HJNO Jul/Aug 2024

HEALTHCARE JOURNAL OF NEW ORLEANS  I  JUL / AUG 2024 59 southeast due to her small size, the refer- ring facility got in contact with our team at Children’s Hospital New Orleans. Because I had completed one previous, successful ERCP procedure on a patient of a similar weight and size, I agreed to take Xinovia’s case. Without treatment, she was at risk of infection and potentially life-threatening sepsis. The Children’s Hospital New Orleans transport team flew to Gainesville on a fixed wing aircraft to bring Xinovia to New Orleans where she was admitted to the pediatric intensive care unit. Upon arrival, first the significant amount of fluid on her belly was immediately drained, and then comprehensive testing and imaging stud- ies began to fully understand the cause of her pain and fluid build-up. It was discovered that Xinovia had ab- normal anatomy of her bile and pancreatic ducts, which ultimately caused a perfora- tion of the bile ducts due to inflammation and fluid buildup. She also had gall and pancreatic stones, which needed removal. It was determined that the gall stones would be removed through her common Russell Zwiener, MD Director of Endoscopy Director of Pediatric Advanced and Therapeutic Endoscopy Children’s Hospital New Orleans for follow-up, where her stents were suc- cessfully removed. Due to Xinovia’s abnormal anatomy, she will need regular follow-up care and mon- itoring, but she is doing very well and is back to feeling like a happy, active 2-year- old again thanks to our ability to work quickly and collaboratively in treating her difficult condition. n Russell Zwiener,MD, is a gastroenterology,hepatolo- gy,and nutrition specialist at Children’s Hospital New Orleans.Zwiener serves as the hospital’s director of endoscopy and director of pediatric advanced and therapeutic endoscopy.After earning a medical de- gree fromSt.Matthews University,Zwiener complet- ed a one-year general surgery internship at the Uni- versity ofTexas Health Science Center at SanAntonio. He then completed a general pediatrics residency at University of Oklahoma Health Sciences Center and then a pediatric gastroenterology fellowship at LSU Health New Orleans at Children’s Hospital. He trained further for an additional year in San Antonio to complete a pediatric advanced and therapeutic endoscopy fellowship at Baylor College of Medicine. Zwiener is board-certified in both general pediatrics and pediatric gastroenterology.Although he treats all pediatric gastrointestinal conditions, Zwiener spe- cializes in caring for children with pancreaticobiliary disorders including acute and chronic pancreatitis, gallbladder,and bile duct disorders.Zwiener performs highly specialized procedures including endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). duct channel, and her condition would be treated by placing stents in the pancreatic and bile ducts, performed endoscopically. Before the surgery could begin, a second drain was put in place to remove the re- maining fluid in her stomach. A stent was successfully put into place in the pancreatic duct, and stones were removed. Unfortunately, the bile duct was not reachable initially due to her abnor- mal anatomy. Alternatively, I collaborated with Interventional Radiologist Richard Marshall, MD, to perform a rendezvous ERCP procedure, where he inserted a wire through the skin, directly through the liver, into the bile duct, and out into the small in- testine to pull the additional stent into the bile duct, which I fed from below, grabbing onto the wire. The rendezvous ERCP procedure was successful, and within three days, there was no fluid present, which signified that the procedure was successful. Xinovia stayed in the hospital for a few days for monitoring and recovery and then was discharged home to Florida. About a month later, she returned to New Orleans "Due to Xinovia’s abnormal anatomy, she will need regular follow-up care and monitoring, but she is doing very well and is back to feeling like a happy, active 2-year-old again thanks to our ability to work quickly and collaboratively in treating her difficult condition."