What's wrong with my gut and what does my surgeon plan to do about it?
What they know is wrong with my gut:
The surgeon plans to begin the operation laparoscopically. He'll attempt to first drain and then remove the abscess. However, the surgeon, my GI doctor, and I all believe that I have a perforation in my bowel (the fistula) that keeps refilling the abscess. So after draining the abscess, the surgeon will likely remove the portion of my ileum with the perforation.
The quantity of small intestine to remove will depend entirely upon the severity of the disease and the length of intestine involved.
After the surgeon fixes these issues, he'll perform a careful inspection of my entire GI tract from the outside. He'll inspect from stomach all the way down to my rectum. He'll be looking for a couple of different things:
Adhesions (scar tissue from Crohn's Disease and prior surgeries on the outside of the intestine)
Strictures (scar tissue from Crohn's Disease on the inside of the intestine)
Inflamed tissue (active diseases portions of the intestine in places other than those spotted by the CT scan)
Other signs of infection or fistulas (looking for any other diseased tissue)
If he finds adhesions, he will attempt to remove them.
If he finds strictures, he will try to use a small balloon to try to stretch them open. If that fails or the tissue is too diseased, he'll have to cut that portion of my intestine out.
He may also find other portions of my intestine with active Crohn's Disease. Since these do not appear in the CT scans, then it is likely the tissue isn't as damaged as the portion in my terminal ileum. Therefore, it is likely he won't need to remove any of this tissue. I hope that he identifies these sections so that we can observe them in the future.
I may have additional fistulas. In fact, my fistula from last year never completely healed. I still occasionally bleed from the external opening of this fistula. I hope my doctor finds the internal opening of this and is able to correct the problem while he's in there. I'm fairly certain that this isn't a priority. When I finish healing from this surgery, I may have to return to my surgeon to get this problem corrected.
If the damage is severe enough, then the doctor will disconnect my small intestine from the lower portions of my GI tract. This will allow my lower GI tract a chance to heal without having food passing through it, however, it also means I'll have to use a ileostomy bag for several months. After it has healed, then my surgeon will go back in, remove the stoma and reconnect my upper GI tract to my lower GI tract.
The best possible outcome for me would be to complete the surgery as laparoscopic with removing a minimum amount of small intestine. I've already had 14 inches of my small intestine removed and it is likely I'll have more of it removed in the future, so the more I can keep, the better I'll do.
In my opinion, a more likely outcome will be that the surgeon will have to switch from a laparoscopic to an open abdominal surgery. My wife states that she heard the surgeon say that he'll try to use the same surgical incision that I have from my 1998 surgery. The anesthesiologist will use a spinal block that should better control the surgical and post-surgical pain. From watching my wife recover from her hysterectomy, I anticipate that this will last 1-2 days. After this time, the pain will be controlled primarily with opiate medications. This hospital uses dilaudid, which works better for me and causes fewer side effects (I only had one headache during the week of my last hospital stay).
The worst outcome, would be open abdominal surgery with the ileostomy bag which would then require another surgery 4-6 months later. I do not know whether the second surgery could be done laparoscopic but I assume that it couldn't.
What they know is wrong with my gut:
- I have an abscess and it is 1-2 inches in diameter as of the last time the did a CT scan. I may have additional abscess other issues.
- I have highly inflamed and damaged tissue in my terminal ileum. The extent of the damage isn't known, however, a colonoscopy revealed that some of the inflammation extends into the cecum (the highest portion of the colon.
- I have strictures in my small intestine that have caused partial small bowel obstructions.
- I have a fistula, probably connecting two loops of my small intestine to each other.
The surgeon plans to begin the operation laparoscopically. He'll attempt to first drain and then remove the abscess. However, the surgeon, my GI doctor, and I all believe that I have a perforation in my bowel (the fistula) that keeps refilling the abscess. So after draining the abscess, the surgeon will likely remove the portion of my ileum with the perforation.
The quantity of small intestine to remove will depend entirely upon the severity of the disease and the length of intestine involved.
After the surgeon fixes these issues, he'll perform a careful inspection of my entire GI tract from the outside. He'll inspect from stomach all the way down to my rectum. He'll be looking for a couple of different things:
Adhesions (scar tissue from Crohn's Disease and prior surgeries on the outside of the intestine)
Strictures (scar tissue from Crohn's Disease on the inside of the intestine)
Inflamed tissue (active diseases portions of the intestine in places other than those spotted by the CT scan)
Other signs of infection or fistulas (looking for any other diseased tissue)
If he finds adhesions, he will attempt to remove them.
If he finds strictures, he will try to use a small balloon to try to stretch them open. If that fails or the tissue is too diseased, he'll have to cut that portion of my intestine out.
He may also find other portions of my intestine with active Crohn's Disease. Since these do not appear in the CT scans, then it is likely the tissue isn't as damaged as the portion in my terminal ileum. Therefore, it is likely he won't need to remove any of this tissue. I hope that he identifies these sections so that we can observe them in the future.
I may have additional fistulas. In fact, my fistula from last year never completely healed. I still occasionally bleed from the external opening of this fistula. I hope my doctor finds the internal opening of this and is able to correct the problem while he's in there. I'm fairly certain that this isn't a priority. When I finish healing from this surgery, I may have to return to my surgeon to get this problem corrected.
If the damage is severe enough, then the doctor will disconnect my small intestine from the lower portions of my GI tract. This will allow my lower GI tract a chance to heal without having food passing through it, however, it also means I'll have to use a ileostomy bag for several months. After it has healed, then my surgeon will go back in, remove the stoma and reconnect my upper GI tract to my lower GI tract.
The best possible outcome for me would be to complete the surgery as laparoscopic with removing a minimum amount of small intestine. I've already had 14 inches of my small intestine removed and it is likely I'll have more of it removed in the future, so the more I can keep, the better I'll do.
In my opinion, a more likely outcome will be that the surgeon will have to switch from a laparoscopic to an open abdominal surgery. My wife states that she heard the surgeon say that he'll try to use the same surgical incision that I have from my 1998 surgery. The anesthesiologist will use a spinal block that should better control the surgical and post-surgical pain. From watching my wife recover from her hysterectomy, I anticipate that this will last 1-2 days. After this time, the pain will be controlled primarily with opiate medications. This hospital uses dilaudid, which works better for me and causes fewer side effects (I only had one headache during the week of my last hospital stay).
The worst outcome, would be open abdominal surgery with the ileostomy bag which would then require another surgery 4-6 months later. I do not know whether the second surgery could be done laparoscopic but I assume that it couldn't.
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