Treatments for strictures?

[xmdmom]

I'm wondering what are the possible treatments for a terminal ileal stricture (10 cm). Let's assume it's fibrosis rather than inflammation.

There was one episode that may have been a partial temporary obstruction that took care of itself (vomiting, pain, some distension).

I've heard of balloon dilations --who does them, gi doctors or surgeons?
Also what foods to avoid?

I know surgery is sometimes necessary. Are there different possible surgeries? What are they?

Thanks.

 

[SarahD]

The main options for a fibrotic stricture are balloon dilation, strictureplasty or resection. Some strictures can be managed with a low residue diet too.

I was set to get a balloon dilation last year, only my supposed fibrotic stricture was nowhere to be seen when the dr got in there. This kind of procedure is performed by a dr trained in doing colonoscopies. It's basically like a colonoscopy and then the balloon is used when they arrive at the site of the stricture.

Balloon dilations and strictureplasties are best for short strictures, and less suited to long strictures.

If you want to look into it there are also different types of strictureplasty. Some are more suitable for short strictures and others can be used for medium length strictures. I'm not really sure what constitutes a small or medium length stricture, a surgeon would be a good person to ask about that.

Sarah

 

[xmdmom]

Also if they would do a resection in the terminal ileum, what would they resect and do they ever just reconnect or is there always a temp ileostomy?

 

[Clash]

There are resections of that area that dont include ostomies. I think both children of Dusty had this surgery.

 

[Momtotwo]

xmdmom- I read about this in a NYT article recently. I don't know any experience with it or knowledge other than the brief NYT mention and this site: http://nyp.org/enews/surgery-crohns-spares-intestine.html

 

[Momtotwo]

http://www.medscape.com/viewarticle/805774_7
This had good info, too.

 

[emmaaaargh]

Resections in the terminal ileum can be reconnected and don't always require an ostomy! I had a resection of about 30cm of intestine in 2009 - the ends were reconnected and life went on as usual.

 

[Daisy123]

I also had strictures that disappeared before the dilation procedure. I have had this done a number of times but it didn't last with me. I ended up having a resection for the last strictures. I have no ostomy.

 

[xmdmom]

Definitely good to hear that an ostomy isn't necessarily necessary!

 

[DustyKat]

Sarah is spot on with options available for stricture xmdmom.

The requirement for an ostomy is very much dependent on two things:

1. What is the likelihood of an unknown complication being found when they go in for surgery.

2. Is the inflammation acute or chronic.

If no unknown complications are found and inflammation is chronic and stable then the chances of a stoma are pretty much zero. Most stoma’s are done because there is acute, active inflammation and a temporary stoma is done to reduce the amount of bowel that needs to be resected. So resect the area of bowel beyond repair and leave the area of acute inflammation, do a stoma, wait 3-6 months, inflammation settles, reverse stoma and anastomose the healthy disease free ends.

Sarah’s surgery was an emergency and without a diagnosis and Matt’s was planned with known and unknown complications but neither required a stoma.

A resection of the terminal ileum means an ileocaecotomy will have to be performed. Due to the differing anatomy between the large and the small bowel the only way they can successfully anastomose the bowel is to remove the affected terminal ileum (this will include the appendix), ileocaecal valve, the caecum and couple of centimetres of large bowel.

Dusty. xxx

 

[If*]

I've heard of balloon dilations --who does them, gi doctors or surgeons?
Also what foods to avoid?

Thanks.

Hi there! Looks like the others have responded well to the other part of your question. So thought I would reply to 'the foods' part

With a stricture I have avoided fiber foods ~ like but not limited to.
Wheat whole grains, rice, corn, lettuce, NUTS, popcorn, mushrooms, fruits with the peel on and hard to digest meats if you eat meat. As a stricture gets worse it can get to where nothing can pass and fluids can cause vomiting.

Foods that were a bit easier depending on how advanced the stricture is: jello, pudding, soft soft cooked carrots, celery, onion, potato in soups,mashed potatoes, yogurt, soft goat cheese and honey or creamy peanut butter on plain crackers, if you eat eggs they can be good protein, go easy on green juices since us crohnies can get kidney/gallstones. But look into organic fruit smoothies for C vitamin. There are also different nutrition drinks, I like the Boost powder form since at the very least I can mix it with organic liquids ie almond milk, coconut milk, milk, etc.

Hope today finds you doing better..