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Hi
My son had Jpouch surgery last year; it has been six months from the last stage. We are still waiting for things to get better.
The first issue is the abdominal pain. It has been there from the beginning. It comes in waves and is very intense while it lasts. Sometimes it is accompanied by loud noise that can be heard across the room. The MR Enterography did not show anything to shed the light. After the bout of pouchitis in December the 3 weeks of flagyl did not change anything. The doctors are saying pain is not a typical symptom of pouchitis. The surgeon looked at the pouch, it looks OK. Now he was prescribed cipro 250 mg for 10 days with the idea that it could be pouchitis or SIBO. The pain was better on some days but it still there. The doctor also added entocort. Did anyone have this kind of pain?
He is also severely anemic and getting iron infusions. His hematologist said he has a collection of such patients and that they don’t absorb iron from the gut. Why would it happen, he was doing great during the ileostomy stage and was never anemic during the worst colitis days?
Another question is about cuffitis. Canasa or hydrocortisone foam do not help. What else can he try?

Regards and Best of health

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Canasa and topical hydrocortisone are the typical treatments for cuffitis. He might have better luck with hydrocortisone suppositories than the foam, so that it is concentrated in the right spot. He could also try asking about adding oral mesalamine to see if that helps.

Hopefully the Entocort kicks in and takes care of things. Before settling on long term Cipro, I would want to be sure there is no chance this is C. difficile, as they have found that it is associated with use of Cipro.

The pain sounds very much like obstructive symptoms, so I would be concerned there are adhesions causing problems that are not seen on imagining. The only way to diagnose is to rule out other causes and doing exploratory surgery to find them. Most people who have had this issue did not have any positive imaging findings, yet they had chronic obstructive type pain (pain in waves, as if something is stuck inside). I would suspect that the offending adhesions are at the stoma site or beyond, since he was OK while with the stoma.

If you have not done it yet, go to the pouchitis forum and print the article by Dr. Bo Shen "What Every Gastroenterologist Should Know." You might get some new ideas there.

Jan Smiler
Jan Dollar
Thank you so much for the hydrocortisone suppositories idea, I will ask the doctor.
The surgeon said the same thing about exploratory surgery as last resort. The pain is not localized at the stoma site, it is in the upper abdomen as well. During ileostomy stages he kept getting obstructions at the stoma site. The surgeon told us after the last surgery he does not have adhesions. Could adhesions cause such thunderous noise?

I am not sure what Entocort takes care of, general inflammation?

He just had a test for C.Diff while still on Cipro. He only had Cipro for 10 days, can it cause C.Diff so fast? I understand they gave him Cipro just to see if it helps since there is no firm diagnosis. The hematologist said anemia would suggest pouchitis, but son has no issues with frequency, it has been the same.

Regards and Best of health
T
I totally agree with a bowl obstruction/blockage. I have had my pouch for a year now and I have had three of them. The first 2 I was able to wait out and the third put me in the hospital recently for 5 days. The pain is indescribable and when you said it comes in waves and last a little while that is the exact feeling I've experienced everytime and was pretty intense this last time. Scar tissue from surgery is usual what causes these and I have alot where my ileostomy bag was also where I had a twisted bowel where I had to get an emergency surgery to fix. If he is experiencing this frequently have you tried to change his diet at all or trying to increase his fluids? I have learned from experience and now drink alot while I'm eating and also chew my good until it disintegrates on my mouth.
P
I wanted to comment on the anemia but first I just wanted to say I hope you get to the bottom of the pain issue. I don't have any experience with that.

I've been anemic since my takedown surgery 3.5 years ago. I too go for iron infusions. I just don't absorb the iron or hold onto it. I don't have any bleeding so it's just really frustrating. I have asked why to my surgeon PCP, GI, and hematologist and not one of them can offer me any answers. They say it's not an absorption issue but that's bull it absolutely is. I've come to learn in my reading that many, many j pouchers are anemic.

Hope you get some answers for your son very soon.
mgmt10

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