Hello,

I had a one-step Jpouch surgery 9 monhts ago.

For the past 2 weeks I have been having a constant low grade fever 99.0-100.5. I am concerned why I would be having a low grade fever for such a long period of time. When the fever first began, pouchitis returned as I was trying to wean myself of a 3 month supply of Cipro. Even though I recently increased the Cipro dosage back to 1000mg and my pouch feels better, I still have fever? Is this normal? Is the fever related to the pouchitis or possibly the use of long term Cipro?

A brief medical history

1) 9/29/07 - Surgery
2) 10/06 - 12/06 - Recovery
3) 1/07 - Surgical Dilation / Pouchitis
4) 1/07-3/07 - Pouchitis on and off. On and Off Cipro.
5) 3/07 - Surgical Dilation / Pouchitis returned. GI put me on 3 months of Cipro - 1000mg.
6) 3/07-6/07 - 1000mg Cipro - No Pouchitis.
7) 6/07 - First two weeks - 750mg of Cipro , Second two weeks - 500mg of Cipro. (Goal was to
eventually get to 0mg)
8) Late June - Pouchitis Returned - Cramping, Urgency, Fever. Increased dose to 1000mg of Cipro. Cramping, Urgency, etc went away almost immediately. But I still have the fever?????

I have a routine pouchoscopy and another dilation next week - Friday. *With every dilation I have had thing have improved in the positive direction.

Any advice would be greatly appreciated.

Keith

I'd say it was related to the pouchitis. However, have you had any imaging to rule out abscess, just to make sure?

Jan

I had a routine CT Scan back in March - no sign of abcess. What is the main symptom of an abscess?

Do you think I should call my GI about the fever I have had the past 2 weeks, even though the pouchitis symptoms have gone away last Thursday(when I increased to 1000mg of Cipro)?

Thanks

Yes, your doc should know about this symptom.

Primary symptom of an intra-abdominal or pelvic abscess is an unexplained fever. Then comes pain and GI disturbances. Typically, the fever can be low grade for quite some time, but usually will spike eventually. My abscess was in the immediate post op period. I had a low grade fever for 2-3 weeks, then it spiked to 104-105. I had severe tailbone pain and a constant ache.

There are many, many causes of fever, some serious, some not. But if you have an unexplained fever that does not resolve, it definitely needs to be checked into. Keep in mind however, that a temperature of 99 is not considered a fever. Normal temperature range is up to 99.6. If you are going over 100 consistently, especially while taking Tylenol, then something is up. Sometimes it is something as simple as dehydration. You can try getting more fluids in to see if that does not resolve the minor fever issue before getting too excited.

Jan

This message has been edited. Last edited by: Jan Dollar,

Thanks for your info!!

I spoke to my GI and he said that it could be an abscess, but said to wait and see if the fever does not go away and if I encounter pain.
If it gets worse, then he will order a CT Scan. Besides the fever, I do have a constant dull/ache/tightness feeling in my lower abdomen. . Not painful per se, but just a feeling that my lower abdomen exists. (Does that make sense? - LOL)

I have a pouchoscopy and dilation scheduled for next week. If it is an abscess, I am just wonderingf if these procedures can do any harm?

Ohh and I drink tons of water and my output is quite formed, so I doubt it is dehydration?!?!

Hi Keith -

I have no advice, but a question...what does your surgeon say about the pouchitis? That you got it so soon after your surgery and that it's not going away with the antibiotics?

Sorry if this is intrusive, but I can't imagine how frustrating this would be for you and it made me curious...

Lisa

Keith, sounds like you have a good plan. One thing to note is that the deeper an abscess is within the abdominal cavity, the more vague the symptoms can be and the more difficult it can be to find and diagnose. Even with a CT, it can remain hidden.

Before my abscess became very large and caused serious pain and fever, my discomfort was more of a dragging sensation low in the pelvis and a dull ache when I was sitting. Since it was mere weeks since my 1-step surgery, it was difficult to separate surgical pain from this pain. By the time it was causing unmistakable symptoms it contained over 500cc of fluid. By then, it showed up easily on CT and could be felt on a rectal exam.

Jan

Thanks again Jan!!!

Lisa, the "Theory" is that with my recent history of strictures causing me to not fully empty my pouch properly, the bacteria can build up in the pouch and fuel the pouchitis.

Luckily the Cipro works very well when I am on 1000mg. It is when I try to get off the antibiotics it seems to come back. My GI said that he has several pouch patients on Cipro for several years at a time. As long as there are no side effects and it still works, it is OK with me!