new w/ possible fistula

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madabs
Regular Member


Date Joined May 2008
Total Posts : 377
   Posted 5/9/2008 10:14 AM (GMT -7)   
Hi..
1st time poster here, but have a great educational experience lurking on Crohn's and UC boards.  I know many with CD have had the unfortunate experience to of dealing with fistulas. 
I was DX w/ UC three years ago via a biopsy taken during a colonscopy which found active, mod-severe colitis. GI saw little to no inflamation as I had been on meds for about 7 weeks before the scope and they were working great.
 
I have been flaring on and off for about 5 months now.  I developed a rectal abcsess about 8 weeks ago.  It was surgically removed/drained and I spent three days into the hospital because the infection was "systemic?".  Afterward the wound was kept open with gauze packing for another fifteen days.
What I have left now is a small hole next to my anus that drains stringy green glop and a pink or brown colored clear fluid.  GI looked at it about 2 weeks ago but couldn't be certain if it was an unhealed wound or a fistula..A fistula, to me, seems like a crazy unreal thing and brings to mind tiny aliens with tiny rayguns blasting their way through my flesh (most likely to escape the vile, malordorous events transpiring in that region lately) :) 
 
Finally my question(s), Is it possible to develop a fistula such a short time after having an abcsess.  I thought that generally, a fistula comes before an egg, I mean, an abcsess?  Does what i have sound like an abcsess to those who know about them?  Also next to the hole is a small red flap of skin that looks likes a tiny part of my insides trapped on the outside (probably the work of the fistulizing aliens).
 
Thanks in advance!

AlwaysRosie
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Date Joined Jan 2005
Total Posts : 8616
   Posted 5/9/2008 10:20 AM (GMT -7)   
Hi madabs,

Welcome to the forum!! I'm sorry I don't know much about fistula's except what I've read here . . . no personal experience (thankfully). But I wanted to welcome you to the forum. I'm sure some 'experienced' members will be along shortly to help.

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

Co-Moderator - Lupus Forum

UCTD, Inflammatory Arthritis, Diverticulosis, (recent dx - Sjogrens, Crohn’s 4/08)

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AlwaysRosie
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Date Joined Jan 2005
Total Posts : 8616
   Posted 5/9/2008 10:22 AM (GMT -7)   
Question that might help the others to help you . . . . what doctor did your surgery for the abscess??? Depending on his specialty, he 'may' or 'may not' have had a lot of experience what he was 'actually' dealing with.

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

Co-Moderator - Lupus Forum

UCTD, Inflammatory Arthritis, Diverticulosis, (recent dx - Sjogrens, Crohn’s 4/08)

Clickable Links:  Lupus Resources    Lupous.Org   Lupus Criteria (4 of 11)   Lupus Chapter Locator


madabs
Regular Member


Date Joined May 2008
Total Posts : 377
   Posted 5/9/2008 11:08 AM (GMT -7)   
Thank you for the welcome. It was a colo-rectal surgeon. He saw me fourteen days post op and said abcsess was healing fine and that it would drain for "a little while" longer. I guess I should have had the presense of mind to ask him to be more specific. It was my GI who looked at it two weeks ago. I am going in for a much needed colonoscopy on Monday. I wonder if I should ask GI to take another look then or if I should call the surgeon.

Take care.

chroniemomx2
Veteran Member


Date Joined Apr 2005
Total Posts : 2346
   Posted 5/9/2008 2:55 PM (GMT -7)   
I have had abscesses drained, and depending on how deep they are, they do take time to heal, and I don't think that 8 weeks is too long to worry about it being a fistula yet. I have had open and draining still for around 4 months. There is a 30-50% chance that you will be left with a fistula after you have an abscess drained, so don't be too surprised. I would definitely give it a couple more months before I would worry about it being a fistula.

You had it properly taken care of which is great! So, it is healing from the inside out the way it is supposed to, so hang in there. Do you soak in the tub at all? When mine are healing, I soak in the tub as often as I can and in the hottest water that I can stand. The hot water brings the blood there and promotes healing.

