Path report back. Have a question

[Traumanurse]

Hello.

Had my second bowel resection 5 weeks ago. Just got the path report back last week. Basically the 18 inches they took out was a mess with a large stricture, mucosal ulcerations, loss of mucosal folds, grey colored instead of pink, acute inflammation, lymphplamacytic inflammation, and lymphoid aggregates.

I understand all this, basically it was a mess, and it's Crohns.

What is bothering me is that it says the surgical margins show active disease. This is where they sew it back together. I know they try to get "clean" margins so it will heal well, and it doesn't sound like they were able to do that. The surgeon said he didn't SEE and inflammation there, but the path report shows it.

Does anyone know: does this affect remission chances? I'm on Humira now, but does it slow the healing at the surgery site? I hate that they put two bad ends together! Anyone have any wisdom?

Thanks so much! Just need some reassurance!:eek2:

 

[xmdmom]

I was curious and just looked this up. I found this from 2012

Resection Margins
Initial studies suggested that radical resection, allowing wide resection margins of macroscopically normal bowel to ensure clearance of all macroscopic, and possibly microscopic, disease was associated with a reduced rate of postoperative recurrence.36, 130–134 Subsequent studies have found that nonradical resection, where there may be residual microscopic disease due to limited resection margins, results in the same postoperative recurrence rate as more radical resection.2, 52, 56, 61, 81, 135–141

In a controlled trial by Fazio et al,137 152 patients were randomized to either limited (2 cm) or extended (12 cm) macroscopically disease-free proximal resection margins. Patients were further categorized on the basis of whether there was any residual microscopic disease. Clinical recurrence (33.3 vs. 28.8%) and surgical recurrence rates (25.3 vs. 17.9%) were not significantly different between the two groups. Nor was there any significant difference in recurrence rates among those with residual microscopic disease. These data have given rise to the current practice of resecting only macroscopically involved bowel, in order to minimize the risk of intestinal failure due to short gut syndrome.

http://onlinelibrary.wiley.com/doi/10.1002/ibd.21825/full

So it seems that microscopic disease in the margins didn't affect recurrence. You should definitely ask your surgeon.

 

[Jennifer]

You are on Humira so hopefully that will get whatever is left under control and put you into full remission. Humira does affect the healing process when it comes to surgical procedures but the intestinal lining heals rather quickly. The main concern is the tissue layers above where they had to cut in. It is possible that those will heal slower and there could be an increased risk of infection there so keep an eye on it.