Abdominal fistula / wound sinus.

[bigtruck]

I've had an wound sinus / fistula on my right groin near hip bone, it is a result of where an abscess had been drained. It has healed only to present as a large blister and then burst, this is the third time in a year this has happened , very occasionally I will pass gas through it. Most times wound swabs come back clear and there isn't any smell of the discharge, it is also accompanied by groin and hip pain. I am at my wits end with it anti biotics ease it / clear it up for a while but then it's back to square one. Various tests inc CT, MRI and dye ran upwards from the rectum can't find any connections. Has anyone else suffered this? Every time I think I have it sorted it whips my ass again, I'm currently waiting a loop colostomy reversal for which my midline will have to be re opened, during which my surgeon intends to "have a look" , I am seeing my gastro doc on the 11th as I am not currently on any medication.
I know infliximab would be a good bet but unfortunately I'm allergic to it, anyways if you've got this far thanks for reading and any help or anyone in the same boat I'd love to hear from you.

 

[DustyKat]

Hey bigtruck,

If you pass gas through it there must be a connection somewhere as there should be no free air in the abdominal cavity. Also the fact that it keeps reforming would suggest a connection too.

When you say you have had it drained, has the drain stayed in and a sinogram done to see if the dye runs directly from the abscess back to the bowel?

My son had a right psoas abscess, to me this sounds like where your abscess may be located?? He had a pigtail drain inserted and 5 days later a sinogram. They did find a connecting fistula so the drain stayed in for 3 months until he had a resection to remove the fistula. The reason for the 3 month wait is because they were waiting for his inflammation to go from acute to chronic. During this 3 month period he remained on antibiotics and the combination of the drain and antibiotics did resolve the abscess prior to surgery.

Dusty. xxx

 

[bigtruck]

Yes it's an old psoass abscess site, the reckoning is it may be a pin hole somewhere that only opens occasionally! I don't have a drain inserted it just drains itself. I personally think that there is an inflamed piece of small bowel below it, but will have to wait until I see the surgeon. Hopefully it can be found.

 

[DustyKat]

Matt's perforation was only micro so the fistula could never be visualised by imaging alone. It was always suspected but could only be confirmed by a sinogram. Maybe the next time it occurs they should insert a drain and do a sinogram and see if they can pick up the connection that way?

I hope they can get it sorted for you. Good luck!

Dusty. xxx

 

[bigtruck]

They seemed to think if they tried that the dye would just run into the peritoneal cavity, I will be asking him about it anyway when I see him thanks for the helpful advice.

 

[bigtruck]

Latest swab test clear! How does that work?

 

[DustyKat]

Having a wound more often than not does not equate to an infection.

When looking to infection a swab is only one part of the process and often is not even considered necessary unless you have other supporting evidence. What is your White Cell Count? Is the discharge offensive? Is the skin surrounding the wound inflamed?
If none of these things is abnormal then the exudate (discharge) produced is the bodies normal response to trying to heal a wound and so a swab will return a negative result for infection.

You have at the very least a sinus, this means the opening to the skin is usually small and so will heal over on the surface but the track remains open underneath. While ever that track is present the body will try and heal it. As a part of the healing process the body produces wound fluid or exudate. Now in your case you have a closed track so where does that wound fluid go? It builds up in the track until the pressure becomes so great it bursts through the skin again. The pressure is now gone, it heals over on the surface and then the process begins all over again. Until that track is removed or the wound is made big enough to pack and so allow healing from the bottom up it will continue to happen. Hopefully when you have the reversal done they can deal with this also.

Dusty. xxx

 

[bigtruck]

Yes the surgeon calls it a sinus, the fluid that comes out has no smell at all, hopefully as you say he will be able to do something with it when he does the reversal, his secretary seems to think that'll be another 2-3 weeks. My crp has been as low as 6 in recent weeks so I suppose for a crohnie that's not bad, just my hateful sinus to stress me out. Cheers dusty.

 

[mewringo13]

I've got a fistula that developed from a drain from an inter-abdominal abscess that I had back in July... and it ended up connecting to my colon... for almost 2 weeks it was dry and healed over... and then it was swelling and looked like a zit... I ended up popping it after a a day of watching it... it was healing till i decided to be a little rough with some of my cousins and I had some stool come out of it... so far all i can do is clean it up with baby wipes and spray some neosporin+pain onto it and cover it with 3x3 gauze and apply pressure lying on my back... it sucks cause its in my left hip area and i get a burning sensation or sometimes it feels like somethings going to pop... I have been walking with a cane when I am at home... once i am up im ok but its just getting to that standing position that is bothersome... i am considering surgery cause I've been dealing with this for 6+ months and its getting tiring...

My doc isn't too worried about it since it can be taken care of anytime... as long as im not going septic (thats really bad) and running seriously high fevers or in a lot of pain.... but i am going to see him tomorrow about this... good luck and I hope the right decision comes to you!

 

[bigtruck]

Off to see my surgeon on mon regarding abdominal fistula as it can be fine for weeks then temp fever and pain arrive it then seems to produce a lot more fluid, after that a course of antibiotics settles it down again, I'm starting my second week of 6mp so it's going to be a while yet to see if it helps. Hoping the surgeon can offer some help as I am nearing the end of my tether now and finding it very hard to cope at the min and cannot see any light at the end, I am finding its making me a very grumpy man. Hope everyone is doing well.

 

[Grumbletum]

Ugh, I hope they can do something to get you some relief. No wonder you're feeling grumpy :-( How are you doing on the 6mp re: side effects etc?

 

[bigtruck]

The 6mp doesn't appear to be causing much trouble at the min, I'm still on 50mg daily to increase to 100mg in another week.

 

[bigtruck]

The fun keeps coming a sinogram is where we're headed next! This disease just keeps giving!