Ask your dr. to look around on the inside while he is in there scoping to see he can find an internal opening. Your surgeon should have done that also when he drained it. They insert dye in the abscess cavity and then look around on the inside to see if it comes out anywhere....if it does, that would mean you have a fistula. Keep us posted on your progress.

madabs
Regular Member


Date Joined May 2008
Total Posts : 377
   Posted 5/9/2008 5:24 PM (GMT -7)   
Thanks chroniemom!  That is really useful information.  I am feeling much relieved.  Just a short time ago I had no idea there was such things as rectal abscess' and fistulas (fistulae?).  I do feel like a received good care when I was sick with the abcsess so perhaps my chances are better that I will heal properly with no complications.

UC since 10/05, first symptoms felt as early 1983
canasa and lialda daily
 


FallColors
Veteran Member


Date Joined May 2007
Total Posts : 1220
   Posted 5/9/2008 7:35 PM (GMT -7)   
Hi Madabs,

Sorry to hear you had an abscess. I've had 2 abscesses and a have branched fistula. The fistula starts out from one hole in my rectum and empties out in my periniem. The fistula tube that formed from the hole actually split/branched so I have two exits. My colo-rectal syrgeon is very experineced with CD and put in seton drains in both fistula. These plastic rings keep the fistula open so the stuff can drain out and not plug up and abscess.

There are many threads about fistula and setons. I suggest you use "Search Site" if you want to check them out.

It is critical that your surgeon and GI Doc have experience with fistula. Not many know of them unless they specialize. I've even had the head ER doc at a premier hospital in D.C. ask ME what a seton was. Don't let anyone touch you/cut into you unless they have experinece with CD. Even though you have UC, a Doc who knows CD will know how to handle fistulas. We CD people don't heal the way others so or as fast, so your Doc needs to know how to handle us. I suggest you go see your colo-rectal surgeon -- or one that knows CD.

I hope it works out for you!! Let us know what happens.

madabs
Regular Member


Date Joined May 2008
Total Posts : 377
   Posted 5/10/2008 6:42 AM (GMT -7)   

Hi FallColors,

Thanks for the advice. I am seeing more and more that I need to take charge of my treatment.  Honestly, I have just floated along with this disease as if it would just go away on its own.

 Your situation with abcsess and fistula sound very complicated.  I hope they don't trouble you too much.

 It seems that everyone around here agrees that finding docs with the right experience is most important.  I think I have seen adequate doctors, but I haven't asked the right questions and they haven't offered me enough information.  I actually found out about fistula on this site when I searched for info on abcsess'.  When the GI mentioned them at the last check up , he never explained what they were and if I hadn't read about them here I don't know what I would now be thinking.  He never said a word about seton either, just talked a bit about seeing a surgeon to have it removed. 

Oh well, jumping the gun here anyway, I may just have a slow healing abscess.

Did anyone have a raw looking flap of skin form next to their healing abscess 


UC since 10/05, first symptoms felt as early 1983
canasa and lialda daily
 


FallColors
Veteran Member


Date Joined May 2007
Total Posts : 1220
   Posted 5/10/2008 7:31 AM (GMT -7)   
This site has been an excellent resource for me too. My Docs are very experienced with CD, and are very good about answering questions and educating me. But once home, I always think of more quesitons. The folks here have such a wealth of experience (unfortunately) and are so willing to share. They are wonderful!!

I agree -- learn as much as you can and then don't leave your Doc's office until you get the answers and explanations you need. However, something I know too well is that everyone's CD is different and dealing with damage is often more art then science.

