Leak at anastomosis after ileocolic resection. Help?

[acc929]

Hi all.
Had surgery april 22. Developed a superficial wound infection and abscess near anastomosis. Both cultures came back for staph, nothing enteric in abscess. Drain was placed (next to right Psoas - ouch!) and is still in, as CT and sinogram show communication from abscess (now gone) to bowel, but CT showed none from bowel to abscess. So there's a fistula but it seems one-way, no active crohns. Drainage is nil at this point besides what I irrigate. Surgeon has me eating a fairly normal diet and wants to see if it heals on its own. I have more imaging booked for next Friday. Does anyone have any advice on what I can do to help myself heal? I had a drain in for a month pre-op and am so disappointed to have another, not to mention a leak. Can these things actually heal on their own or only for the very lucky? Insight and similar stories appreciated. Really could use some support, feeling so very discouraged and wondering if this will ever end.

 

[Scaryman]

acc929 Just letting you know I'm watching to see if you get the support you require on this. I cannot chime in on this as I have no experience of fistulas or abscesses. I can tell you that I am going to have my first resection in two weeks. Sorry I cant be of more help, however I know someone can.

 

[acc929]

Thanks Scaryman and good luck on your resection. Know that what happened to me is very unlikely for most patients and I didn't have anywhere near this number of complications after my first resection, and my recovery went quite smoothly. I really do hope someone chimes in though. This is very scary for me.

 

[xxjemmamxx]

Not sure how much help I'm going to be. I had complications after my resection with the wound splitting open due to drainage. I know this is not the same as what you are going through, but I think maybe we may have felt the same - which is panicking and worrying about whether or not everything is going to be ok!

I felt like it was never going to heal but I was amazed at how quick your body can turn things around. It healed up within 2-3 weeks, starting off really slow and then all of a sudden it closed up and healed a treat. My tips to help it heal would be to take a multi-vitamin if you don't already, rest and get plenty of sleep, drink plenty of water and relax. I think these things can heal by themselves (you're body is so amazing at repairing itself) but sometimes they might need more intervention or help. Drains suck so I can totally sympathize with you having to have one in after all you've been through, I hope everything sorts itself out for you.

 

[acc929]

that happened to me as well, xx! i panicked too, especially when the resident came to my ER stall to open the rest of the incision then and there! i can take care of that by myself now. Though it's alarming, i feel silly for making a fuss about the procedure they did on the superficial abscess given there were much graver things going on inside me! for the superficial one (and the microleak), I'm taking lots of vitamins (extra B-12, folate), hydrating as well as making my own green juices, and taking at least a nap per day, and loads of protein (I'm also on lots of valium...and curcumin, l-glutamine, flaxseed and coconut oil, lol). This is my second drain, had one in pre-op as well Tired of these little f***ers! Thanks for your support, I'm glad that yours healed quick and hopefully the same will be true of mine. It looks so gnarly right now when i go to pack it, and it definitely took a few days to adjust to there being a crater in my stomach! I'm glad you seem to be doing better

 

[xxjemmamxx]

It's completely behind me now and things were great about 3 months after surgery, so I hope that will be the same for you too. It's really surreal seeing a hole in your stomach, I remember it making me feel sick every time I had to look at it :lol2: One day I just took the dressing off and it was closed, I couldn't believe it.

It seems like you are doing everything you can, so I think it's just a waiting game for you now. I think you will feel a lot better when you're able to take the drain out too.

 

[acc929]

thanks, xx. but really no one on this forum has had a post-op leak?? seeing how crohn's has put so many of us through the ringer i find it hard to believe! i could really use some help.

 

[xxjemmamxx]

I'm sure there is someone out there, hope you get some advice soon & here's a bump to help xx

 

[Jennifer]

I had an infection at the incision site that had to be packed twice a day for almost 2 months but no issue on the inside and no fistulas either. I'm going to tag Afidz as she's had multiple surgeries and may be able to help and I'm also tagging Jim (POPS) as I believe he had complications after his surgery and went septic.

 

[Jim (POPS)]

I had complacations after my first resection. I got a real nasty infection in the wound and they open it up and I had a wound vac. I also had a absess that was 10cm by 2cm but it cleared up by itself.(this took a few months) My wound took about 7 months to heal completly. I had a bandage on it for almost 8 months.

You will heal with time. Sometimes it just takes longer than other times.

Hope everything gets better for you soon.

Jim (POPS)

 

[Absentminded]

I'm sorry that I haven't replied sooner, I've been a bit absent from the forum for a few months. I had a stoma reversal back in february and had a leak at the join site. This was coupled with a load of other post op complications, I've posted in the stoma sub forum.
I currently have a fistula from the leak draining through my surgical wound, so I've swapped my stoma for a fistula! It's beginning to heal, but it's not very nice. I also had a large hematoma and an infected collection of fluid in my pelvis.

Is this similar to what you're going through? It kind of sounds like it.

