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Congenital Defect of the Windpipe: Surgery Saves Douglas' Life

"He's really a trailblazer."

Douglas Keats was born with a congenital defect of his windpipe, making it hard for him to breathe, particularly when taking his bottle. He had surgery at Cincinnati Children's to create a properly sized airway. Today, Douglas is doing all the things any young boy does, including enjoying some ice cream with his older brother, Patrick.

"We're done. He's back in recovery. He's doing great," Dr. Rutter said to Douglas' parents.

It's good news for Russell Keatts and Marshann Kinman. Their four-year-old son, Douglas, is getting a clean bill of health from Cincinnati Children's Hospital Medical Center Associate Professor of Pediatric Otolaryngology Mike Rutter, MD. Dr. Rutter has just performed a procedure to check Douglas' trachea (or windpipe) to make sure the young boy is breathing normally.

"It looks great. It's wide open and it's the right-sized airway that a boy his age should have," said Dr. Rutter.

A Frightening Beginning

Douglas wasn't always able to breathe normally, and he didn't always have the right-sized airway. Douglas was born with a congenital defect of his windpipe. It made his first few days of life very difficult. "He was breathing hard when he took a bottle and it got to where they had to put a feeding tube in," said Marshann, Douglas' mother.

Doctors at Cincinnati Children's discovered Douglas' windpipe had not properly developed. "His upper trachea is absolutely normal and you're going down everything seems normal and then suddenly, his trachea disappears and that tiny little hole is what he's breathing through and how he survived is quite remarkable," said Dr. Rutter. "Normally you're born with your trachea supported by little rings of cartilage and Douglas was missing a few of those and that's a very rare find. I believe there are only four children in the world that I know of who had that problem."

Four Hours of Life-Saving Surgery

Douglas' airway was so narrow doctors could not see what was beyond the pinhole. Douglas, now less than a month old, needed surgery right away.

"It was terrifying. When I came home, Marsh was crying and saying what are we going to do. I said, he'll be all right, he'll be taken care of," said Karen Kinman, Douglas' grandmother.

The Division of Otolaryngology / Head and Neck Surgery at Cincinnati Children's has a world-renowned program to treat ear, nose and throat problems. Specialists here have performed more than 1,500 airway reconstructions.

In Douglas' case, Dr. Rutter and a team of specialists decided to perform what is called a slide tracheoplasty. It would require putting Douglas on a heart-lung bypass machine as well as making a large incision in his small chest.

"A slide tracheoplasty is where if you've got a very narrow segment of the trachea, you cut the trachea in two and one end you split at the front. The other end you split at the back and you slide the trachea across itself. So you go from narrow to shorter but much bigger," said Dr. Rutter. "This was not an operation we developed but I think we've taken it to new horizons. We've been able to apply it to far more children that was ever initially envisioned for this operation."

A New Beginning for Douglas and His Family

The operation was a success and just one day after the surgery, Douglas was breathing normally. "And as you keep going down you can see his trachea is now normal," said Dr. Rutter.

"Cincinnati Children's did an excellent job...made every effort to make sure the surgery went through correctly and made sure we felt at ease and all our needs were met," said Russell Keatts, Douglas' father.

"The difference at Cincinnati Children's that sets us apart from the other centers in the world who care for these very rare problems of children born with very narrow tracheas has been primarily the team approach in combination with this technique of the slide tracheoplasty," said Dr. Rutter.

Douglas quickly recovered from his surgery and was soon doing all the things any young boy does, including enjoying some ice cream with his older brother, Patrick. "He was just a different child when I brought him home," said Marshann. "I was amazed," Marshann's mother said. "I was thankful that we had Douglas because we could have lost him real quick and he's a blessing every day."

Douglas will still have his trachea checked from time to time, and what he probably doesn't realize at this age is that not only is he making medical history, he is also helping the doctors at Cincinnati Children's.

"He's really a trailblazer. So if I know that he's never had a problem as he grows up, then if I look after someone else like Douglas in the future I'm going to have a much better idea of what I can tell that child's family about what the future holds for them," said Dr. Rutter.