Do a surgery or not? please help

[gryzelda]

Hi, I’m looking for some help to make a decision about a surgery.
I’m 22. I have Crohn’s disease for almost 2,5 years. I sometimes had abdominal pain and a little bit looser stool (but once a day). I had a colonoscopy and doctors gave me mesalazine, after one year they added azathioprine and now adalimumab. But in MRI I had in March doctors found some narrowing in terminal ileum and in ileocecal valve. For 3 weeks I sometimes feel some bigger mass in the right abdomen, but in 1 day that feeling goes away. One week ago I had an ultrasonography - doctor found narrowing and a little bit wider intestine before the narrowing. My doctor suggest me to do a resection about 20 cm of ileum and a valve. Do you think it’s a good idea? Now I feel very good, no pain or discomfort in abdomen. I’m afraid that after a surgery I’ll have diarrhea because of a resection and of more frequent intestinal infection. I’m studing and it’s important to me to be able to continue my studies Please, help me
Sorry for my bad English

 

[Guerrero]

Hi gryzelda,
Your doctor suggest a surgery as the widening before the narrowing means the food stay a bit stuck there, and there may be a risk of intestinal obstruction.

However instead of resection modern surgery favour stricturoplasty as a conservative approach to avoid losing the length of your ileum. You could maybe ask if strictureplasty is possoblenin your case or seek for a second opinion.

Also switching from humira to another biologics may also help

 

[gryzelda]

Thank you for your answer
I've talked to a surgeon recently and said about stricturoplasty. But he said that this method is used when a patient has a short part of intestine left after previous surgery, because that part of intestine narrows in a few years again I was sad he said this beacuse I hoped I could avoid resection. Do you think I should insist on stricturoplasty instead of resection?

 

[ronroush7]

The disease will eventually come back but I tend to agree with the surgeon.

 

[Guerrero]

In my case strictureplasty was the first approach but I had many strictures (like 5 or 7 I dont remember) so maybe this was too long to cut.
You are also young so maybe it could worth a try asking a second opinion to another surgeon with good experience in strictureplasty.

Usually cutting "only" 20 cm shouldnt lead to small bowel syndrome (more diarrhea etc...) , but cutting the valve could make you go more often to toilets, but ask your doctor about that as i'm not 100% sure.

I hope someone else can share experiences about strictureplasy or resection of the valve.

 

[gryzelda]

Hi again, thank You all for answers
I'm after an appointment with my gastroenterologist. He said that according to him the surgery isn't necessary now because it's a high risk that the disease will soon come back in the anastomosis after surgery and another ones will be needed and I'll loose more and more intestine.
Now I feel very good, no abdominal pain, discomfort, normal stools etc. I'm afraid that I'll choose wrong, especially that doctors say different things

 

[ronroush7]

Maybe you should go for a second opinion.

 

[dzwilks]

Hi. I am 57 years old. I had a resection losing my ileocecal valve, 20 cm of ileum, and 10 cm of colon. That was 16 years ago. I did have recurrence at the site after my first colonoscopy.
Over the years, however, I usually had no symptoms of Crohn's. I did continue to medicate with various low risk medications. Most recently my doctor added Humira.
I did not have diarrhea due to the surgery. I started to get diarrhea recently but the Humira took care of that.
I am very happy that I did the surgery. I was in terrible pain and that has never returned, thank God.