Can growing up resolve a stricture

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condor

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My 14 year old teen has a 6cm stricture. He is on Remicade going for his third infusion. Could the fact that he is growing up enlarge the area of the stricture and he might not end up needing surgery?
 
Hi and welcome.

IMO, and that is all I can offer, no. Is it from inflammation or fibrous scar tissue?

If its the latter it will remain. Scar tissue eventually requires intervention (surgery or dialation). There is no medication available to eliminate it.
 
I'm just goin on my experience and I had surgery at fifteen for a stricture that perforated so I don't think growth will make a difference once your intestine scars it won't reverse itself.
 
At this point there is some inflammation but there is a concern for developing stenosis. No skip lesions were seen. He is having some very loud stomach noises, especially right after he eats. We are in the process of consulting a surgeon. Also, he is on a low residue diet otherwise he will have cramping.
 
I'm with MLP on this one not outgrowing stricture. Even if it was possible for you to outgrow and I don't think it is the amount of time this could take seems like it would not be the best option. 14 is such an important time in terms of growth and if he is like my son active disease equaled no growth and development.
If stricture is caused by inflammation then it might be possible to get rid of inflammation and thus stricture. So he is going for 3rd loading dose? Sometimes it takes a little while for remicade to fully work.
 
Thank you all for your responses...this has been very difficult for our family. My son is having a very difficult time accepting his condition. Last month he spend 8 days at the hospital due to an obstruction that resolved with IV antibiotics. It was an infection on top of chronic inflammation. Now we are trying to find the best pediatric surgeon in case Remicade does not work. The loud bowel sounds are making him very uncomfortable at school, he came home stressed out. We are trying our best to be strong for him.
 
Totally understandable.

It's a difficult diagnosis at any age but more so for the younger ones in the developing years.
I'd suggest looking into counciling for him. The psychological side of this disease can't take a toll on anyone.

I do want to encourage you. I was diagnosed young and lead a vary active life (flares require adjustments).

Sending all of you my support.
 
Does anyone know of a pediatric surgeon in the Dallas area that has experience in working with Crohn's patients?
 
Doesn't your Gi have a pediatric surgeon they work with on a regular basis for their crohns kids since surgery is extremely common for kids (75% within 5 years of dx)

I know our kiddie hospital has ones that know crohns well and Bering the Gi during surgery etc...,
 
Since my son is 14 years old could he been seen by an adult colorectal surgeon?
The GI thinks any of the pediatric surgeons deal with many abdominal surgeries.
 
What bothers my son the most are the noises his stomach makes... he can tolerate the pain my brave son but the noises are so loud and he feels embarrassed. He is even skipping homecoming this year and I think he is getting depressed. The GI thinks the noises are coming from the narrowing when food tries to pass through...
 
Has he had an mre ?
Typically the Loud noises are associated so woth the strictures which becomes very dangerous if they start to balloon - then it's emergency surgery .
Most still recommend a pediatric surgeon
Have you gotten a second opinion ( even just record review ) at one of the top three kiddie hospitals ( children's of Philadelphia , children's of Pittsburgh , or Boston children's )?
 
The noises are most likely stricture related. My son had them as well, but they went away after surgery.

I think you're on the right path for now, though I'd stick with a pediatric surgeon. Kids are so much different than adults in many ways and if your son is struggling emotionally with the disease, even little things like how the dr addresses your son when talking to him can make a world of difference. Like MLP said, your GI should be able to recommend one that he works with.

Getting a second opinion will help tremendously as well. If you can get a bunch of experts in the same room to determine if the stricture is from scar tissue or inflammation, it will be much easier to make a decision.

How are his labs? Are CRP and ESR elevated?
 
MLP, I will get the second opinion started, thank you so much for mentioning it I had considered that in the past but did not follow through. CRP and ESR were normal about 3 weeks ago. He had an MRE a month ago and there was a concern for developing stenosis with significant luminal narrowing and reduced peristalsis in the last 6cm of inflamed ileum- he had a an infection that ended up causing the obstruction. It was resolved with IV antibiotics and nasogastric tube.

Mehita, I agree with you about staying with a pediatric surgeon. How was your son's recovery from surgery? My E. is worried about missing a lot of days at school. I hope your son is doing well, my heart goes to all the kids who have to endure this diagnosis.
 
condor said:
Mehita, I agree with you about staying with a pediatric surgeon. How was your son's recovery from surgery? My E. is worried about missing a lot of days at school. I hope your son is doing well, my heart goes to all the kids who have to endure this diagnosis.
Click to expand...

His recovery was pretty smooth. He spent 6 days in the hospital, came home on a a Thursday and was back at school that following Monday. They aren't allowed to do gym class or lift heavy items for 6-8 weeks.
 
Mehita, was his surgery done by laparoscopy ? I still don't know what kind of surgery they will offer my son, his area affected is the last 6 cmm of the terminal ileum probably affecting his ileocecal valve. We are concerned with the possibility of him living without the valve and the consequences. Our hope is that the Remicade will work but meanwhile we are preparing ourselves with the possibility of the surgery. He never had diarrhea, his problem is constipation, even before his diagnosis.

It seems like your son did quite well and I am very happy for him.
 
My son had an ileocecectomy August a year ago. He was 17 at the time. He was in the hospital for 4 days (would've been less but pain meds and his bladder have never mixed well) out of work (part time high school job) 8 or 9 days in total. He went to a flex school and was independent study so he didn't attend every day just on Thursdays for testing and projects. So he had surgery one Thursday and went to the school the following Thursday. No lifting over 10 lbs for 6 weeks.

The ileocecectomy included an area leading up to the ileocecectomy valve, the valve and of course the cecum so that the small and large good be rejoined.

He has said numerous times that surgery pain for him did not even compare to the pain of CD flares he had had in the past. Not really sure since he had been asymptomatic with active disease for over a year before surgery.
 
condor said:
Mehita, was his surgery done by laparoscopy ? I still don't know what kind of surgery they will offer my son, his area affected is the last 6 cmm of the terminal ileum probably affecting his ileocecal valve. We are concerned with the possibility of him living without the valve and the consequences. Our hope is that the Remicade will work but meanwhile we are preparing ourselves with the possibility of the surgery. He never had diarrhea, his problem is constipation, even before his diagnosis.

It seems like your son did quite well and I am very happy for him.
Click to expand...

His stricture was near the end of the jejunum, no where near the terminal ileum, so that wasn't an issue for him. They also removed his appendix so that if he ever complained of pain in the future we could rule out appendicitis right away.

His surgery was supposed to be laparoscopic, but they ended up making a vertical incision about 4 inches long through his belly button. So he has that and the three smaller lap scars from their initial hope to do everything laparoscopically. Being a boy, he says he doesn't mind the scars and assumes he'll have a hairy belly someday to hide the scar. It's not pretty, but he had some issues with it healing.

Hopefully, Remicade works for your son. While the locations are different, it sounds like the quality of life between our boys is/was very similar. What really confirmed our decision was having the radiologist, GI, and surgeon all get together and determine that his stricture was from scar tissue and his small intestine was only 3mm in diameter in that area. Sort of a no brainer for us and very life changing for him.
 
My son had his third Remicade infusion. We have noticed that after every infusion he develops cramping and the loud noises come back for a few days. Could it be that Remicade is working on healing the inflammation and creating more scar tissues? At this point I don't really know what to do, the GI wants to put him on Entocort and repeat the MRE in December. Meanwhile we have an appointment with the surgeon.
 

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