Elective bowel resection - how to decide ?

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Hi
I have been advised by my doctor to have a bowel resection because of scar tissue as a preventative measure.
Some background: diagnosed in 2000 and didn't have much problems except for an obstruction in July 2013 that I had to go to hospital for. Following that experience I started on on 6mp 100 mg and remicade (infleximab) for a year. My blood tests have shown no sign of inflammation and that I am responding really well to the medication. However I continue to have symptoms of loud gas (internal) with pain and occasional diahrea But not symptoms that are like my original flare strong cramping etc. they feel different almost like bad PMS overall my health has improved but because I'm not feeling 100% still my Gi sent me
For a MRI which showed a portion for the bowel ( same spot as previous obstruction ) with strictures and narrowing and bad scar tissue build up around 10-15 cm which has pretty much stayed the same this past year compared to my previous scan. He recommended I have surgery to remove the infected area as there is a chance I can end up in emergency surgery with an obstruction.

Just wanted to hear from others of any similar experience and to be reassured that I am making the right choice for surgery and it's possible side effects rather then living with the risk that I might need emergency surgery some time down the track. I am also concerned that maybe most of the discomfort I am feeling now could possibly be related to the medicine I'm on and not the crohns....
Thanks
 
Hi Sandraleed and :welcome:

First up I don’t have Crohn’s, both of my children do and both have had surgery but for different complications.

Unfortunately when you have scar tissue no medication will penetrate it so it never gets any better. While ever you are symptom free you can live with things the way they are but once the symptoms start, as yours have, then surgery really is your only option. :(

Coming from the angle of emergency surgery versus elective then elective surgery wins hands down every time. One of my children had emergency surgery for a ruptured bowel and it is a place I would not want to find either of us in again. You have no control, you would likely lose more bowel and you may end up in ICU if an obstruction leads to rupture. On the other hand with elective surgery you are in control, the risks are significantly reduced and recovery is normally quicker as you are in a much better physical state.

Surgery is never an easy decision and even less so when you don’t feel an urgent need for it so I hear where you are coming from. :ghug: But again elective surgery is preferable over emergency.

Since you do have time on your side perhaps you could seek a second opinion?

Have you consulted with a surgeon?

Dusty. xxx
 
I'd get a second opinion, but consider surgery very seriously, especially given the scar tissue.

A bit if background - I was diagnosed in 1990, ended up in remission for quite a few years and started having issues again in late-2009. I had a scope in late 2010 in which they could not get the scope through. A CT scan showed narrowing. A scope in early-2011 had the same result and I ended up in the ER later that day with an obstruction. I had two surgical consults in 2011 and it wasn't the time for surgery.

In 2013 I began to lose weight, have a lack of appetite and experience abdominal cramps which progressively got worse. Another CT scan showed the stricture was still there and my GI said it was not a question if I needed surgery but when. I late 2013 I scheduled another surgery consult, had the consult in January 2014 and had surgery in February. The surgeon scheduled a CT colonography between the January consult and the surgery so he would have a better idea of what he was dealing with as they could not get the scope through on the previous colonoscopies.

I had the surgery and would do it all over again. I didn't realize how sick I was. Talking to the surgeon at the follow up appointment 2 months after the surgery, he mentioned the pathology report noted the bowel was beginning to perforate.

I waited for a couple of years based on the initial surgical consults, but would not have wanted to wait any longer.

I'd recommend talking to your GI about a surgical consult.
 
My resection in 2010 was the best thing I could have done. I too was more sick than I realized,
 
As someone who just had a small resection at my Dr's advice, if I were to do it again I would think about considering a strictureplasty instead of a resection. I am still trying to figure it out but I think I have another stricture (called anastomotic stricture) after surgery. If you dont have inflammation then a widening instead of a removal may be something to think about...or at least worth asking and seeing what the Dr's response is.
 
I believe that is done via an imaging scan or colonoscopy. From the articles I have read, determining the source of the stricture is very important in determining treatment. Inflammation will react to meds but types of scarring will not. I think they can even tell how deep the scarring is etc.

Despite having an asymptomatic stricture for about a decade, I'm now just reading about them as it does seem that they become a larger problem as Crohn's progresses and will impact changes to someone's treatment.
 


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