Advice ASAP regarding ABSCESS recur #5

[BoyMama2000]

Hi Everyone,

My 15 year old almost had his abscess heal. Still no fistula seen on MRI but he is flaring according to fecal calprotectin and the abscess got more pus filled and looks so bad tonight! He is going in tomorrow for a small bowel follow through and then a visit with a nurse so we can learn to do methotrexate injections.

He doesn't have a fever. Will he be able to begin injections tomorrow? We don't have an appt. with a colo-rectal surgeon until August 8th and I fear he is going to need drainage #5 since things seem to not be emptying enough with the wicking material.

I guess we will be at the hospital but we won't be seeing any doctors. I plan to pack an overnight bag in case it is needed. He has hockey tryouts in 2 weeks and school in 3. He missed his spring lacrosse season because of this abscess and 4 weeks of school. I can't believe this is happening again right now.

Any advice would be appreciated!

 

[AaronMSB]

My guess is that he'll still be able to start the injections. I started methotrexate with an active infection. The drug takes 3-6 months to really activate anyways. Sounds like a seton is in order to keep the wound from healing and perpetually forming an abscess over and over again. Not sure where the abscess is, but these can help a great deal. Good luck!

 

[BoyMama2000]

Thanks, we did start it Thursday. The shot was easy to give and so far...no side effects but I know it is early. The abscess is looking a little better so I am hoping it continues to drain enough to allow him to function. We see an adult colorectal surgeon on Thursday. He did have a seton in (3 surgeries ago) but he abscessed around it. The MRI done with the seton in did not show a fistula so I don't think it was done in the right place or perhaps there was none there at that time. We will see if the new surgeon wants to look at the abscess and perhaps do an EUA to see if he can find a real fistula! My son's first surgeon is a pediatric surgeon and does not have a lot of experience with this.

He will be trying out for hockey in 2 weeks so I hope that we can put off surgery until after that time. The seton really hurt him last time. Perhaps that is because it was no in the right place.

In the meantime, I hope the methotrexate works! How did it work for you? Did hit help with perianal disease. His abscess is peri-rectal.

Thanks again.

 

[Sailorluna]

Are you saying he has a seton but no fistula? I did not think that was possible because setons are placed in fistula tracks...?

 

[BoyMama2000]

The seton was placed in what the surgeon thought was a fistula track in a prior surgery. He became septic and was readmitted 2 weeks after the surgery. He also missed 2 weeks of school while in severe pain. When he was readmitted, sigmoidoscopy and MRI were performed. The MRI did not show a track and the surgeon did not feel he got the right tract because he re-abscessed right after the seton placement and drainage.

I really do think he has a fistula that they are having a hard time finding. After his barium study, the drainage from the abscess changed to a similar color of the barium and is now back to the traditional pus color. I think that certainly tells us we need to find that tract!

We see the colorectal specialist Aug 8th. The issue is he has hockey tryouts (7 month season) on August 16-18. He need to be able to try out and so I am not sure when we could do another surgery. He also starts school August 22nd. We had all summer and of course it is right now that we are finally getting to the route of all of this. Ugh.

 

[AaronMSB]

The methotrexate has yet to really work for me (I started it 3.5 months ago so I hear that it's still a little early to be seeing results). I do have perianal fistulas (at least two different ones with 6 different external openings) and three new openings occurred since I've been on methotrexate while taking cipro and flagyl.

On thing they did at my visit to the Mayo Clinic was a peroxide treatment while I was under anesthesia. This was meant to help them find the internal opening of a fistula tract. They couldn't find mine, but supposedly it'll bubble out where there's an internal opening. You might suggest that to the surgeon that you see on August 8th.

Sorry I don't have any answers for you. I hope that your son is able to try out for hockey.

 

[BoyMama2000]

Thanks for your input. I will mention the peroxide treatment to the surgeon. I forget, do you have any in place or are they unable to find any fistulas? I hope you find relief soon. Do your fistulas develop into abscesses or do they drain without abscess development Have you ever tried remicade or other anti-tnf meds? Perhaps you should look into hyperbaric oxygen treatment in your area. I will let you all know if it gets approved and if it works. The doctor at the HBO2 clinic said there is a clinic near our home that does it in one person chambers that is not covered by insurance but is much less expensive. If it does not get approved, we may bite the bullet and pay for them ourselves to see if that helps.