Stricture at ileostomy closure site

I've had mine dilated endoscopically within the first few years of my surgery. Haven't had a problem since. I was told there are two basic surgical approaches use to take the loop of bowel down from the stoma and reconnect, and either of them can end up with some stricture at the site.

Have you been scoped in a while?  An endoscopist might have a different suggestion than the surgeon.  

Thank you so much for your response. I’ve only ever had pouchoscopies, post 2009. Somewhat frustrating, as I’ve always felt that the stricture was located quite a ways beyond the jpouch. This was confirmed when I had a CT scan that showed the entire small intestine, and the stricture was confirmed to be along the ileum, above the jpouch. Where the stoma was, pre-takedown.
My last pouchoscopy was done about 6 months ago, and maybe 3 or 4 times prior to that over the last 5 years. I asked the surgeon about balloon dilation, and the resident basically told me it was pointless because of rupture risk, and that it might not work. But…there are risks to every procedure. And I’ll take the chances of “it might not work” if it means I can avoid a 4 day stay in a hospital. I’m a mom of 3 young kids, and I’m trying to be practical. I live in Canada, where my experience has been that doctors err on the side of caution, and they aren’t exactly bold in their treatments. They go with what’s maximally guaranteed, and I think they are intimidated by the “intermediate” options.

I’d be cautious about overinterpreting “there are risks to every procedure” to create a false equivalence. Risks can vary enormously between procedures (and practitioners) in both likelihood and severity. That being said, a resident isn’t likely to be qualified to help you navigate this. Perhaps you can get a referral to a well qualified procedure-oriented gastroenterologist who really understands the options and tradeoffs?

@Scott F posted:

I’d be cautious about overinterpreting “there are risks to every procedure” to create a false equivalence. Risks can vary enormously between procedures (and practitioners) in both likelihood and severity. That being said, a resident isn’t likely to be qualified to help you navigate this. Perhaps you can get a referral to a well qualified procedure-oriented gastroenterologist who really understands the options and tradeoffs?

Hey Scott,

Agreed! I did ask them to refer me to someone with experience in this field, so I’m just waiting for that. Could be about 4-6 weeks to hear back, so I just wanted to see if anyone had a bit of experience.

@AMB posted:

I've had mine dilated endoscopically within the first few years of my surgery. Haven't had a problem since. I was told there are two basic surgical approaches use to take the loop of bowel down from the stoma and reconnect, and either of them can end up with some stricture at the site.

Have you been scoped in a while?  An endoscopist might have a different suggestion than the surgeon.  

Hi. Which end did they go from to reach that area?  I had a bad stricture in my stoma closure and was getting bowel obstructions from anything physical and from food. I had a pouch redo and at the time my surgeon also resected the old stoma closure. Pathology noted a severe stricture with dilation of the adjacent bowel in the specimen. Post redo and resection I can tell my stoma closures are still an issue at times. I would want to consider a dilation like you did if they get severe again. Thanks!

Mine was balloon dilatation of the pouch inlet during a pouchoscopy by a very experienced gastroenterologist.  

@AMB posted:

Mine was balloon dilatation of the pouch inlet during a pouchoscopy by a very experienced gastroenterologist.  

I actually think I underwent the same procedure within the first year of my takedown. I was young, so I don’t remember the details, but the surgeon said there was a narrowing at the pouch-anal junction. And they dilated it a bit. I recall not having any issues at that point, but he insisted I do it anyway. It was definitely not where my current stricture is.

@Matchaqueen -

I associate narrowing of segments of small bowel with Crohn's Disease, treated surgically with strictureplasty or when strictures are extensive, resection.  Any chance this is what you're dealing with?  Or just scar tissue (again)?

@AMB posted:

@Matchaqueen -

I associate narrowing of segments of small bowel with Crohn's Disease, treated surgically with strictureplasty or when structures are extensive, reaection.  Any chance this is what you're dealing with?  Or just scar tissue (again)?

I have UC. There has never been any suspicion of Crohns. I think my current stricture is associated with scar tissue from the incisions.

@AMB posted:

Mine was balloon dilatation of the pouch inlet during a pouchoscopy by a very experienced gastroenterologist.  

I see. I had a severe pouch inlet stricture with kinking and sharp angulation also. That required a redo along with all my other issues. I don’t think they can reach the stoma closure endoscopically, right?

My stricture was at the stoma site.  The endoscope can get up past that spot to view a bit of the small intestine above the pouch also, I believe.