We expect our gastrointestinal tracts to function, but few people are lucky enough to go through life without experiencing the symptoms that arise — some of which can be difficult — when problems develop. In Linda Pierce’s case, two conditions conspired to produce a complicated picture. The Attleboro resident is grateful to Brian Hinnebusch, MD, colorectal surgeon, for his expertise, empathy and bedside manner.
Ms. Pierce says she had a sensitive GI tract for as long as she can remember. But she never received a diagnosis, so she lived with a degree of unpredictability. Trouble began brewing more than a decade ago. “My bowels slowed down,” she recalls. “As a result, I was constipated a lot.”
She later learned about dysmotility syndrome, where the muscles — in her case, in the intestine — do not move food along effectively, which can result in cramping and bloating. But Ms. Pierce’s dysmotility took a back seat to something else: a case of diverticulitis that began flaring and landing her in the hospital. Diverticulitis is characterized by the formation of bulges in the intestinal lining that may become inflamed or infected, as well as painful.
“I’ll never forget my first bad diverticulitis attack,” she says. “I was put on antibiotics and hoped that would take care of it.” She was not that fortunate, and ongoing attacks affected her ability to work as a customer service representative. They occurred every four months, and she knew her situation was worsening.
Ms. Pierce remembers the day when Dr. Hinnebusch walked into the emergency department to speak with her and her husband. “He sat down and took the time to educate us about diverticulitis,” she says. “It was very comforting. We found Dr. Hinnebusch to be compassionate and down-to-earth.”
Dr. Hinnebusch was preparing Ms. Pierce for the difficult surgery that he needed to perform. “Linda’s diverticulitis was progressing, and she was very sick,” he recalls. “In such instances, we perform a colon resection — removal of a section of the colon — often without including a colostomy, but her situation was urgent. I told her that would be the most prudent approach.”
A colostomy allows the colon to heal by rerouting feces through an alternative channel — an opening in the abdomen, known as a stoma, and into a bag that can be emptied. “I knew it was temporary, and I trusted Dr. Hinnebusch,” says Ms. Pierce. “Lots of people end up with permanent colostomies, so I did what I had to do, and the time went by quickly.”
Three months later, Dr. Hinnebusch performed surgery to reattach her healthy colon and reverse the colostomy. “No more diverticulitis,” says Ms. Pierce.
Feeling like a new person
She welcomed a period of relief from GI symptoms, but it did not last long. Within a year, her dysmotility syndrome was back and making her life miserable. “My bowels had slowed down,” says Ms. Pierce. “My physician tried a number of different medications, but nothing helped.” It was time to contact Dr. Hinnebusch.
“Linda had been living with both dysmotility and diverticulitis, which can be debilitating — and not something we see very often,” he notes. “The goal now was to determine how to best treat her dysmotility, a condition that can be difficult to diagnose.”
Dr. Hinnebusch first had Ms. Pierce take a sitz marker test, which determines how long it takes for food to move through the intestine. He then suggested that he perform a loop ileostomy — surgery that would bypass the large intestine. “This was the real test,” he explains. “If bypassing Linda’s large intestine relieved her symptoms, we’d know that was the source of her motility problem.”
Bypassing Ms. Pierce’s large intestine, or colon, meant having another temporary stoma and the diversion of stool into a bag, but the loop ileostomy gave them the answer: her colon was causing the dysmotility symptoms that she had lived with, on and off, since childhood. In 2016, Dr. Hinnebusch proceeded to perform a total colectomy — removal of her entire colon — and reverse the loop ileostomy.
“People function fine without a colon, although it typically results in more frequent bowel movements,” says Dr. Hinnebusch. “Linda had a complex medical situation; both her diverticulitis and dysmotility required careful planning and a thoughtful surgical approach to achieve good results.”
“I’m satisfied with how I function today,” Ms. Pierce says. “Since I met Dr. Hinnebusch five years ago, he’s performed five life-changing surgeries for my diverticulitis and motility problems. There were times when I was scared, but he assured us and devoted the time my husband and I needed. He always reminds me to be sure to contact him with any questions or concerns.
“In addition to the compassion he shows his patients, I appreciate the way Dr. Hinnebusch stays calm; this put me at ease. I had been sick for ten years, so after that last surgery, I felt like a new person. He’ll never know how much he has given me.”
“Regardless of how complex, or how much time is required,” says Dr. Hinnebusch, “I never lose sight of the fact that I am taking care of a person — not just a disease process.”
Surgical collaborations expand treatment available at Emerson
Since arriving at Emerson in early 2018, Dr. Hinnebusch (pictured at right) has found his surgical specialty — colorectal surgery — to be in demand. His fellowship training in colon and rectal surgery at the Cleveland Clinic got attention, as did his appearance on Boston Magazine’s Top Doc list in 2017.
Patients come for a range of treatments, from office-based procedures for hemorrhoid banding to complex surgery not typically performed outside of Boston. For example, Dr. Hinnebusch performs neorectum surgery in patients with low rectal cancers or inflammatory bowel disease by using the small intestine to create a pouch. The result is improved quality of life for patients.
Denise McGee-O’Clair, a Boxborough resident, had been suffering for a year with bilateral sciatic hernias: her intestine was pushing on the sciatic nerve. “It was very difficult,” she says. “I never knew when the pain would be bad. I had gone to a surgeon who said he couldn’t help me.”
She did not hear that from Dr. Hinnebusch, who was ready to relieve Ms. McGee-O’Clair’s pain. “When Denise told me she also had a hiatal hernia, I realized we should try to repair that during the same surgery,” says Dr. Hinnebusch, who turned to two of his surgical colleagues to plan and perform the complicated, staged surgery. Laura Doyon, MD, a bariatric surgeon who also specializes in foregut (esophagus) surgery, repaired Ms. McGee-O’Clair’s hiatal hernia first.
Before Dr. Hinnebusch began his surgical procedure, Jason Gee, MD, a urologist, placed lighted stents adjacent to Ms. McGee-O’Clair’s ureters. “I needed to place a mesh to perform the repair, but it meant moving among her ureters, nerves and blood vessels,” Dr. Hinnebusch explains. “Having the lighted stents nearby assured we did not damage any structures.”
The outcome of the surgery, which was performed laparoscopically, amazed Ms. McGee-O’Clair. “As soon as I woke up, I knew my sciatic pain was gone, and with the hiatal hernia repaired, my reflux disease is much improved,” she says, noting that she had been rushed to the hospital more than once with symptoms that mimicked a heart attack. “What a wonderful team.”
Area residents are benefitting from Dr. Hinnebusch’s instinct to collaborate, notes John Libertino, MD, director of Emerson Urology Associates. “I have operated with him on several occasions and find him to be an outstanding technical surgeon with excellent judgment,” says Dr. Libertino.
He and Dr. Hinnebusch performed successful surgery on a patient after she was told at a teaching hospital that her colostomy could not be reversed. “We look forward to ongoing collaboration with Dr. Hinnebusch.”