Abscess and Crohns

[BoyMama2000]

Hi Everyone,

My son as diagnosed with a mild case of Crohn's 16 months ago. It was isolated to the final inch of his terminal ileum. He had absolutely no symptoms or signs but his growth slowed and then stopped. He didn't gain weight fo 2 years. Since beginning pentasa, his iron normalized and he has grown 5 inches and gained 30 pounds. He was doing great but decided to stop taking his meds when away for a hockey tournament and staying with teammates.

He came home and got an abscess the next day. They did 1 week on antibiotics and then had to drain it. He feels good and at hi 5 day post op check up he feels he is healing well.

He said we will need to see how this goes and if it returns or becomes chronic, they may need to change meds. My question is....

Do these happen with flares or when things are unstable or are you just more prone to abscesses because of Crohns.

Should we ask for another set of scopes to see if things have spread?

Does he now have Crohn's in his anal region?

Thanks.

 

[KWalker]

Unfortunately abscesses aren't uncommon with crohns but we are more susceptible during flares. I have been dealing with terrible abscesses for years and unfortunately for many people, once you get an abscess you are more likely to keep having problems with them. I would definitely ask for a colonoscopy, especially if it has been a little while since the last just to see how things are going and if they are progressing.

 

[xX_LittleMissValentine_Xx]

I don't think it always happens during a flare. I developed fistulas and an abscess while having no other symptoms. But then them developing due to crohn's would indicate active disease so I suppose it depends what you call a flare. What I'm trying to say is, they can sneak up on you quietly!
Yeah I think you should ask for scopes and maybe an MRI or similar scan to see if it has been caused due to fistulas.
Good luck and I hope they don't cause him too much trouble!

 

[annawato]

i've had three anal abscesses years apart with no other sign of crohn's in the anal region (mine is also around terminal ileum). I have had anal fissures too but they've healed with no problem as did the abscesses. I've also had many intra abdominal abscesses due to sections of diseased bowel around the TI.
So having an anal abscess doesn't necessarily mean he now has crohn's in that region unless they continue and cause fissures and fistulas I wouldn't worry.

 

[gemmalouisee92]

hi im 20 years old and suffer with anal abscesses i was diagnosed with Crohn's when i was rushed into hospital with my first abscess in my bum at age of 15. ever since ive had quiet a few anal abscesses my doctor told me you do tend to get them when you have Crohn's disease you can get ulcers anywhere from your mouth to your anus. once you get one abscess they are most likely going to keep coming back. They can come and creep up on you at anytime whether your having a flare up or starting to get healthy. I was doing well didnt have one for about 5months i started to put weight on again and started feeling abit more healthier last week then all of a sudden come monday i have one the size of a golf ball in my bumcheek im in agony and i cant walk or sit down its horrible and very painful. Also i advise to have a sigmoidoscopy when i had an abscess before they put a camera up me and also found another two and they got rid of all three so its worth having tests cus they could be hiding anywhere just waiting to attack

 

[annawato]

Wow Gemma, you've been through a lot with them. I was fortunate that they were all relatively external and cleared up quickly. I've always been thankful that I havent had more because they are soooo painful.

 

[Ozboz]

Can you have one with no fever I'm in horrid pain lately non stop and feels like a lump on my lower left side thinking going to er on monday if things don't improve over the weekend and I had anal fistula bout 5 years ago never want to go through that again

 

[BoyMama2000]

Gemma, Sorry for your struggles with them. I could see how painful a small one was on my son (only about an inch long) and can't imagine one as large as a golf ball. Hope you get relief soon.

Ozboz, YOU CAN have one with NO FEVER! Most often you would only have a fever after it has been around a while. I would go to your doctor ASAP to get it checked out. It would be worth an appoinment today or tomorrow so you can get some relief and treatment. The sooner, the better!

It sounds like my son's was very mild but as we all know, only time will tell. How do you clean down there after drainage? Do you put any vaseline or antibiotic ointment on the area for a while?

Best of luck to everyone.

 

[BoyMama2000]

My son just called me. He is out of state at a tournament. Last night and today he has had pain in the same area of the abscess after having a large firm bowel movement. I ased my parents who are with him to by miralax and have him take a little to soften his bm's so it hopefully won't continue to irritate the area. He also took a hot shower. I really should have thought of that last night and sent him with some.

Do any of you experience increased symptoms after having a bm after the abcsess is drained? I am trying to figure out if it is healing normaly and being irritated or if the infection has returned to the spot. When it was drained there was not a lot of pus according to his surgeon and he had very little drainage. My hope and guess is that it is irritated and we need to get his bm's a little soft but I can't be sure since I can't see it. I did send him with augmenton. He wants to take it because he said the diahrrea he got from it was better than the formed stool! I told him our goal should be soft stool and not diahrrea which will also irritate the area.

I am interested in hearing about the healing post op from those who have experienced it.

Thanks

 

[gemmalouisee92]

yes annawato i have been through the wars with the things lol they are extremely painful. BoyMama2000 the best way to keep it clean is salt baths everyday and to use wipes instead of tissue vaseline and ointments could just annoy it because its healing. i am now going through healing an its annoying i have a salt bath in morning and a shower on the night constantly use a wipe to keep both my areas clean. not much else you can do. you still get in pain during healing and you still 'leak' i would only worry if lumps started forming as this could be a new infection

 

[BoyMama2000]

Thank yo! That makes sense. He is away so is showering a lot and it seems to be helping. His doctor's nurse sad to stop the vaseine/oinment too! It is a bit of a relief that this is normal healing!

