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Hello All-

I am now over 6 months post take-down. However, I have an abscess around my tailbone that refuses to go away.

Because of its location, it cannot be drained via the radiologist. I have been on antibiotics for about a year now, and they seem to be wearing off. My tailbone area has become increasingly tender, and I am experiencing some discomfort when emptying the pouch and urinating.

I have been told that, if the antibiotics fail to fix abscess, the Dr. will need to clean the area out surgically.

Has anyone seen or experienced this type of scenario before?

If so, what does the surgery entail, and how long will I be out of commission?

Much thanks!
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Hi Nomore,
Well, usually what they do is excise the abscess by making a slightly wide opening, scraping the zone out and cleaning it out completly and then they pack it with gauze and do Not close it up again (I have had a few and they never close them) and then they allow them to drain while healing. Generally the wound needs to be cleaned and packed daily as it slowly closes. Depending on how large/deep the abscess went you will be able to gage your healing time...the ones that were the size of a baseball took around 6 weeks, the size of an apricot about half that.
I have never had one that they have closed up but it is possible that they will choose to do that and leave a drain in to help it heal.
If my memory serves me well, it was not really painful after a couple of days, just bothersome.
Sharon
If this is a presacral abscess, it should be able to be drained by interventional radiology. That was what happened for me. I had my drain for about a month. It was inserted through the gluteal muscle, near the sacrum. I was told that if they had to do open surgery to deal with it, I could lose my j-pouch.

If it is more near the tailbone (coccyx), maybe there are problems with it being too near the nerve bundles, but I'm not sure.

Have you gotten a second opinion? Antibiotics alone usually are not enough...

Jan Smiler
quote:
otics alone usually are not enough...


Indeed, antibiotics have not done the trick (I have been on them for over a year now). They tried to drain it through interventional radiology, but were unable to reach it due to its location (I'm not sure what they meant by that). They also tried a drain. I suspect they will need to do the open surgery to get it (at least that is what I've been told). They say it could result in osteomyelitis. I am very worried not only about loosing the pouch, but also being bed-ridden for another month!

Has anyone had open surgery for an abscess?
I had the same thing happen...abscess between the pouch and tailbone. Not easily operable.
As explained to me by my j-pouch surgeon, they would remove the j-pouch in tact, remove the scar tissue where the abscess was, trim some of the cuff off, and re-do the anastamosis (connection to the anal cuff). This would once again require a loop ileo for three months while healing, and a loop takedown afterwards.

I went and got a second opinion. I opted to visit Dr.Shen at Cleveland Clinic due to praise given by individuals on these forums. I expected he was going to tell me the same thing as my GI surgeon...that surgery was needed. But, he offered another option. It was a procedure where he'll treat the abscess endoscopically. The intent is to open the abscess up to the pouch interior so that it will be come part of the pouch wall. In theory, this would prevent stool from getting trapped in the abscess and allow intestinal mucosa to flow and coat the scar tissue and protect it from inflammation, etc...This requires multiple endoscope procedures and is minimally invasive. Side effects of each procedure is mostly the same as that of having a normal endoscopic check-up (some discomfort from being inflated like a balloon). This type of treatment has apparently provided relief for many of his patients and he is one of the few who will perform this.

I have a 6 month check up at Cleveland next month. I haven't had significant improvement in my symptoms at this point. If all else fails, the surgical option is still there to fall back on for me...I'm hoping not to have to take that option...

As Jan said, get a second opinion, whether it is with Dr. Shen, or another surgeon/doctor in your area. You may find you have more options than you realize...
Dr.Shen told me that he has about 100 success cases of using the needle/knife procedure to fix sinuses in the manner screaminweasel described above- making the sinus part of the jpouch. He also said he has to do this many times on patients to reach success. When I met him in his office last time he told me the guy in the room next door had to have 9 of these procedures, but then it was fixed. Also told me of a case that a lady needed 19 of them. Point is though, these procedures are relatively harmless. And if he does have 100 success cases, then it sure seems like a viable approach to avoid a surgery.

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