Strictures & Surgery

[Mehita]

Last fall my son flared due to a 6" stricture in the middle of his small intestine. He was put on a liquid diet and steroids initially, tapered, and has been on Pentasa for five months now. Since last fall he has gained 6 pounds (woohooo!), so we thought things were going well.

Lately, he's been having ribbon poop again, getting stomach cramps, and not eating as well. We just increased his Pentasa to 1000mg 2x/day because his labs showed some inflammation. He has maybe one great day for every three so-so days. The symptoms are subtle, but my mother's intuition is telling me something is up. At his MRI last fall, the stricture was the only issue. No inflammation any where else, no other troubles.

So, my questions:

Is there an easier way to check for strictures besides contrast MRI's? It's hard to down contrast with a stricture.

From what I've read, strictures don't go away unless surgically removed... true? And if that's the case, then isn't Pentasa just a band aid approach to fixing the problem? Or any drug for that matter? I don't think the Pentasa is working for him and I lay awake at night wondering if a stronger drug (6-MP) is really going to do anything more. His gastro has said that would be the next option, followed by surgery.

What are the risks with having surgery to remove a stricture and has anyone gone through this? What were your results?

Thanks much...

 

[archie]

Hi I have IBD myself not a child so not sure if it's the info you want but my understanding is if the stricture Is caused by inflammation then drugs can help improve this by reducing inflammation it may need something stronger than pentasa though. If it is caused by scar tissue then it will require surgery. I had 1 ft of stricture that failed to healnwith steroids and pentasa and it was deemed scar tissue and had a resection to remove it with great results. The next step for you is to get it checked again with maybe a small bowel series and then a consultation with your GI to discuss options.

 

[kimmy86]

hi

I have crohns I'm 25 and sound very similar to your son. I had a stricture which they said was caused by inflammation they thought at the time it was about 6cm long. I was very ill severe pain vomiting and weight loss. I too was put on pentassa which could not control the symptoms on it's own. I then went onto steroids as I was getting worse I started prednisolene they were great I picked up so much had my energy back and felt amazing but obviously they were only a short term solution I tapered off pred and started on azathioprine which have worked really well 4 me but after several consultations it was decided surgery was the best option. they told me the blockage wud never go away on its own that I would always have obstructive symptoms and the longer I left it the worse state my bowel would end up in. I was feeling fairly healthy when I had my very first surgery a week ago I was terrified!! I ended up having about 15cm of small bowel removed my iv valve and a small amount of large intestine plus my appendix so far I'm doing really well and hoping I made the right decision. it's a hard 1 to make but I think consultants will tell your son wen surgery is necesary. If you have any questions I'm happy to answer them wish him well xxx

 

[DustyKat]

Hey Mehita,

I'm sorry to hear your boy is going through a rough patch...:hug:

Unfortunately scanning is the best and safest way to visualise the area when there is a stricture present.

Whether a stricture needs to be surgically removed depends on what the stricture is. If it is inflammation alone then it won't be surgically removed but if the inflammation has been present for some time then it is likely that some scarring has occurred and it is the extent of scarring that determines if surgery needs to be done as scar tissue is inflexible.
If it is inflammation only then stronger medication is useful as it can reduce the inflammation and therefore the risk of scarring and hopefully you can avoid surgery.

Both of my children have had surgery due to complications, including stricturing and for them the risks of not having surgery were greater than that of having it. Surgery put both of my children straight into remission and they have stayed that way. My daughter is nearly 6 years post surgery and my son was 1 year post surgery last month.

Good luck and best wishes!

Dusty. xxx

 

[Mehita]

Thanks for the input! It's good to hear that you all are doing well. Sounds like I need to find out if the stricture is scar tissue or inflammation. I vaguely remember the doctor saying it was scar and that is why he brought up the thought of surgery at our first visit with him.

With strictures, there is a risk of it getting so bad the the entire bowel can be obstructed, right? Will it be obvious if he gets to that point?

Thank you for your help...

 

[Kelly2]

If surgery is necessary, ask your doctor if a strictureplasty would be possible for your son, instead of a resection.

Kelly

 

[archie]

you'll know if it's an obstruction your son will be in agony and vomitting as it is very dangerous he would need immediate medical care if he shows these symptoms. He can also have a partial obstruction so you need to be aware of these symptoms also. Have a look at the wiki section there might be more info if I was a technophobe i'd put a link to it but i'm sure someone else will.

 

[DustyKat]

Yes it is possible that obstruction could occur but archie is right hun, you won't be left guessing that happens...severe pain and vomiting. It doesn't leave you guessing if you should go to the ER or not.

Dusty. xxx

 

[Sparkle2012]

Here is a youtube video that depicts strictureplasty -- I thought it would make this surgery clear to me - but I'm still confused. It does say the mortality rate for this surgery is low which is comforting because strictures are mostly my issues. I seem be able to eat most things without pain as long as I eat small meals. I feel good now but i wonder: if it's possible to remove the strictures when there is no inflammation - why not do it and have some peace. That is something I will discuss with my doctor as I am newly diagnosed.

video on YouTube:

http://www.youtube.com/watch?v=eW3hQE8JP7s&feature=youtube_gdata_player

 

[Farmwife]

:ghug:Sorry to hear your son is having problems again.
No real advice here. Which is OK because you've already been given some great advice already. I hope all goes better.

Farmwife

 

[crohnsinct]

No experience with strictures but hoping your son is doing well and really, really hoping he NEVER has to deal with an obstruction!

 

[Mehita]

Just an update... L has been on prednisone the last two weeks after labs showed a small bit of inflammation. So small it was even questionable whether to put him on prednisone or not. It took about a week for symptoms to go away and he was feeling pretty good until last night when he was so nauseous he slept with a pail next to his bed. He continues to alternate between being constipated and impressively large volumes of mushy poops (he's been taking Miralax). When on the toilet, he says he can "feel it all clogged up" in the area just below his belly button... right where I'm guessing his stricture is. He'll sit there for 30 minutes at a time and poop the entire time.

Now I'm thinking that this last flare maybe wasn't really a flare but is related to his stricture. My theory is that he eats for several days, the food piles up and can't get thru the stricture, the Miralax eases things a bit, and then he gets the massive mushy poops every 3-4 days. It sure would explain a lot. The predinsone has helped with the stomach aches, nausea, and cramping, but it hasn't done much to improve the constipation cycle.

Does this sound typical of a small intestine stricture?

We're altering his diet a bit and trying to remember smaller meals throughout the day, but really, I'm not sure the predinsone helped much and that we're looking at a scar related stricture.

Any thoughts?

 

[Sparkle2012]

Strictures and blockage

I have strictures, am on Myralax for Constipation and it sounds similar. Sounds like stricture trouble. It is my opinion big meals get stuck....water seeps through because water is very persistent and takes whatever mush will accompany it resulting in mushy BM....eventually everything moves and the formation is semi-normal for me. My GI told me that the mush is what you get when there are no solids to move thru and it is just mucous and bacteria? I can't emphasize the importance (for me) of eating small frequent meals with strictures and chewing well - and when I'm getting "stuck" from NOT doing that, I eat soft foods and lots of water and generally I get out of stricture. I don't have issues nearly as bad as you are describing and I have several strictures. Based upon what you have described, it sounds like he is 'blocked" and the bowel is gathering fluids to move it along resulting in the large release of mushy backed up BM 4 days later. Blockages are painful and can be dangerous too.

 

[Sascot]

Sorry no experience there - just hope he feels better soon. What a bizarre disease this is - symptoms are so varied from person to person. :ybatty: