I saw Dr. Shen in April for some issues I've been having since my hospital stay in April and July of last year. I've been trying Cipro, Flagyl, VSL 3 and Xifaxin over the past year for pouchitis. Xifaxin was the only one to help for any length of time. While dealing with pouchitis, I've been having increasing discomfort while sitting. I go to work, come home, and lie on the couch with a heating pad until it's time to go to bed. I go to church on Sunday, and spend the rest of the day sleeping, recovering which gets me to work through the week. My gastroenterologist insisted that I head to Cleveland Clinic to see Dr. Shen, and I'm glad I did. He ran every blood and stool test possible. And,because of a recent perianal abscess, recommended an MRI of my pelvis.He had asked me to email him after the test so he could review it before my upper and lower endoscopes scheduled for two weeks later. Two minutes after I sent him the email, he responded with the MRI results. This showed three Fistulas and an internal abscess. He wanted to see me earlier than my scheduled scopes. I'm headed back up to CC on Wednesday for both scopes. Dr. Shen had mentioned that if the MRI showed an abscess, he would be able to inject medication into it while performing the scope. I don't believe he mentioned anything about treatment of Fistulas, however what I've googled (I have to remind myself to not view the images next time I google a medical issue) and read on this forum, I'm freaking out a little bit. What is the standard treatment for this, and have any of you seen Dr. Shen for this? Thanks in advance for your help!
Replies sorted oldest to newest
I have a simple intrasphincteric perianal fistula that started as an abscess. I have a draining seton, because my surgeon feels that surgery there could render me with incontinence because of the previous J pouch surgery. I am completely continent now.
Overall I'm frustrated with things, but I suppose it could be worse. My new GI is reluctant to call it Crohn's, because overall, my innards look too good, and pathology only came back for mild inflammation. So the seton stays for now...
Overall I'm frustrated with things, but I suppose it could be worse. My new GI is reluctant to call it Crohn's, because overall, my innards look too good, and pathology only came back for mild inflammation. So the seton stays for now...
Dr. Shen injected doxycycline into my fistula tract in an attempt to create scar tissue and close it. After 3 attempts and no changes to the fistula, he referred me to a surgeon at CC who put in a seton; this was 2 years ago now.
If this is what he would like to do with your fistula, I would specifically ask how many times he has used this technique on fistulas, and how many times it was successful, or is it just in "trial" stages. He was pretty convincing when explaining how the doxy works, so I jumped at the chance to maybe close the fistula in a non-harmful way. However, in the end it was just an expensive trial which did not work in my case.
If he plans to inject medication into the abscess, I don't know anything about that, sorry.
Best of luck.
If this is what he would like to do with your fistula, I would specifically ask how many times he has used this technique on fistulas, and how many times it was successful, or is it just in "trial" stages. He was pretty convincing when explaining how the doxy works, so I jumped at the chance to maybe close the fistula in a non-harmful way. However, in the end it was just an expensive trial which did not work in my case.
If he plans to inject medication into the abscess, I don't know anything about that, sorry.
Best of luck.
I guess I'm wondering if they have talked about removing the pouch and going back to the ostomy. Would that take care of the issue or will it just reoccur another place? I'm having a bit if trouble with continence, probably because one of the Fistulas and the abscess is going straight through my sphincter. Thank you both for the information!