MRI, MrE, COlonoscopy

[Lizette]

Hi All, I need some advice. Here goes the story. In March I took Mkchael to a colorectal surgeon to check on his anal abscesses, he said definitely the Crohn could be there, he suggested a sigmoidoscopy, prior to visiting he was going to the bathroom quite often, fate visiting the colorectal and schedule a colonoscopy 2 Weeks later, Micahel started using more often the bathroom and complain of pain. In his 10 yrs of Crohn never had pain or diarrhea, when we do a colonoscopy the hole colon was with inflamation colitis due to Cdiff. Any ways he was treated for Cdiff we retested and it was gone, it took about a 2months to finally started making form stool.. Obviously he lost 10 lb got anemia and all that. We decided to take him to a new Gi for opinion. He suggested his anal area was bad, but we needed to do a MRI!MRE and colonoscopy. He had all Michaels record from previous dr and hospitals. He said nobody has seen his small intestine. Well he had a enterograpgy in 2010 and he only had a fistula, 2013 a MRI everything was perfect plus a colonoscopy wich the dr did go to the ileum it was remarkable.. At mayo clinic they did go to he ilieum. He insisted none of the doctors has gone to small intestine.. So we decided to do and MRI and MRe to check on abscesses , fistulas and small bowl, because he says he thinks he has a stricture, can you please tell me what is that? I thought a stricture you have pain and can not pass stool .. Well he had those test, he has inflamation on left side colon sigmoid and rectum. With a fistulas now ano in the 6 o clock) we new that. I did not show nothing from small bowl the nurse calm me and said since they don't now if there's inflamation in teh small intestine he needs to to a colonoscopy because she insisted no one has gone there.. I said yes.. My question why does he want to do a colonoscopy I'd we already know where the inflamation is? Doesn't MRI or MRE show smal intestine, why is he saying he might have a stricture.. Shouldn't that been shown in this tests? We thought getting another opinion will be good. His Gi at Childrens said there should not be stricture.. So can some one explain why the other Gi says that.. What was the purpose of doing MRI MRE if is not going to show..
Thank you
Michael 17 dx at 6
He is going to start with Uceris. Last medicine before going to remicade

 

[my little penguin]

You can have a stricture and still pass stool
Complete Obstruction is where you can't pass still
Strictures can balloon and rupture similar to obstructions
Is he talking double ballon endoscopy or push endoscopy ( where they inflate a balloon to widen the small intestine and push the scope through to view the entire small instestine )
?
Or capsule endoscopy ( pill cam)?
Which can visualize the entire small intestine but requires an Mre first to check for strictures?

 

[my little penguin]

Uceris is a steriod and to be used for short term a few months not designed for long term maintenance. Not as many side effects as pred but eventually the same side effects

 

[my little penguin]

Was the Mre of his pelvis and abdomen ?
They are two seperate scans .
Pelvis Mre would show rectal issues but not small intestine
Has he had another colonscopy since the C diff ???
What did it show ?
When was it done ?

 

[Lizette]

Was the Mre of his pelvis and abdomen ?
They are two seperate scans .
Pelvis Mre would show rectal issues but not small intestine
Has he had another colonscopy since the C diff ???
What did it show ?
When was it done ?

No, the only colonoscopy was in March and it only showed inflamation due to Cdiff. He had MRE and MRI. He drink the barium sulfate plus they inject him some contrast with IV..

 

[Lizette]

Was the Mre of his pelvis and abdomen ?
They are two seperate scans .
Pelvis Mre would show rectal issues but not small intestine
Has he had another colonscopy since the C diff ???
What did it show ?
When was it done ?

Yes it was for pelvis and Abdomen. He had it Sunday. We got results yesterday. It says.
MRI pelvis so and w contrast additional sequences an MRI abdomen so and w contrast .
There is abnormal bowel wall thickening/post contrast enhancement and restricted diffusion extending from anus to splenic flexure( left colon) with associated adjacent fat stranding, vascular engorgment and fat stranding. No evidence of infra abdominal fluid collections discrete estero enteric fistulous tract.
Approximately 6:00 perianal fistulous tract along the intersphincentric region extending into the skin without evidence of adjacent ring enhancing organized fluid collections.
Visualized non dilated cecum,ascending transverse colon and small bowel show mild none specific diffuse homogeneous post contrast enhancement.
This are the findings
Lizette

 

[Lizette]

Uceris is a steriod and to be used for short term a few months not designed for long term maintenance. Not as many side effects as pred but eventually the same side effects

Yes, is a steroid to use 8 weeks and taper it down.

 

[my little penguin]

The colonscopy makes more sense now
Since they found thickening indicative of inflammation on his MRE then the next step is a scope to visually see the extent of the damage as well as biopsy
Scopes during cdiff wouldn't be as informative since the cdiff was the cause of the inflammation and the was no way of knowing what was result of crohns or not
They would need the entire picture which a colonscopy would provide

They did this for Ds in April
Mre first then upper lower colonoscopy / pillcam