Abscess -> Fistula -> Anger

[Bob31]

My husband is actually the one with Crohn's.

He was admitted to the hospital in July, after many years of refusing to go the doctor, and not on any maintenance medication, he gradually got worse and worse until he was forced to go to the hospital for it. He had an abscess. He was in there for a week, because he had mrsa, which they eventually cleared up. They put him on prednisone and other meds and released him.

Shortly thereafter (a few weeks), he developed another abscess in the area that the drain he had in the hospital was in. He went to see a surgeon, in addition to his gastroenterologist, who opened up the wound more fully so it could drain properly, showed him how to pack it daily, and sent him on his way.

That was in August. Since then, he's been to the ER five times, most recently this past Friday, he misses about one day of work each week, and he's thoroughly miserable. He isn't having any Crohn's pain, it's this stupid new abscess which apparently is now a fistula, according to the ER doc. Every time he goes back to the surgeon (he has an appt every two weeks), the dr just says it's healing very slowly, tells him to keep packing it, and sends him on his way. Three solid months of drainage. Three months of pain. He thinks the drainage is actually getting worse instead of better, but he could be a bit biased I suppose.

It seems to me that this is on the verge of ridiculous. They have surgeries to fix fistulas, don't they? Outpatient procedures? He can't keep missing work, and this can't drag into the new year (our deductible is quite high - his work doesn't offer very good insurance). Does it sound normal to continually pack a wound, an open wound he's had for over three months, rather than try another course of action? He's becoming depressed, he spends a lot of time sleeping, and it's hard on me too since he can't do anything and I have to tend to everything that might need done.

He has an appointment tomorrow with the surgeon, and has requested I go along, because he can't confront the doctor himself for whatever reason. Do I have reason to be upset at this doctor? Reasonably, that is.

Thanks for any help.

 

[DMS]

Sorry to hear that your husband is dealing with this.
I believe that Crohn's patients heal much more slowly than non IBD patients do, so for this reason it's possible that the Dr. wants to give it more time to heal naturally. My son has Crohn's (not me) and his symptoms started with an abscess as well, this was back in March 09. He had 3 fistulas, he has one that is still draining - 18 months later - Dr.'s do not want to do surgery as it may do more damage than good - fecal incontinence, etc.
This last fistula is very close to being gone, but it has been a long haul.

There are definitely surgeries to fix fistulas, but unfortunately they don't have a very high success rate, and sometimes come with their own complications, but this is certainly something that can be discussed with the surgeon, ask him what your options are - other than just packing the wound.

Is your husband on meds? Some seem to do a better job with fistulas than others.
Good luck at his appointment.

 

[DustyKat]

Hi Bob31 and :welcome:

So sorry to hear your husband is going through this. I don't have any experience with what you are going through but like DMS said, is he on any medication to assist with the healing process?

Where is the fistula located?

As far as the wound is concerned, depending on how deep and complex it is will dictate how long it will take to heal and then throw Crohns into the mix! Unfortunately some fistula's can take quite a long time to heal and the packing is going to ensure that it heals from the bottom up rather than heal at the surface, which could happen quite quickly, and then leave it to continue festering underneath.

I hope all goes well with the appointment, good luck! I don't know if you have cause to be upset as I haven't dealt with this but by all means ask all the questions you have here and don't let him gloss over it. Don't leave until you get the answers you seek!

All the best,
Dusty

 

[bouble]

I have Crohns, and have been suffering with continual falre-up's since diagnosis in July 2008. This weekend i went to my GP who told me i had a perianal abscess, which believe me is has left me bed ridden for 3days so far. I have been given a dose of Amoxicillin for a week, its my 3rd day on them and the pain is getting unbearable, it makes me wake up crying in the night.
I am worried that it may turn into a fistula, what are the differences between the two? And what can i do to ease the pain/heal quicker? Any comments much appreciated.

 

[DMS]

An abscess is the puss filled pocket that forms due to inflammation, the fistula is the tunnel that forms when the abscess is trying to find a place to drain. The fistula may go internally, or it may go to the outside, sometimes (often) both ways. Cipro and flagyl are usually the antibiotics that are first prescribed for an abscess, abscesses in the rectum are the most difficult to treat (according to our GI). My son was on antibiotics for 3 months - for him they did next to nothing, inflammatory markers were still high, lots of pain, abscess did not go away and developed 3 fistulas. In hindsight I wish they would have drained his abscess, I *think* he may have been spared the fistulas, but who knows. My son's abscess took about 2 months until it started draining, but it was very painful for a long time.

My opinion is that as long as your Crohn's is active you will not be able to heal the abscess/fistula. Once you get your Crohn's in remission your body can go to work on the abscess. This is just based on what I've seen my son go through in the last year and a half. My son is in remission now and his last fistula is almost gone.

To ease the pain - hot epsom salt baths, tylenol, that's all I can suggest.

 

[Bob31]

Thanks for the replies.

My husband is scheduled for surgery tomorrow. They're going to clean it all out and hook up a wound vac. The doc said that in a normal person, this clears it up in 3 weeks, so we can expect a longer period for someone with Crohn's. And if it isn't going so well, he'll prescribe Remicade. It's a fairly simple procedure that's done as outpatient.

My husband was so happy that something is getting done about it, he nearly cried. The dr is concerned that the fistula is now partially in his bowel, as my husband was having dark flakes that smelled bad in his drainage.