Fistula due to resection

[Mister_Hotspur]

Hi all,

Just seen my doc and quickly been through my MRI results, he says the crohns is very aggressive and i have a fistula from the resection join area heading outwards to the skin!

Firstly, SHIT! Secondly, has anyone else had one of these?

My doc has put me on Lower Dose Aza and Allopurinol for now, he needs to discuss the result in more detail with the MRI dept to get find out how far from the skin it is etc. But for now im a little worried.

Say if the new med works and the Crohns calms down, what happens with the fistula tunnel? does it just sit there forever? retract? or do i have to have surgery? i read about setons and such but i gather that is for the anus?

Ive done searches but not come up with the right answers, i really dont want to be sat at work and suddenly my shirts brown because the fistulas breached the surface :blush:

 

[Mister_Hotspur]

 

[glum chump]

Hi Mister Hotspur:

Shit is right! I'm not sure of the exact answers to your questions. I get fistulas about twice a year, but they've all been detected in the perianal area. The fistulas are hard and they start to form an abscess. When I have a fistula, even though I'm on 150mg of Aza, my GI prescribes antibiotics as soon as I see any signs of a fistula.

Did your GI mention antibiotic therapy at all? My understanding (very limited as it is) is that some form of surgical intervention may be necessary ensure that the fistula is draining effectively.

I hope you get some answers soon. In my experience, when the fistula breaches the skin, it doesn't go gushing things out unless there's an opening. I have a heck of a time trying to keep my fistulas open in order to control the draining. Hopefully, it'll be the case that if your fistula breaches the skin, it will appear hard until it eventually opens up.

Kismet

 

[Mister_Hotspur]

Thanks, well he started me on Allopurinol, which makes the Azathioprine more effective. He mentioned Infliximab as well so im not really sure, i think he intends to review my case and MRI results a bit better and then go from there. I know it sounds a bit vague but my GI is pretty good, in fact i think hes the leading crohns doc in the country.

Ive just felt a bit down, im really worried about more surgery and having a bag etc, and having to take time off work - and explaining it to them, from what i have explained to my boss so far he just had a glazed look on his face.. and also having pains in my side today, i keep loosing concentration, thinking 'is the pain the fistula?

 

[Cookie]

Hi Mr. Hotspur,

Sorry to hear about your woes. Like Glum Chump, by experience with fistulas has been in the rectal area, so please keep that in mind as I don't want to give you any false information. But here is what I know based on MY experience with RECTAL fistulas:

1. If there is no opening on the other end of a fistula, it will likely become an abscess when it starts to fill up with stool, pus, etc. and there is nowhere for that stuff to go. Abscesses become fistulas when the pathway opens and they are drained (either done surgically or on their own). Fistulas can also form branches that can become abscesses, so it is possible to have a fistula and an abscess at the same time...hope that makes sense.

2. Most doctors will prescribe you antibiotics (usually flagyl and cipro) to keep infection away.

3. Fistulas can close on their own with the help of some meds. Most common for this is Remicade (Imfliximab), but I think also Humira can be used.

You might want to talk to your doctor about the things I mentioned here. Like I said, I have never had an internal fistula like that, so I'm not sure how much of this applies.

Good Luck!