Over the last week I have had more drainage out of one fistula. Yesterday, I felt a very small swelling but it is hard to feel because it is under the scar tissue from the last abscess surgery. I was trying to feel what was going on when I felt a small popping feeling and a small amount of bloody stuff came out of the fistula -- small amount, a couple spots of the toilet paper. This is probably another abscess off of the fistula. I will get into my colo-rectal sugeon ASAP but I'm wondering if this won't be a wait-and-see situation. The whole area is probably like swiss cheese!! And maybe I will get these problems now and again. What I will ask my Doc, after we decide what to do about the current problem, is in the future, should I call him at the first sign of something?? Should I take an antibiotic (I have a small stash) and call him only if it doesn't resolve itself after a few days??? Having a plan of action will really help me know what is important and what we can watch. All part of disease management. I'm blessed that my colo-rectal guy is sooo willing to take the time to discuss everything!!!

Anyway, hope your situation resolves itself very soon!!

chroniemomx2
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Date Joined Apr 2005
Total Posts : 2346
   Posted 5/10/2008 6:19 PM (GMT -7)   
madabs....i think that little flap of skin you are talking about is basically healing tissue...it has a name but I can't think of it right now. It's not a big deal, so please don't worry about it. If it bothers you, your surgeon, can burn/freeze it off, or something like that....doesn't hurt, znd they do it right in the office.

madabs
Regular Member


Date Joined May 2008
Total Posts : 377
   Posted 5/15/2008 6:07 AM (GMT -7)   

Thanks to everyone who helped me out with my question.

My doc took a look at my little hole during my scope and said it is fistula to nowhere and may heal in time.  I guess since I have uc I am not likely to have such severe complications from the abscess as someone with crohn's.  I think I was just being overly sensitive because I felt like perhaps my hygiene was coming into question since people with UC don't get abscess' or fistula.

Thanks again!


UC since 10/05, first symptoms felt as early 1983
canasa and lialda daily
 


Jen77
Veteran Member


Date Joined Mar 2006
Total Posts : 2689
   Posted 5/15/2008 9:04 AM (GMT -7)   
Welcome! That's exactly how my fistula developed. I had a rectal abcess, that I let drain on it's own (took about a week, ouch!). After that it just never healed, and would be a draining hole. Quite painful really. I didn't have a Crohn's diagnosis yet, and for some reason my doctors were never putting 2 and 2 together. Which just amazes me, looking at all my symptoms. They were still saying IBS.

But anyway, I went in and had it surgically fixed (fistulotomy). That took a WHOLE YEAR to heal up. It wasn't painful, but very annoying having that heal so slowly. Without Crohn's treatment, I'm really surprised that it did heal, in all honesty.
~Jennifer
 
Diagnosed with Crohn's Disease 2/06 after sever GI bleed. Has been suffering since 1998. History of rectal fistula and gallbladder removal. Currently taking Predisone 40mg, and Asacol.


chroniemomx2
Veteran Member


Date Joined Apr 2005
Total Posts : 2346
   Posted 5/15/2008 12:51 PM (GMT -7)   
Are you sure that you don't have crohns???

As far as the hygeine comment, my surgeon told me to stop being so anal about keeping it so clean down there. :)

madabs
Regular Member


Date Joined May 2008
Total Posts : 377
   Posted 5/15/2008 5:26 PM (GMT -7)   

lol chroniemom, I am totally "anal" about keeping clean down there too!  It is just that when I was in the hospital for the abscess I must have been told about twenty times that when I went home I must keep that area clean.  Made me insecure I guess.

Whether or not I have Crohn's....my gi just did a c-scope on Monday to check exactly that and he says, nope, I still have mod - severe left sided colitis and biopsy just came back UC as well.  I think he was rather pleased with himself not to have to change his diagnosis. 

 

=Jen77 - Thanks for the welcome.  I am sorry it took so long for your fistula to heal that you ended having surgery on it.  I am resigned to remain in "wait and see" mode regarding mine.  You were very brave to let your abscess drain.  Mine made me so sick, I think it would have nearly killed me to have let it go on its own. 


UC since 10/05, first symptoms felt as early 1983
canasa and lialda daily
 

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