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Sadie's Story: When the Best Surgery Is No Surgery

February 15, 2017

Sadie with her mom and dad, Nicole and Ethan

It was a gut-wrenching moment for Nicole and Ethan Hoinacki as they watched an ambulance carrying their newborn daughter, Sadie, leave from a hospital in downstate Springfield for Ann & Robert H. Lurie Children's Hospital of Chicago, 170 miles away. There, they were told, she would undergo immediate surgery to remove a mass of blood vessels in her liver.

But something unexpected happened. Through close monitoring of Sadie, who appeared to be thriving as a newborn, pediatric surgeon Timothy Lautz, MD, was able to postpone her surgery several times. He ultimately discovered that Sadie had a rare anomaly that resolved itself without surgery.

"Sometimes the best surgery is no surgery at all," says Fizan Abdullah, MD, PhD, Lurie Children's Head of the Division of General Pediatric Surgery. "I often tell our trainees and fellows that surgical judgment is the most important thing. It's the experience and judgment to know when to perform surgery and when not to that differentiates a good surgeon from a great surgeon."

A frightening diagnosis

Sadie was diagnosed before birth with an arteriovenous malformation (AVM) in her liver. An AVM is a type of vascular malformation that results in an abnormal tangle of blood vessels, disrupting normal blood flow and oxygen circulation. A large AVM can cause major complications in two main ways: by stealing blood flow from other organs and by rapidly recirculating blood in the body, leading to heart failure.

Sadie was born four weeks premature, and shortly after arriving at Lurie Children's, she underwent an MRI scan. The results showed that while the mass in her liver wasn't as extensive as originally thought, it was large enough to divert about 50 percent of the blood flow from her aorta.

Dr. Lautz specializes in treating rare and complex conditions of the liver, pancreas, bile ducts and gallbladder. Upon meeting Ethan and Nicole, he explained that AVMs in the liver are treated in one of two ways. The first is through a minimally invasive embolization procedure performed by an interventional radiologist, and the other is through surgical removal of the mass.

The best possible news

Sadie was closely monitored, and surgery was finally scheduled for when she was six months old. A few days before the surgery, Ethan and Nicole were in a waiting room while Sadie was undergoing her presurgery CT scan. Suddenly, Dr. Lautz arrived, eager to share the results.

"We could tell he was really excited about something," says Ethan. "He said, 'We've got the best possible news for you. The mass is shrinking, and Sadie won't need surgery after all!’"

To the surprise of Dr. Lautz and his colleague, interventional radiologist Jared Green, MD, the scan showed that the mass that had originally occupied 33 percent of her liver had shrunk to just 5 percent. Dr. Lautz told the stunned couple that instead of an AVM, Sadie instead had a rapidly involuting congenital hemangioma. These vascular malformations have many similarities to AVMs but usually resolve without surgery.

What Sadie’s case teaches us

"Cases like Sadie's are extremely rare," says Dr. Lautz. "In fact, only a handful of similar cases have been documented worldwide. What patients like Sadie teach us is to not jump to conclusions and make a diagnosis based solely on how an anomaly like an AVM looks on a diagnostic scan, but instead on how it acts."

Dr. Lautz says that he hopes to collaborate with the handful of other physicians who have treated children like Sadie. He said sharing data could lead to better identifying patients who, like Sadie, could potentially avoid surgery.

Sadie today

Sadie is now a healthy 16-month-old who, her mom says, "is crawling around and is into absolutely everything.

"We're so grateful for the care we received at Lurie Children's and for Dr. Lautz, who always dealt with us on a personal level," says Nicole. "I remember saying to him, 'I know you're a great surgeon, but I'm glad you didn't have to prove it with Sadie!'"

This article originally appeared in the Winter 2017 issue of Heroes magazine.

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