 

[acc929]

Hey Lucinda, thanks for the response. I'm so sorry about all that stuff, it really is the worst. I'm just dealing with the healing open incision, and they put a drain in by my psoas a couple weeks ago. Just went in for an abscessogram to see if the fistula from the leak had closed. It hasn't. It's crazy though because I'm draining like nothing into the bag, I guess it must be a one-way tract kind of deal, who knows. Another surgery's scheduled for June 5 to fix it. So no ostomy, but I'm concerned I'll end up with one though I guess it'll just be temporary. Feel like I haven't been horribly lucky the past couple months, as my surgery was due to a perforation/abscess and had a drain in for a while before op. Hard to remain optimistic when all this stuff happens, eh? I'm just beginning to understand the occasional gravity of these conditions, and I was diagnosed ten years ago.

 

[Absentminded]

Yep, it really is the worst! Let me just get this straight in my head, the fistula doesn't really go anywhere? But you do also have a draining incision and a drain in your abdomen? I'm sorry I'm being really dumb today!
But yeah open incisions suck, and like you said it is so hard to stay optimistic. I had so many dark thoughts when my fistula started draining. I felt disgusting and that no one would want to be near me, as well as feeling totally out of control of my body and disease. Completely irrational, but also very natural responses to the situation. These things do make you re-evaluate your illness, even after so many years of diagnosis.

i was told that to help fistulas like ours heal, you need good nutrition, so a healthy diet or in my case extra fortisips as I can't eat properly yet, you also need to have no narrowings or inflammation further down your bowel from the fistula, as they encourage the fistula to stay open.

Hopefully the surgery in June will sort things out. If you do have to have a stoma it really isn't the end of the world, honest, and if it's just temporary then I'm sure you'll cope. I kinda wish I still had mine now! If you want more info take a look at the stoma sub forum, you'll find a lot of people with really positive experiences of them.

 

[acc929]

Yes, I looked around the stoma subforum before my last surgery - my docs told me that, because of my infection and perforation, it could be that they'd get in there and confront a total mess and I'd need the temp. So I kind of wrapped my head around it beforehand in preparation, though I remember the first time someone said 'ostomy' to me I was totally shocked. At this point I'd just be pissed because I'm set to leave for Paris for my Masters in September - I don't have time for three months to the reversal! lol.

No, the fistula seems to go nowhere now that the abscess is gone, but it's essentially no-output at this point. I also had an abscess underneath the incision, now it's an open incision but healing up beautifully I'm told. I think before there was communication at the anastomosis, but now that the wall of the abscess has disintegrated and the infection is gone, it's just this tiiiiiiny hairline fistula that I guess must just communicate with the drain at this point, or with nothing. The thing is that nothing enteric is coming out of the drain (and I've drank beet juice) and nothing enteric cultured from the abscess. I'm actually getting negative drainage (when I was flushing it with saline, today they told me to just stop flushing it since it hardly seems to matter if the tube occludes). With the abscessogram they flush in at least 7ccs of contrast and it goes into the bowel, but it really seems like nothing's coming out, which is good. The drain and bag do kind of make me feel like a freak though and have made me less social, so I know what you mean about the social aspect, the being out of control. The past couple weeks trying to help this thing heal up I ate more protein than I ever have in my life, juiced at least a litre of veggies and oranges a day, took supplements and vitamins. Today when they said it was still there I was like, are you kidding me????? What does my body WANT?

In any case, fingers crossed about June, but at this point I've resigned myself to the fact that it serves no purpose to freak out about what might happen with this down the line. The drain sucks, but I think it must be good for us to try to act as normally as possible. I made plans to see friends this weekend and beginning of next week, have a couple drinks (off antibiotics etc) and generally try to act more like a 22 year old. I really hope your fistula heals up - when my incision started draining I absolutely FREAKED out. Such a jarring thing to deal with. I really hope you get better soon .

 

[Absentminded]

I am so sorry that I haven't replied sooner! I meant to, and then lived up to my username and totally forgot. I just wanted to see how you're getting on. You had surgery on the 5th yeah? I really hope it went well and you're recovering ok?

I'm doing ok, my fistula is nearly gone! Just a tiny pinprick sized hole now.

Anyway, sending you lots of healing thoughts! X

 

[acc929]

Hi! I totally forgot I even asked this question. Flagyl is making me soo forgetful I think so no worries! I'm really glad your fistula is healing up and I hope it continues to do so! Nasty little things eh? My op was on the 5th, yes. I seem to be doing ok. I don't want to go ahead and call all clear quite yet but I do feel better every day. Rougher the second time around for sure discomfort-wise, but seeing improvement and I think once the heavy dose of antibiotics is done (tomorrow!) I'll be a lot closer to feeling like myself again (just now realizing that I haven't in years). Healing thoughts to you too xx

 

[Absentminded]

Oh I'm so glad that it went well! Sorry that you've been feeling more discomfort this time round, hopefully it'll ease ASAP!
I know the feeling of being back to being yourself, I'm finally feeling like that too It's good isn't it?!
Yeah, fistulas are evil, glad mine is on the way out!