Imaging for abcess/fistula

Should be able to with MRI. I think it is mostly a cost and availability issue (easier to schedule). But, the cummulative radiation is a valid point and it makes sense to bring it up. But, he may say, no, only the CT will show me what I need. If that is the case, you are sort of stuck.

Ultrasound, I don't think is as detailed. If you've ever seen one, you'd see why. It is OK for fluid filled organs, but I don't know about dense areas. If you had a large abscess, it would show up on an ultrasound, so it might be a cheap, easy first step.

Jan

I have been with Dr. Milsom and Dr. Remzi for a fistula. Dr. Milsom won't CT me anymore as he says he doesn't want to radiate me anymore, but Dr. Remzi does. I always have an MRI and it seems to be a more accurate test.

FYI
CT's are cheaper than MRI's and I think my insurance company has to approve the procedures in advance.

Way cheaper, by $1000 or more. Plus, the MRI machines are super expensive, so hospitals tend to have fewer and the waiting list is long. Plus, there always seems to be emergencies pushed to the front of the line (as it should be).

CTs have improved greatly in the past 20 years or so. When I first started having CTs, they took about an hour. That was back in 1995. Since then, they have reduced the radiation exposure and the last time I had one, the whole thing took about 10 minutes, tops, for an abdominopelvic exam, and that was for with and without IV contrast.

They didn't even have CT scans when I was first diagnosed, and I had a number of lengthy flouroscopic exams. Fingers crossed that I have not been "overexposed." I am not sure that they even know what the threshold is...

Jan

I was told by dr. Shen today that mris are much better at finding fistulas. Think he said they only catch about 30% on cat scans verse about 80% on mris.

But the stuff jan said is very true. Mri machine availability is much less than cat scans. Hospitals have fewer machines and its a slower procedure. Also mris are not run thru the night usually. And i believe cat scans are cheaper on the insurance

But if you have had a lot of scans and it is not an absolute emergent situation, definitely request an mri. I just did this and it was no problem. Just had to wait a day for the test but no big deal.

Before I had my colon removed I had prednisone toxicity. My doctor wanted me to have an MRI of my brain and didn't want to wait for insurance approval, so he admitted me in the hospital. Because I was in the hospital, we did not have to wait for approval and I had the MRI that night. Obviously, this was more of an emergency, but I have had approval since then in a couple of days. I guess I have good insurance because it doesn't cost me anything. I don't know if it's because I am in NY, but there are lots of hospitals and out patient facilities to have an MRI, although, I always have mine at the same place. I had one in August, another in November and my next one in April. For me they are medically necessary and never a problem.

My understanding is that MRIs are much more detailed than CT scans anyway, but then again, it also depends what they are looking for. CTs are still better for certain types of procedures. I've had 3 or 4 CT scans, which compared to some here isn't that many, but I've had more abdominal x-rays than I can count. I just had an MRI enterography last week. Interesting experience; still waiting for the results.

We're lucky in Ontario because MRIs are now run 24/7 at most major centres. It's reduced the wait times in most cases from 3 months to 3 weeks.

I have lymphoma and was getting CT scans and after 10 of them, mostly for my UC-crohns, I found out your chance for getting cancer or in my case another cancer goes up quite a bit. I now get only MRI's for both diseases as the radiation from ct scans really builds up, there is none with a MRI.

Thanks for all the great replies, everyone!

My surgeon doesn't want to do any imaging right now, as the abscess has drained and will likely heal. If things get worse, he's comfortable with me having an MRI instead of a CT scan.

Again, thank you all for the replies.

clouseau,
Thanks for posting that as I've had 5 and am going to request MRI's instead going forward. If I remember correctly one CTscan has 8 times the radiation we are exposed to per year from the environment so I've got an extra 50 years worth. Again I'm not sure I remember this correctly but am convinced it is not what I want to have anymore.

CT scans vary enormously in radiation exposure, so it's hard to generalize. They are always much more radiation than a conventional x-ray, and the number of them really does matter. A sophisticated imaging center is more likely to do the work to minimize unnecessary CT radiation exposure. The equipment can be operated using various "protocols," and only some of those protocols do a good job keeping the exposure to no more than necessary.

Yes, and a new machine vs. an old one really makes a difference on exposure. Same with mammograms.

Jan

yes mri's from here on out, unless its an absolute emergency. I started tallying up my CT scans and quit counting after 20.

