seconds."
About two days later, Cassi finished a feeding and sat Corey up to burp him. "That's when I found the lump on his back, right at the center of his spine." She told the NICU nurse practitioner, who brought in specialists to determine what it was.
A magnetic resonance imaging (MRI) check of the infant's back indicated a solid mass. An excisional surgical biopsy was conducted, during which Dr. Abdessalam removed much of growth.
Tests indicated the mass was rhabdomyosarcoma, a cancerous tumor that originates in the soft tissues of the body, particularly in the skeletal muscles that attach to bone. At the time Corey was diagnosed, this type of cancer had been reported nationally in only 14 other newborns over the past 50 years. "It's extremely rare in newborns," Dr. Abdessalam says, "but very treatable."
Pediatric neurosurgeon Mark Puccioni, M.D., played a critical role in the surgical process. He removed portions of bone along the spine to allow for a complete removal of the tumor and help the baby avoid radiation therapy which can be detrimental to spinal development in a newborn. Instead, Corey was given six months of chemotherapy under the direction of David Gnarra, M.D., a hematology/oncology physician at Children's.
"After the third surgery, he had to lay on his stomach for two weeks to recover," Cassi says. "We had to put his clothes on backward, his diapers on backward. I was thankful he was so little so he didn't know."
Dr. Abdessalam says Corey "tolerated the chemo extremely well. His follow-up exams and scans have been clear. His story is truly an absolute success all around."
Corey's treatment and recovery illustrate the collaborative effort put forth on a daily basis by the specialists, subspecialists and medical staff at Children's. "The team approach that we take helps yield great outcomes like this," Dr. Abdessalam says.
Corey's mother says because of her experience at Children's and caring for her son - giving him shots at home and keeping his central line clean and intact for delivery of the chemotherapy - she is planning a career in nursing some day.
"The doctors and nurses were all incredible," Cassi says. "I love all of them, especially Dr. Abdessalam. He treated us as if we were his own friends and family."