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Possible interpretation of CT results

Hi, my name is Bill and I've had Crohns disease since I was 20. I am now 56.

I recently had a colonoscopy done and everything came back fine except for the narrowing of my ileum which was expected.

I had a follow up CT scan and was hoping if anybody could help interpret some of the results.

My gastroenterologist and colorectal surgeon say that I should get operated on immediately. All they said was that I have a fistula and it should be taken care of. They didn't say anything about any possible cancer whatsoever.

However, I've had fistula's before and they have closed up especially with the use of Remicade and had gone into remission for years. I'm not experiencing any significant pain and not running to the bathroom.

Here are some pertinent excerpts from my CT scan and was hoping for some advice on how to proceed. My doctor now has started me on prednisone to take for 1 month. If I don't want to go through with the surgery, he would put me on either Remicade or Humira.

Here are some of the excerpts from the CT scan:GI Tract: There are extensive, chronic-appearing inflammatory changes
involving the distal and terminal ileum. There is stricturing of the
terminal ileum with circumferential mural thickening. No resultant
obstruction however.

There is a complex fistula arising from the distal/terminal ileum with
fistulization and retraction of the adjacent sigmoid colon and ileum.
There is no evidence of abscess formation.

There is extensive submucosal fat deposition within the mid to distal
ileum with hypertrophy of mesenteric fat, in keeping with a chronic
inflammatory process.

Focal intraluminal filling defects are noted within the ileum (2:93 and
2:82) measuring up to 1.9 cm. These are incompletely characterized in
the absence of a precontrast acquisition, however focality is suspicious
for polypoid mass.

There is moderate inflammatory change and increased number of nodes
within the ileal mesentery. Jejunum and proximal ileum are normal in
appearance. Enteric contrast transits to the rectum.

1. Extensive, chronic inflammatory changes of the distal and terminal
ileum, including nonobstructive stricture of the terminal ileum with
associated complex ileoileal and ileosigmoid fistula.
2. Two polypoid filling defects within the distal ileum measuring up to
2.0 cm. These are incompletely characterized on the current examination,
however suspicious for inflammatory or neoplastic lesions. Finding may
be further evaluated with CT enterography or direct visualization.
3. No evidence of abscess formation or free perforation.
4. Hepatic and renal cysts.
5. Nonobstructing 4 mm intrarenal calculus.
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Hello. I am not an expert but your CT scan shows you are having fistulas, inflammation, strictures etc etc, and if you don't take care of those it will get really bad. I know biologics will stop inflammation and will help with the fistula. Not all persons will have pain or runs to bathroom but that does not mean your GI track is not having damage. Please take the advise from your Doctor, I do hope you get better soon. Let us know how it goes.
I think you should take your doctor's advice. Certainly strictures won't heal with any medication and could be worse with Remicade. I know it is scary but I have had 7 operations and don't regret having any of them. I wouldn't be here without my fantastic surgeon.
Thanks so much to araceli & Daisy123.

I really appreciate your input. I was mainly really concerned about those two possible inflammation (polyps?) points in my ileum. I can't tell both of you how much your support means to me. I was so concerned that I might have ileum cancer. But I'm hoping that's due to the direct inflammation of my ileum actually having the fistula and going to my sigmoid colon. The fistula is long.

I "feel" healthy, no weight loss, good appetite, my red blood cell and white blood cell counts are within normal range. My lymph nodes next to the ileum are reactive probably meaning fighting the fistula infection since it's actually stemming from the ileum itself. It also appears from my report that the other organs inside my body are unaffected. I also had a small bowel GI series 8 months ago and none of this showed up. So, I'm hoping since it's a short time frame from then to now, everything will be OK. Any input from what I just commented on would be much appreciated.

I already have the surgery set up for the next week or two and will let you know how it goes. If you have any other words of encouragement or advice, from my above input, please feel free to share.

I've been living with this disease for 36 years now (initial surgery) and it's probably time to get the whole thing taken care of now.