E.Coli in previous abscess s/p trauma andloss of bowel. ileostomy with fistulas

[lintn]

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Hi everyone.. I need help. My son was hit by a truck while on motorcycle July 30th. Besides other injuries, he has lost all bowel except 150 cm of small intestine. The remaining intestine has two fistulas where anastamosis were placed and sloughed off. 8 weeks ago developed peritonitis with an abscess on his left side (affected side of other injuries) and continues to have e.coli and strep (drainage cultures) drainage from this area. Ct scan with contrast showed no VISIBLE communication between the ileum and the pocket where abscess was.
e.coli lives in bowel... there must be a thin communication to the pocket for E.Coli to be in granulating tissue? or is there possibly retained e.Coli in tissues granulating pushing this drainage out that still contains the bacteria??

 

[Catherine]

Welcome to the forum, sorry you had to find us.

Paging DustyKat.

 

[DustyKat]

I am so sorry to hear of what your son is going through. :ghug: What an awful time it must be for you all.

Just a couple of questions about the abscess and drainage:

Does he have a drain in or did they drain the abscess and take the drain out?

If he has a drain in is it being flushed regularly?

Staphylococcus aureus isn’t an unusual pathogen in an abscess but Streptococcus on the hand is more unusual. E.Coli would certainly raise the question of a fistula if it remains as a pathogen when the infection is being treated. If your son doesn’t have a drain in but needs to have to have the abscess repeatedly drained then something is feeding into it.

What antibiotics is he on?

I wouldn’t necessarily rely on a CT scan to visualise a fistula if their is any sort of inflammation present around the ileum/abscess as this may obstruct the view. If your son has a drain in place or will be having one placed to drain the abscess I would request a sinogram be done. What they do is place the drain under CT guidance, once the abscess is drained they inject dye through the drain into the abscess, they are then able to track if the dye leaves the abscess via a fistula into the bowel.

Dusty. xxx

 

[lintn]

Thanks but I think both of us are confused/
In his remaining bowel he has two fistulas that are midline ileum and are closing. He has had abscess for about 7 weeks on his left side. The doctors placed a pigtail drain in for drainage. It is flushed once a week. The catheter may be contaminated. or the bag. unless you change it out, one would not know. Anyway, trying to figure out why still draniage

 

[DustyKat]

Is your son on antibiotics?

How long has the drain been in?

It is not normal for an abscess to keep draining after a few days if it is a closed abscess. Continued drainage would normally point to fistula draining into it and hence the continued drainage into the bag.
Would it be possible that he have a sinogram done? That way you will have definitive answers as to whether a fistula is indeed present and the cause of the continued drainage.

As to contamination, if there is a bowel to abscess fistula then it isn’t a clean system any way as the bowel is not a sterile environment. Do you think he may have contamination from an outside source?

I know I am coming from an Crohn’s perspective when I say this...my son had a pigtail insitu for 3 months and he did have a fistula. The regimen of flushing for him was initially 3 times a day and after about a month reduced to twice a day for the entirety of the time it was in.

Dusty. xxx

 

[lintn]

Thanks... he had a ct done and they could not identify a "trail of contrast " leading from bowel to abscess. But obviously there is one. i wonder if mri would be better...

they flush only briefly couple times a week. drainage is about 10-20 cc/day

 

[DustyKat]

I would still recommend a sinogram/fistulogram, it goes the opposite way…abscess back to bowel or an another organ. It is more accurate and targeted than a straight CT/MRI.

Dusty. xxx