Enterovesicular Fistula

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Jul 19, 2011
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I was diagnosed with Crohn's with 13. At that time I had an abcess drained due to a perianal fistula. I took several medications including Prednisone, Flagyl, Asacol, 6mp, and Prevacid. I'm not sure which combination did the trick at the time, as it was 12 years ago, but after a couple years I eventually went into 'supposed' remission when I was 16 or so and stopped taking meds altogether although i was left with a nasty scar from abcess/fistula.

Cut forward to January 2011, I'm now 25. I started peeing blood and went to the ER with a bladder infection. They put me on Cipro for 10 days. I felt a little better, but after a couple of days my symptoms were back with a vengeance. I started peeing air in addition to the blood. I ended up getting a fever of 104 F and was hospitalized with a severe kidney infection. During my stay I met with a GI and told him all my symptoms. He determined that I have a fistula into my bladder from somewhere in my intestines. He did a colonoscopy and found a bit of bleeding but no fistula and concluded that it must be in my small intestine somewhere. I had TONS of bloodwork, a few X-Rays, and a Cat Scan? CT Scan? not sure, haha, but that was all. No barium, no ultrasound, none of the other tests that were done on me when I was 13. For the tests that were run, however, everything was inconclusive. It was fairly obvious, however, that all my symptoms led to an enterovesicular fistula. I was on a potassium and Flagyl drips, prescribed Pentasa, Prednisone, Levaquin, Prilosec, and iron. After about a week I got a bit better, was released and then started Remicade treatments.

I received my 3 loading doses of Remicade and continued on Pentasa and by April I felt awesome. It was as if I never were sick at all. No symptoms whatsoever. I continnued to take Pentasa and was scheduled for Remicade every 8 weeks. Then, the Friday before Easter I ate a meal that contained carrots. Next day, they came out in my urine.

And thats basically where I'm at today.. peeing carrots still. Oh, along with that scar on my bum leaking. My GI doc really wants me to continue with Remicade once a month but says I may be at the point of surgery. I'd prefer not to get surgery if I can help it, but I don't seem to be reading too many success stories concerning Remicade and bladder fistuals from the small intestine. I'm really at a loss as to what i should do. I'm fed up with Crohn's dictating my life, though I am aware that it will always play a role. I've searched the forums quite a bit, as well as some extensive Googling, but there seems to be little in the way of information about these types of fistulas. From what I understand, everyone is different with Crohn's and not all treatments work the same for everyone. Remicade really seems to be hit or miss and in treating this specific condition it seems to miss a lot more. But I'm quite terrified of surgery..

So I guess I'm here to try and find out something, anything, about possibly treating this fistula without surgery. Are there viable treatments? Are they worth it if the fistula just reoccurs? I appreciate any feedback anyone might have. Thanks.
 
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hey deel0410 :)
i have an anal fistula and have had it for about a year. i have a seton tube in place to help it drain, and the tubing has been there for about a year as well.. the tubing isnt annoying or anything, although i would love it gone!

i have not really been given any other alternative treaments.. but i am also on remicade/infliximab, and its amazing. i love it to peices!! i have regular EUA (examination under anesthetic) so that they can check the fistula and stick a new tube in..

i hope i have helped in some way :)
good luck
 
Hello Deel. Sorry to hear about the fistula, but I'm glad you found your way to the forum. I also have a bowel to bladder fistula. I was having recurrent UTIs before I started on meds, and bowel gas showed up in a CT scan. I haven't started peeing carrots...........yet!!?
From what I gathered from a bit of googling and from more experienced people here on the forum, this type of fistula is very hard to heal with meds.
My GI basically confirmed that yesterday. I was prescribed a week's worth of Cipro and Flagyll a few weeks ago and there has been a definite improvement in the bladder symptoms, though I don't think it has gone completely. The doc said to me yesterday to work up to 100g Aza (Imuran) and see how it goes, but if this current treatment plan doesn't succeed in closing the fistula, then surgery is the next option. No mention of Remicade at all.
I don't relish the idea of surgery either, but after a year of draining UTIs and worrying about wetting myself ( which I have done on a couple of occasions! ) if that's what it takes, then it's got to be done.
Did the GI say how long to give the Remicade before deciding if it's solving the fistula problem or not?
 
I appreciate the replies thus far. Thank you.

Grumbletum: I was just put on Cipro and Flagyl again a few days ago, 2 weeks worth, and then another Remicade at the end of the month. The doc hasn't specifically stated how long we should let it go, but I'll give it a couple months just to see if the Remicade kicks in at all. If by.. September/October I'm still having issues then I'll go the surgery route. Unless someone can come up with another alternative that is. Can I ask what is your diet like? I've pretty much restricted myself to clear liquids(Boost Breeze, Jello, water, and occasionally chicken broth are all I take in) for the past 2 months with very, very minimal solid food intake and it seems to help. At least until I bend over wrong or eat something that causes too much gas.
 
Hi again
I stick pretty much to the SCD diet. I eventually settled for that because I'd already identified sugars, caffeine and yeast as main triggers of pain and UTI symptoms.
With the 'debris' in your urine, as smooth and liquid as possible sounds sensible. Have you lost a lot of weight? I wonder if it would be worth seeing if you can get referred to a dietician?
 
Actually I have lost weight.. again. My normal wieght is about 115lbs(52.25kg) I'm about 102lbs(~46kg) at the moment. It was worse in January, I was around 97lbs(~44kg) then i took prednisone and the weight just piled on. I was at about 117lbs in the beginning of April. So yeah.. I've lost 15 lbs since then. I've thought about seeing a nutritionist.. but never got around to it. Might be a good idea, eh? haha. Problem is.. Aside from the usual taboo foods with Crohn's, pretty much everything else makes me sick or gives me gas. haha
 
Yea, it's a real juggling act! Red meat is allowed on SCD but it hurts me too much to eat it. I'm seeing a dietician at the end of the month. I was worried cos I was getting really fatigued, but I think now it was the Crohns rather than the diet.
Really hoping the Remi will kick in for you...and soon :)
 
Hi there! We are practically neighbors!

I am sorry about this stubborn fistula. I don't have any experience. However, I know many on the forum who have had surgery and have done so well. Some have experienced years of remission afterward! So, if it does come to surgery, try to think positive! Good luck!
 
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