Saving Evan's Kidney
“My side hurts.”
Evan Scott’s parents figure the eight-year-old must have made that complaint several times a week for about three months.
Yet each time – just minutes later – the active boy would be playing as if everything was fine and the pain had passed.
“He didn’t seem to be sick,” Jon Scott of Portsmouth said of his son’s health during those months. “But there were times when he said the pain was really bad, so we took him to his pediatrician.”
Evan’s doctor took a wait-and-see approach after finding no particular symptoms of illness. Over the next several weeks, the Scotts were instructed to alert the doctor if new symptoms appeared. None did.
Then one day last May, Evan and his brother, Jake, were with their mother, Wendy Jessup, in Virginia Beach when something changed. “He was suddenly in awful pain, but it seemed to come and go a lot. He didn’t have a fever, but he was vomiting at this point,” Wendy said. So she called Evan’s dad and took their son to the nearest emergency room.
In the ER at Virginia Beach General, an X-ray revealed a greatly enlarged kidney, a sure sign of something terribly wrong. “That’s when things got hectic,” Wendy said.
So Evan and his mom were taken by ambulance to Children’s Hospital of The King’s Daughters in Norfolk. “I was really worried, but Evan was excited about being in an ambulance,” Wendy said.
In the Emergency Center at CHKD, pediatric urologist Charles Horton Jr. was paged while the emergency medicine specialists ordered a CT scan of Evan’s abdomen. He remembers being calm for the radiologic procedure that requires a child to be very still. “I didn’t mind,” Evan said. “It was kinda cool.”
Though a night in the emergency room can seem like an eternity to worried parents, Evan bravely endured the poking and prodding and tests. The pain was still coming and going, but he was used to it by now and fully expected to be back playing with his brother and friends by daylight.
But when Dr. Horton saw the CT scan results, he knew that wouldn’t be possible. He told the family that Evan appeared to have an obstruction of the ureter, which channels urine from his left kidney to the bladder. It’s a congenital (present at birth) condition that sometimes goes undetected for years, he explained. As a result of the buildup of urine, his left kidney was swollen to twice its normal size.
“We had no idea,” his dad said. Evan had been born with a heart valve disorder and had visited the cardiologists at CHKD through the years to monitor the condition. “Despite the heart problem, Evan was always so well,” his dad said. “He rarely complained until this pain in his side started a few months before. You can imagine our surprise when we learned it was his kidney that wasn’t normal.”
The next step for Evan was surgery and a few days in the hospital to recuperate. “We were relieved when Dr. Horton told us that Evan would not have to lose his kidney,” Jon said.
But Evan’s situation wasn’t exactly like most other patients with ureteral pelvic junction (UPJ) obstruction, Dr. Horton said. In his case, it was an extra blood vessel – called an accessory renal artery – compressing his ureter and limiting the amount of urine that could flow from the kidney at one time. The presence of the extra artery made his surgery more complicated, he explained. “We didn’t want to disturb the artery, just create a path around it,” he explained.
Evan’s surgery lasted about two hours as the surgeon removed a small piece of the ureter and spliced it back to the kidney above the blood vessel.
A tube was put in place during the surgery to drain the kidney until it healed, so for a few days in the hospital after his surgery, much of his nursing care was focused on preventing infection. “He had a small tube coming out of his side for urine,” said Julie, his stepmom. “He didn’t like that, but he was a pretty good patient through it all.”
What Evan did like were the play times in the hospital activity room and the video games brought to his bedside when he was confined to his bed for a couple of days after the surgery. His parents took turns staying with him, and his brother and little sister, Grace, came to visit, as did many extended family members.
“His brother was a patient at CHKD when he was a baby,” Jon said. “He also had a congenital heart condition.” But unlike Evan, Jake’s heart condition required surgery. “So we were familiar with the hospital and very grateful it was there for us in both boys’ situations.”
After a few days, Evan went home when the tube was removed from his side. “He was shocked to see the length of his scar,” Julie Scott said. “He hadn’t seen that while he was in the hospital.” Now Evan gladly lifts his shirt to show his scar.
Though he couldn’t play his favorite game of soccer for a period of recuperation, Evan has now happily returned to the soccer field. “We’re a soccer family,” said his dad, who coaches Evan’s Force United team in Portsmouth and plays in an adult league.
Evan was back in school at Court Street Academy in Portsmouth before the school year ended. He maintained his straight-A average despite the break from classes. “We never worried that he wouldn’t keep up,” Jon said.
The family learned that Evan’s kidney would be slightly smaller than normal because of the condition, but there was no longer anything preventing normal flow of urine. “The doctor told us that years ago they might have had to remove his kidney. We’re glad that didn’t happen,” Jon said.
In late October, Evan returned to CHKD, where Dr. Horton performed a renal scan to make sure his kidney was functioning normally.
“It was all good news,” Jon reported, beaming.
He added that he was glad they had trusted in the pediatric specialists at CHKD. “We know it takes special people to take care of kids. And our kids are very special to us.”
Dr. Horton practices with CHKD Health System’s Children’s Urology.