Advice on Surgery

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Jan 23, 2014
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Hello,

This is my first post, but I have been reading many stories/experiences throughout this forum. It is nice to know I am not alone!

First, my story: On Dec 2, 2013 I started to feel a strange pain in my lower right abdomen. After it had not subsided by the weekend, I decided it was best to go to the ER and to get it checked out. After a CT scan, I was told it was an abscess growing near my terminal ileum, most likely caused by Crohn's disease. This was news to me! The abscess was not very large, so the doctor's put me on antibiotics (ciproflaxin and metronidozal) and sent me on my way. I scheduled a follow-up appointment with a gastro doctor ASAP, who then scheduled a colonoscopy and CT scan to get a grasp on what was happening in my intestines. A few weeks later, the colonoscopy revealed severe inflammation near the terminal ileum the doctor could not even get the camera past. The CT scan a few days later revealed the abscess had grown, and the doctor called and informed me that I need to go immediately to the ER to get it drained. I did as I was told, and had a drain in place for 5 days. The surgeon decided that it could be removed so I happily went to his office to remove it. I felt good, and was eating well. 4 days later, I feel the same pain back in my lower right abdomen. I knew what it was, so I go back to the hospital to have another CT scan performed to confirm. As suspected, the abscess has regrown, and another drain is placed. I have this drain in me for 10 days. Since I had it removed 7 days ago, I have felt fine besides some tenderness near the wound, which I expected.

In all, I have been on antibiotics (metronidozal and ciproflaxin) for 7 weeks. I have lost 15 pounds. This is a large amount as I was already lean at 145 pounds standing 6 feet tall. I have had 4 CT scans, 2 drains placed by CT scan, a colonoscopy, and an MRI and have spent a combined 9 days in the hospital since Dec 7th, 2013. Also, I am a 24 year old male, for what it's worth.

Throughout this process, I have been in discussion with my GI doctor and Surgeon. They both recommend I have the surgery ASAP in order to remove the diseased part of the intestines, and "move on from it". They will be removing 6-10 inches of intestines between the large and small, and will remove my appendix. The goal is to perform this laproscopically which will result in 7-10 days of recovery time. If they are forced to slice me open further, the recovery time shoots up to 4-6 weeks. I will then be placed on medicine to ensure there is no flare-up in that area.

The other option is to start a trial-and-error process of finding medicines that make me feel better, which may take some time.

I have never had surgery, so I am hesitant to quickly sign up for it. If I feel fine, why commit myself to several weeks of recovery time? I know that ~80% of people with Crohn's end up having some type of surgery, but I also know that this surgery is in no way a guarantee that further surgery will not be needed.

Is there anyone who was placed in a similar predicament. It would be nice to hear about those who chose either of these paths (medicine vs surgery). Thank you for your time.
 
Well, I will say this... my doctor (and surgeon) have always tried their best to make sure I could put off surgery as long as possible. My IBD doc doesn't want to resort to keep taking out intestines until it is absolutely necessary.

With that said, I have had two surgeries. I was diagnosed in 1998, with a surgery in 2007, and a surgery two weeks ago. These surgeries were absolutely necessary as I had started partially obstructing a lot more often, and with foods that shouldn't really cause this issue (breads). This meant things were way too small and needed to be removed.

Overall, they had tried to use medicine as long as they could keep things moving through. They said as long as I wasn't having many issues in regards to obstruction, etc. that I could keep putting it off. However, if you are more often than not having issues... then it may be wise to get the bad part taken out...

In regards to recovery, while I am young (25), I tend to heal quick. Both surgeries I have had.. I was back to work within 2 weeks time. This time, I came back to work on Monday... meaning 1 1/2 weeks following my surgery. Many people seem amazed at this, but I had the willpower (and really did whatever I could... including walking 3-5 times a day in the hospital starting the day after my surgery, and only used narcotics for about 4 days). They did my surgery laproscopically, though even less invasive than that... as I only had one 2 inch hole opened up... without any port holes like I had in my previous surgery.

Either way, this is just my own experience with this all... take it for whatever you want. If you are having more issues more often, it may be wise to take the plunge and get the intestine removed. This last surgery, I had 40 cm removed (so about a foot and a half)... and I recovered quick. I only have some pain yet, and some oozing of part of the area at this point (a day over two weeks following surgery). Just up to you, and how well your body can tolerate pain/heal.
 
Hi Jackofall and :welcome:

I’m sorry to hear of all you are going through. :ghug:

First up, once you reach the point of abscesses then you have started to develop complications and that puts you in the realm of severe disease. Since your abscess reformed following drainage did they do any tests to rule out a connecting fistula?

Medications: You may have to two issue when it comes to treating your Crohn’s with medication in its current location and your recent complications and that may be why both the GI and the surgeon are recommending surgery to you.
Firstly, abscesses are deemed serious infections and if there is any hint that they will be an ongoing issue for you then biologics, the big guns of treatment, are contraindicated.
Secondly, if you do have a fistula then unfortunately fistula’s originating in the terminal ileum are notoriously difficult to treat with medication, unlike those in the perianal region.

Whilst it is true that in many cases that surgery is considered a last resort there are studies that have in the past suggested that ileal Crohn’s is best treated by surgery…

To argue for immediate surgery in all cases of Crohn's disease would ignore the potential for morbidity following surgery, and dismiss the beneficial effects of medical therapy, particularly with the possible advent of an exciting new era of immunomodulation. However, it is clear that surgery is mistakenly considered the “villain” in the management of this complicated disease. The evidence presented above should enlighten those entrenched clinicians and persuade them that not only is surgery an extremely good therapeutic modality for Crohn's but delay can lead to significantly greater pre and postoperative morbidity and significant decay in quality of life compared with implementing appropriate and timely surgical intervention.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773273/

…there continues to be studies suggesting that surgery for ileal Crohn’s is still, in a number cases, the preferred treatment outcome even with advancements in medication therapies.

I don’t have Crohn’s disease, both of my children do. They both required surgery very early into their diagnosis due to complications of fistulising disease and abscess, actually one was diagnosed on the operating table. They have both had the surgery you may face and both have had wonderful outcomes. That is not to say that surgery may not come with own its own set of legacies but it doesn’t negate the fact that they have both been in remission since surgery 7.5 and 3 years ago respectively.

Good luck with the decisions you are faced with and remember, there is no such thing as a wrong decision in these matters just different ones.

Dusty. xxx
 
Hi Jack. So sorry to hear of your issues. I had an internal absceds and fidtuls too. Dusty wsrnef me at the time that they rarely heal with meds. My local GI referred me to the mainland for surgerg. But when I got there, the GI there decided to put me on Infliximab. After 3 infusions i had a clesr colonoscoph so they stopped the infusions and kept me only on the Aza. My symptomd returned a few months later.
Within a few days of the surgery I could tell the difference. It was like being back to normal for the firdt time in two years.
 
Yes Grumble, you blame the phone. Ahahahaha

I just thought it were getting a wee bit mixed up with the English and Gaelic.
banana-with-kilt-smiley-emoticon.gif
 

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