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Anastomosis stricture

Hi. I had surgery 7 years ago to remove structures in my ileum. Now a CT scan found narrowing at the anastomosis site. I was referred to general surgery. I will see new GI doc next month. Being in remission for 7 years meant being dropped as an active patient so I have to start all over with a new doc. I would love to hear thoughts from anyone with experience with this stricturing at the anastomosis. Thanks. Adam
 
To clarify a little more, I'm wondering how they will know if I have Crohn's inflammation or scar tissue or both causing my problem. It has responded partially to prednisone. I assume surgery is likely if the narrowing is scar tissue.
 
Location
San Diego
The narrowing at the anastomosis is very likely scarring that is caused by recurrence of the Crohn's inflammation. Recurrences at the anastomosis is very common after Crohn's surgery, and without inflammation there is probably no real good reason for a lot of scarring or other narrowing to form - hence the conclusion of likely of Crohn's inflammation being the culprit.
 

emmaaaargh

Moderator
Staff member
Yes, surgery really is the only way to deal with a fibrotic stricture, although the fact that surgery will eventually lead to scar tissue again means that it isn't usually considered until the stricture starts causing problems. MRI can be used to distinguish inflammatory from fibrotic strictures, probably CT also, but I've never had a CT so I can't confirm that. I had a slew of strictures in my small bowel, most of which were scar tissue, so I had surgery in November (strictureplasty in some areas and resection in others) to deal with them all. I'm happy to help if you have any questions about surgery!
 
Yes, surgery really is the only way to deal with a fibrotic stricture, although the fact that surgery will eventually lead to scar tissue again means that it isn't usually considered until the stricture starts causing problems. MRI can be used to distinguish inflammatory from fibrotic strictures, probably CT also, but I've never had a CT so I can't confirm that. I had a slew of strictures in my small bowel, most of which were scar tissue, so I had surgery in November (strictureplasty in some areas and resection in others) to deal with them all. I'm happy to help if you have any questions about surgery!
Thank you both for your reply! I figured that active Crohn's inflammation was the culprit. In my experience, unfortunately, I only get symptoms once a stricture has formed, once scarring has occurred. Before that, it's a silent process except for increased susceptibility to gi viruses the kids bring into the house. I really question former gi doc's approach after my surgery-no treatment until symptoms return. For him, you had to have diahrea and high crp to get his attention. I will probably advocate for treatment with meds regardless of symptoms to prevent this. I won't know about surgery for awhile-couldnt get appt with surgeon until May! I have an appt with new doc next week. Fingers crossed she is a good fit.
 

emmaaaargh

Moderator
Staff member
My recovery has been going well, all things considered. The plan was that I’d have a temporary ileostomy to let the surgery site heal without being irritated by stool flow, but we had to correct or remove much more of my bowel than originally intended, so my ileostomy is in fact a jejunostomy, because my jejunum is the closest bit of healthy bowel. Because of that, I’ve only got about 50cm of my small bowel in use currently, which means I’ve got short bowel syndrome until my reversal. I rely on total parenteral nutrition to keep me hydrated and well-nourished, otherwise I would pretty much be unable to survive, because the bit of intestine currently still in use is too short to absorb food or water adequately. But I was already on TPN at the time of my surgery (I was incredibly underweight from the Crohn’s flare, so I was started on TPN in the summer) so not a lot has changed for me.

Apart from adjusting to the stoma and the short bowel syndrome, recovery has been fine. I was in the hospital for a month because they couldn’t arrange for me to have TPN at home for many weeks, but I was probably fit enough to go home by the second week. I wasn‘t in much pain after my surgery at all because they gave me a spinal anaesthetic injection before they opened me up. Once I was walking and various tubes (a catheter, my cannula for my pain meds, the surgical drain in my abdomen) were removed I improved really quickly. But my surgery was sort of an emergency, and I wasn’t in the most optimal state physically (I was trying to gain weight for the surgery, but I was so close to perforation we ditched that idea before I hit my target) so my recovery took a little longer than the average person’s . It was still much faster than I expected it to be, though! As soon as I left the hospital a month after surgery I went straight back to work and I’ve been chugging along quite fine ever since.
 
My recovery has been going well, all things considered. The plan was that I’d have a temporary ileostomy to let the surgery site heal without being irritated by stool flow, but we had to correct or remove much more of my bowel than originally intended, so my ileostomy is in fact a jejunostomy, because my jejunum is the closest bit of healthy bowel. Because of that, I’ve only got about 50cm of my small bowel in use currently, which means I’ve got short bowel syndrome until my reversal. I rely on total parenteral nutrition to keep me hydrated and well-nourished, otherwise I would pretty much be unable to survive, because the bit of intestine currently still in use is too short to absorb food or water adequately. But I was already on TPN at the time of my surgery (I was incredibly underweight from the Crohn’s flare, so I was started on TPN in the summer) so not a lot has changed for me.

Apart from adjusting to the stoma and the short bowel syndrome, recovery has been fine. I was in the hospital for a month because they couldn’t arrange for me to have TPN at home for many weeks, but I was probably fit enough to go home by the second week. I wasn‘t in much pain after my surgery at all because they gave me a spinal anaesthetic injection before they opened me up. Once I was walking and various tubes (a catheter, my cannula for my pain meds, the surgical drain in my abdomen) were removed I improved really quickly. But my surgery was sort of an emergency, and I wasn’t in the most optimal state physically (I was trying to gain weight for the surgery, but I was so close to perforation we ditched that idea before I hit my target) so my recovery took a little longer than the average person’s . It was still much faster than I expected it to be, though! As soon as I left the hospital a month after surgery I went straight back to work and I’ve been chugging along quite fine ever since.

Wow! I wish you didn't have so much Crohn's damage to contend with. You sound like a good spirited, strong person which must serve you well. Can I ask what meds they are using to treat the flare?
 

emmaaaargh

Moderator
Staff member
Thank you! Well, everything we've tried so far hasn't worked at all - azathioprine isn't enough any more, and Remicade and Humira both failed. I can't get into to see the GI (I'm seeing one of the most senior doctors now because my disease is so bad, but he's understandably quite busy) until the end of March, so I won't know what they're thinking until then. Probably Stelara next.
 
That's so long! I say that because I know most treatments besides prednisone takes weeks to months to work. By the sounds of things, that amount of time is significant with your inflammation. I hope they get you in sooner. I was surprised that I have to wait until May to talk to a surgeon. Its ok though.
 

emmaaaargh

Moderator
Staff member
It is an incredibly long time. I was originally supposed to be seen next week, by my GI, but that appointment got cancelled because one of the most senior GIs wants to see me (I guess my GI didn't think he could handle me any more? Not sure.) and his first free appointment was at the end of March :(
 
Both times I had a stricture I went to the ER uncomfortably bloated and they immediately put in a tube down to my stomach to pump me out, giving me some relief. After x-rays they called a surgeon in to consult and I resigned myself to a procedure. Instead my GI doc put me on heavy Prednisone, and after a couple days things had calmed down.
Four years later I went in early when I felt the symptoms starting again. They admitted me, put me on Prednisone and it worked without the nose tube.
I had an ileostomy and reconnect in 1982 and went 31 years before inflammation at that site caused a stricture. Since my last one I switched from Humira to Entyvio. We'll see.
 
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