Only had one mri before the one earlier this week.I am extremely claustrophobic and the first mri I had many years ago was awful. And seems docs always default to CT for all the reasons stated earlier. But for the MRI this week.. the machine was much bigger, and they drugged me up, and the nice MRI man put a washcloth over my eyes and big headphones on my ears. And he put me in feet first so my head never had to pass through the machine. It made such a huge difference.

Hi
I also have a perineal fistula, which I have had numerous mri scans on and also numerous treatments and procedures in the last 2 years to try and sort this problem out, I also have a sinus in the peri anal area following my proctectomy 2 years ago. I was given an mri and a ct at one hospital I was referred to, but having recently moved areas my latest hospital are going to do an mri scan and also a sinogram, which will eventually lead to major surgery to solve these troublesome painful problems.
Let me know how things go for you.
Good luck
Shelly x

shelly what are they talking about doing in terms of major surgery to solve these problems? curious as flap repair is now in the future for my wound/sinus tract from jpouch removal and I have yet to find anyone who has even had to think about this, let alone go through it.

Hi Lizz
My previous surgeon who had done all my surgeries even tried something that had never been tried at the hospital before called endo-sponge vacuum assisted closure, it was like a wound vac, the sponge was placed in th perianal wound and I had a vacuum drain which I had to carry around ( it wasn't a good luck!) but that didnt work although I hear it works for some, it was suppose to be 10 weeks of 1-2 small procedures a week under general anaesthetic, for them to change the sponge and see how things were healing, unfortunately due to the vaginal fistula there was air coming through so they could not get a good suction and seal on the pump, they gave up after 6 weeks as it had only closed 2cms and they weren't happy with that and apparently it was very expensive, most of the time I had a normal drainage bag in place as the vacuum hardly ever worked. luckily been in the Uk I didnt have to foot the bill for it though . When I was finally referred to a plastic surgeon and another colo rectal surgeon at a different hospital, they did mri scan n ct scan with contrast, I never really got to know the results of those scans as I saw both surgeons together before them, they told me they would probably do one of the flap procedures, but told me it was a big operation and that one of them would 'take me to bits and the other would put me back together'. They told me it would be a tough recovery, but they couldnt be definate which procedure they would do till after the results of the scans came through. But I moved before I got to find them out , I do know my next procedure with them would have been an eua. My current surgeon , is going to get all my previous scans from previous hospitals but also want to do their own to compare and see if things have got worse.. She told me that they would probably go in through my scar in my abdomen and use the abdominal wall muscle, Im sure I will have alot of scar tissue as one of my previous surgeons told me it was a mess inside due to the three times they have opened me up ! So I am currently waiting for another scan and a sinogram, although they told me it isnt a quick fix. I gathered that after 2 Yrs!!! lol. I also had a presacral abscess following removal of my Jpouch aswell but I am led to believe by my first surgeon that was all healed before I was referred. Although lately I have been having alot of the same pain in the same places and increased discharge so I am wondering if it has returned. Has your surgeon explained in detail any of your procedures he may have to try if things dont heal ?
Best wishes
Shelly

shelly- thx for the info. I am up to almost one year anniversary of my jpouch removal surgery. Along with that comes one year of dealing with a sinus tract going into a large chronic unhealed wound (from where the jpouch was). My surgeon - best of the best- has tried everything. I have had 9 EUAs for incision and drainage and even an experimental glucose injection to instigate scar tissue formation in the last 10months. Last EUA was just last week, which included a nice 5day hospital stay! Anyways - sinus tract was too long to ever use any kind of wound vac device.

So just last week they have decided its time for a flap repair. A plastic surgeon was in on the EUA last week for a "looksie"! Anyways.. I don't know anymore yet. I understand they can use abdominal wall, butt, or thigh muscle. I would be concerned about abdominal wall because of my stoma and also because what if at a future date.. my stoma would need relocated? But also concerned about losing functionality if they take the flap from a butt or thigh muscle. Anyways.. I will learn more in a few weeks as I am meeting all the experts individually to find out the plan. I do understand it is a big big surgery and I am quite petrified. I have yet to find anyone who has gone through it. Let me know if you do.
best wishes.
liz

Liz , please let me know how you get on, I never thought about whether I would at some point need a stoma location, so that will be one to ask my surgeon after my scans depending on which procedure they decide on. Im hoping in the next few months I will be going surgery as this is having an effect on every aspect of my life, and I'm fed up off it now, with the pain, discomfort, discharge and feeling unwell.
Good luck Liz.
shelly x