Perforations??

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Bammer
Regular Member


Date Joined Mar 2008
Total Posts : 381
   Posted 4/29/2008 7:35 AM (GMT -7)   
What causes perforations? Can this occur in the small intestine and colon? Is it usually from a stricture or blockage or obstruction? Know a stricture can be composed of scar tissue or inflammation but not sure about the others people refer to. Also some people say they did not know they had Crohn's until there intestine perforated? No symptoms or warning?
55 yr. old F dx. CD 07/07
Currently on no medication


MBJOH
Regular Member


Date Joined Mar 2007
Total Posts : 257
   Posted 4/29/2008 8:11 AM (GMT -7)   
I had a perforation of the intestines about 10 yrs ago - I had the regular crohn's sypmtoms going on but not all that bad. I had golfed that day for a work function, came home and was watching my son in our pool and all of a sudden was in intense pain with an uncontrolable fever. It felt very much like labor pains but I knew that wasn't it. I spent 5 days in the hospital having antibiotics pumped into me. So no, in my case I had no warning signs or symptoms. Kinda scary. I recall it scared me from traveling anywhere for quite a while. I would make sure anywhere I did go was near a major hospital. MB

belleenstein
Veteran Member


Date Joined Feb 2007
Total Posts : 1010
   Posted 4/29/2008 5:07 PM (GMT -7)   
MBJOH just wondering if you were on steroids at the time? I have not suffered a free perforation, but the path report from my last surgery indicated a defect proximal to my anastomosis that was about to break through. At the time of my surgery I was on steroids (and a host of other drugs) just to keep me functioning until I could be operated on. My surgeon described my intestines as being the consistancy of wet toilet tissue from the steroids.

But typically perforations can be due to deep ulcerations that literally just break open the bowel or they can be caused by excessive pressure within the intestine, usually associated with a stricture/obstruction. Usually, instead of a free perforation, the body walls off the area of infection in an abscess, which often opens and drains as a fistula instead of as a free perforation into the abdominal cavity.
Belleenstein:

30+ years living with Crohn's.


chroniemomx2
Veteran Member


Date Joined Apr 2005
Total Posts : 2346
   Posted 4/29/2008 5:48 PM (GMT -7)   
belleenstein....interesting. Thanks.

Dave D
Regular Member


Date Joined Aug 2005
Total Posts : 404
   Posted 4/30/2008 5:37 AM (GMT -7)   

I perforated in the colon in 1993. I was on Prednisone and my third week of Methotrexate. My symptoms to begin with was a low grade fever and off and on severe sweats. When my gut let go I got "wish you were dead" groin pain, just like an obstruction. I could BM a little bit but not much. My family Dr. thought it was a reaction to the Methotrexate and just kept feeding me a regular diet and Tylonol Codienes for the pain. After 3 days he sent me 350 miles to see the DR. that prescribed the Methotrexate. Now perforated for four days, I was in horrible pain, my belly was distended like I was pregnant. When I got to the hospital, I went into shock before the emergency surgery to resection and clean up the Gangrene and Peritonitis. I actually watched the surgery from above. My fever approached 106 and I spent a month on an ice water mattress in the ICU.

Too much information?

Dave D


Retired male in late 60's. Perforated Colon in 92. Diagnosed as Ulcerative Colitis in 93. Uncontrolled flareup in 97 dictated J-pouch surgery. 04 Capsule endoscopy diagnosed as Crohns not UC. Emergency surgery in 05 to remove lodged camera capsule. Biopsies positively diagnosed Crohns at that time. 12/06 Unsucessfully tried Naltrexone(LDN). 2/07 developed scleritis of the eye, tearing and detaching the retina. Treated with high doses of Prednisone. 6/07 Thought eye was healing and started taking Entocort counting on the residual (non-systemic portion) as treating the eye. Wrong. In October eye was not stabilized. 11/07 Started Remicade to try and reduce the ocular inflamation of the Scleritis since I had been requiring more and more Prednisone to keep the eye quiet. 12/07, retina tares and detaches again so it's still not working. Now blind in that eye. 1/08 now taking Remicade monthly with no real progress treating inflamed eye. Vision still <20/200. Inflamation starting to show up in good eye. I haven't given up yet, but it doesn't look promising.
Married with 4 grandkids.


MBJOH
Regular Member


Date Joined Mar 2007
Total Posts : 257
   Posted 4/30/2008 6:26 AM (GMT -7)   
Belleenstein - I can't recall as to whether or not I was on steroids at the time.  I am thinkng I was because the doctor I had at the time was big on pushing steroids as the cure all and I ended up changing docs for that reason and haven't taken steroids since.  I also know that I had horrible ulcerations at the time because shortly after the perforation I had a resection due to narrowing from strictures.  I know when I went to the ER, I phoned my doctor first and my doctor had told me not to let anyone else see me except him when I arrived because a perforation resembles a ruptured appendix and they would surely remove my appendix and that was not the problem.  That is also when I learned that a silent stomach is not good, you want to hear the rumbles in your stomach.  I too had a very high fever and was pretty much dilirious when I arrived.  Not an ordeal I care to go through again.

belleenstein
Veteran Member


Date Joined Feb 2007
Total Posts : 1010
   Posted 4/30/2008 7:57 AM (GMT -7)   
I'm just glad you survived. I can only imagine your pain. I have suffered septic shock from abscesses twice and that was bad enough. It is amazing to me Dave that you were able to stand the pain for four days. Isn't it incredible what we can tolerate? Actually, scary is a better word. I have tolerated far too much pain and misery in the course of this disease. Sometimes it has been because I thought I could just will myself to not be sick, other times it was because I allowed others to determine how sick I was, even when intuitively I knew. All these examples just remind me that we really need to trust what we know to be true.

Dave, it sounds like you walked much too close to the edge and MBJOH I wonder if it is possible that, in retrospect, you might have been minimizing how sick you really were in the months leading up to the perforation? We sometimes can get really good in rationalizing our misery, especially when the slippage is incremental and over time. We just keep adjusting and adapting to a new norm as the disease slowly worsens. What do you think?
Belleenstein:

30+ years living with Crohn's.

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