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Abscess in same spot as healed fistulotomy

Hi Everyone,

My 16 year old son suffered for 10 months with a perianal abscess when he was 14. After poor management we found a great surgeon. None of his docs including this colorectal surgeon have ever seen any signs of Crohn's related inflammation in the perianal, rectal or sigmoid colon. In fact, his intestinal crohns is only in his terminal ileum. His only first system was delayed growth and puberty. I am happy to say he is 12 inches taller than when diagnosed at age 13 and feels good when he has no abscesses!

Last Wednesday, he woke up with a small red swelling in the groove where the fistula surgery was done. It never fully filled in. His surgeon put in on augmentin and 2 days later it was a small abscess. It was drained and he is now pain free. He was never pain free last time. There is almost no drainage. Maybe a very very small amount in the pad.

We go back next Thursday to see if there is another fistula. I fear the skin never fully epithelialized and perhaps he got a surface infection and abscess or there is another fistula in a similar place. It was superficial and simple last time.

What do you think the odds are of it just being an abscess this time? Should we do another fistulotomy if it is simple and superficial so really no risk of incontinence. I am very hesitant to put him on remicade because of the increased risks with that drug in teenage and young men. I would like to put off that med until he is in his late 20's or longer if at all possible.

We are very glad we have a great surgeon now who is also very caring. Last time the drainage and management was so messed up that a 2"x3" abscess had to be "unearthed" during the fitulotomy.

Thanks for your input. We see GI next week. The last time he had an abscess he also had a bad small bowel follow through with a fistula. In August, the small bowel follow through was completely normal after 1 year on methotrexate. I want another one to see if there is a link. We should also get his fecal calprotectin results this week. That is a great indicator for him since his SED and CRP are never high.


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How is the area looking today?

I'm not sure what you should be doing to treat it. Sorry. Go through all the options with the doctor.

Regarding Remicade: I understand not wanting him to go on Remicade. Keep in mind the risks are very low. If he keeps getting fistulas talk to the doctor about the next steps in treatment. I got a perminant ileostomy years ago and one of the reasons was fistulas.

Sending you both my support.