Moving forward

Surgery for pancreatitis, massive hernia steers Cedar Rapids man down a healthy path

For Daniel Speidel, it was no ordinary stomach ache.

“I’ll never forget the date: Dec. 2, 2015,” he says. “We had tickets to see the Iowa Hawkeyes in the Big Ten football championship in Indianapolis that weekend, but I left work early on Wednesday feeling terrible. I was cramping and throwing up. I couldn’t hold anything down.”

That evening, when his symptoms didn’t go away, Daniel and his fiancée, Sarah, went to the emergency room at a Cedar Rapids hospital. Tests showed that he had acute pancreatitis, which is inflammation of the pancreas—the gland in the upper abdomen that produces enzymes for digestion and hormones that help regulate how the body processes glucose (sugar).

Over the following days and weeks, missing the football game would be the least of Daniel and Sarah’s worries. Despite staying in the hospital for rest, intravenous fluids, and pain medications, Daniel’s condition worsened. By the weekend, he was transferred to the intensive care unit.

“Daniel was having a lot of pain and discomfort,” Sarah says. “He was retaining a lot of fluid, having trouble breathing, and becoming agitated and anxious. He even pulled out his breathing tube and tried to ‘escape.’ Finally, they had to sedate him just so he’d calm down.”

“I don’t really remember any of that,” Daniel says. “I was really out of it.”

With severe acute pancreatitis, portions of the pancreas can become necrotic and die, which ultimately can lead to life-threatening infection. After more than a week at the Cedar Rapids hospital, Daniel was transferred to University of Iowa Hospitals & Clinics.

On Dec. 16, he underwent emergency surgery – the first of four procedures over the next two weeks to remove the “dead” areas of the pancreas and drain excess fluid from his abdomen.

“Necrotizing pancreatitis is serious,” says Luis Garcia, MD, FACS, the acute care surgeon at UI Hospitals & Clinics who performed the first two of Daniel’s operations. “The mortality rate for patients with this condition is quite high, and Daniel’s condition was critical.”

Garcia and former UI acute care surgeon Prashant Khullar, MBBS, MS, were successful in removing the necrotic tissue.

However, Daniel still had a considerable amount of inflammation in his abdomen, which meant that the surgical team could not sew his abdominal muscles back together after the fourth operation.

Instead, they used a mesh-like material that dissolves over time to cover Daniel’s abdominal area and protect his intestines. A few weeks later, Daniel returned to UI Hospitals & Clinics to undergo a skin graft procedure – performed by UI acute care surgeon Dionne Skeete, MD – to provide additional “coverage” of the abdominal area.

In surgical cases like Daniel’s, the development of a hernia at the site of the incision is not uncommon. A hernia occurs when part of an internal organ or tissue bulges through a weakened area of muscle – often in the abdominal region.

When Daniel did develop an incisional hernia, it was not unexpected, Garcia notes.

“Given the complexity of his case, we couldn’t sew up Daniels’ abdominal muscles right away,” Garcia says. “As a result, we knew he would likely develop a hernia, which is why we placed the mesh and did the skin graft – knowing he’d come back several months later so we could repair the hernia.”

In August 2016, Daniel returned to UI Hospitals & Clinics for surgery. By this point, his hernia was massive, measuring nearly 10 inches in diameter.

“The bigger the hernia, the greater the challenge in treating it,” Garcia says. “With Daniel, this was a complex procedure – to not only repair the hernia but also prevent another hernia from developing down the road.”

The first step for Garcia and the surgical team was to remove the skin graft and separate Daniel’s bowels from the graft. Next came a technique called a component separation, which allows some looseness in the muscles in the abdominal wall so that they can be brought together for suturing (stitching). Mesh-like material also was used to help reinforce the site. Over time, the body forms scar tissue around the mesh, which minimizes the chance of another hernia occurring later.

Daniel’s hernia surgery went smoothly, and after six days in the hospital, he was back home in Cedar Rapids. Garcia credits his team’s expertise in ensuring Daniel’s procedure was a success.

“We have a multidisciplinary team that includes general surgeons, plastic surgeons, and minimally invasive surgeons who all work together as needed – especially with complex cases or big hernia procedures like this one,” Garcia says. “We also have a dedicated group of intensive care physicians and nurses 24/7, which is important for patients who may require around-the-clock monitoring and follow-up care.”

Daniel now has a new outlook on life, which began in earnest during the months he spent waiting for the go-ahead on his hernia repair. He and Sarah got married in April 2016. Daniel also focused on making lifestyle changes.

“The doctors and nurses told me to watch what I eat, abstain from alcohol, and also stay active," Daniel says. “Carrying the hernia around, I couldn’t do a lot, but I could walk. So, I set a goal to walk 5 miles a day. Soon 5 miles turned into as many as 15 miles on some days. I went 87 days before my hernia surgery without missing my goal.”

Daniel admits that he didn’t think about his health before that severe stomach ache in December 2015.

“I drank alcohol, ate whatever I wanted,” he says. “Now, Sarah and I have adapted to a whole new lifestyle. We go on long hikes, we’re eating better, we’re not drinking, and now I’m into cycling – a 50-mile ride is nothing for me.”

He remains grateful for the care and expertise available at UI Hospitals & Clinics.

“Without those doctors and nurses, I might not be here right now,” Daniel says. “Medical miracles happen at the University of Iowa every day, and I feel like I’m one of them.”