 

[gemmalouisee92]

yeah showering will help alot it helps relieve my pain for a while anyway

 

[BoyMama2000]

HELP!! My son had to come home early from school yesterday due to pain. I could see puss on the outside of his abscess area. We did sits and a lot of pus came out with gentle pressure. I sent photos to the doctor and he thinks there is a fistula. His surgical drainage was 2 weeks ago. He wants us to call his GI which I already did. As far has his Crohn's, his iron was normal and he is growing like a weed so they felt it was under control with pentasa.
My questions are:
1. Will continuing with the sits and gentle pressure possibly work or would this be done if it was just an abscess? The surgeon does not want to do antibiotics.
2. His Crohn's is only in his terminal ileum (2 inches). Would he need to remain on 6mp or remicade long term or for a limited amount of time? (Of course, we may need to verify this is still the case.)
3. The surgeon did say that resection of his diseased area may work since the tissue around it was so healthy. Would any of you recommend seton placement or laparoscopic resection instead of using meds?

Do any of you have a more mild case of Crohn's and have had to deal with fistula treatment? I am not 100% comfortable assuming there is one without further testing but perhaps that is because this is all new to me!

Thanks for any input. I always truly appreciate your real life perspective and expertise!

Thanks.

 

[xX_LittleMissValentine_Xx]

Hey,
I would have thought it was better to have some kind of scan to understand where the fistulas are. Like an MRI scan.
There is always a chance his crohns has moved and a fistula is linked up to the rectum, or any other part of his intestines. I suppose a surgeon would have a better idea than me, but I don't see how you can do surgery assuming its from his terminal ileum.
Anything to keep the fistula/abscess draining is a good thing.
If the fistula is linked to the terminal ileum and a resection is possible - it might be the best way to get rid of the fistula. But it might be better to hear with someone with experience of this.
Good luck,
And also, this happened to me as well. The abscess built up again and kinda popped, two weeks after surgery. It was very frustrating!

 

[BoyMama2000]

When that happened to you, did you require more treatment than continued drainage of the area? I wonder why the surgeon wants us to discuss with GI before further eval as well. It seems to me we should investigate more before we plan more treatment or at least give continued drainage and antibiotics a try.

How did you and your docs manage after the abscess returned? Did they assume fistula as well?

Thanks.

 

[xX_LittleMissValentine_Xx]

We already knew there were fistulas there because they did an MRI scan straight after the first drainage. They also wanted to know if they had got everything in the op.
At the time it reappeared I think I was still on antibiotics. Then I didn't get anything for a few months. When I started feeling again after that it never drained out. So thats why they needed to operate in Jan to try and treat the fistula. I have a follow up appointment on Monday with the surgeon, so hopefully he will say its been successful.

 

[Catherine]

Hi

As very wise lady (DustyCat) told me. If there is fistula your not dealing with mild Crohn's anymore. Maybe this because of where Sarah's fistula is small bowel to small bowel.

You need to find out first whether there is fistula and go from there.

 

[BoyMama2000]

That is why I don't understand why they are waiting to do an MRI or further investigation. Anal abscesses frequently (60% of the time) cause fitulas in people without Crohns so we need to look at his big picture to see if there is a fistula and if there is, if there are sign of crohn's outside of his terminal ileum. Then we need to switch meds. If not, we need to determine the best treatment or the abscess and/or fistula. For some reason, they are content to wait and perhaps it is a cost thing. His GI said he would be surprised if it progressed since he is growing so rapidly and his blood looks good but of course, you never know! His bowels have also remained normal as they have always been and he said generally you see Crohn's colitis with perianal disease. Again, he said that is not always the case but usually the case.

I guess it is that waiting game time and I have a tough time with that! Time will tell as always.

 

[xX_LittleMissValentine_Xx]

I think that abscesses and fistulas can develop silently - they did to me. I felt well until I suddenly had an abscess and and MRI scan showed complex fistulas. For some reason there seems to be a belief they can only develop if you are really unwell.

 

[annawato]

The problem with resections is that the disease frequently returns where the bowel is rejoined so you don't want to rush in have one before its necessary. Thats why it would be good to have an MRI to see whether the disease in the TI is causing the anal problems. (can you get anal fistulas linked to the TI? I would have thought they were too far away but I could be completely wrong on this). The MRI would also show how the TI is going with the present meds - maybe the meds have helped the TI and this abscess is just by the by, or maybe it is because there is disease in the rectum too.
I'm not saying don't get a resection, just don't get one before its absolutely necessary. Everytime the surgeon goes in scar tissue is formed and this can create its own problems.
Re abscesses just forming, my intestinal abscesses have always just suddenly occurred without evidence of active disease beforehand, ie I had normal bowel movements etc. However when they have done an MRI there is extensive disease. So you think you are well but the crohn's is doing its own nasty little things inside.
I hope your sons abscess sorts itself out and doesn't form a fistula. Its tough enough being young with the disease without having to deal with that as well. Fingers crossed,
:heart: anna