MRI

Hia all,   After struggling with almost permanent partial obstructions for the last 3 years things and being on a virtual 100% fluid diet, things have got worse.    I have lost far too much weight and have to spend more and more time in bed, lying on my stomach.   My Gastro sent me for another MRI which I had on 10 Oct and it has shown up an abnormal section of thickened diseased small bowel and multiple adhesions some of which are attaching to my pouch.    My follow up with the Gastro is not until next week, so I have been worrying about it for some weeks not knowing what the abnormality is.    The MRI report referred to the section being diseased, but that there was no active disease at the time of the MRI and there was no lymphatic changes.   So I am thinking that it is the site of my old ileostomy or perhaps Chron's (which my Gastro suspects given my ongoing poor health and Ankylosing Spondylitis).     I did have a previous MRI in 2014 which did not show any abnormalities, so this makes me think it is not my old ileostomy site.

I know, I should just wait till next week, but just wondered if anyone else has had similar MRI results and what the outcome was.

Thanks

Caroline

 

Original Post

Although your post is not detailed enough for me to be able to know where this issue is precisely, I had an MRI Enterography done a few years ago which showed inflammation and bowel thickening in the area at and above the J Pouch inlet. This is not uncommon and can be from backwash stool/SIBO in the neoterminal ileum due to the lack of a backsplash valve in the Pouch. In addition to this my J Pouch inlet is also narrowed due to inflammation which shows up as a thickened bowel wall. 

Doctors have problems discerning whether this issue is Crohn’s Disease or just SIBO and pouchitis due to an inherent mechanical problem in all J Pouches (no backsplash valve). The actual or correct diagnosis is irrelevant; it’s bowel inflammation, and either way it has to be treated.  All treatments for bowel inflammation in that area are the same. It’s how you respond to them which varies with the individual.

Well I had an MRI of my pouch and it said, "there is wall thickening or mural hyperenhancement of the pouch. no pouchitis. Dr Shen at Cleveland Clinic is my GI, and after a pouchoscopy 2 months later stated that the pouch looked great. So not sure about the wall thickening thing.

Thanks for your replies.   I had not considered SIBO, but given that my bowel always functions better when I have antibiotics it makes sense.   It also links in to the whole leaky gut debate and it's connection with all the Spondyoarthropodies, anklylosing spondylitis in my case.

It is very difficult when you have a number of medical issues to differentiate between them.    All these inflammatory autoimmune diseases are connected and just so difficult to treat.

My thickening is about 30cm proximal to my pouch and an adhesion from this area is then joined to my pouch.   My pouch actually functions really well and the biopsies taken recently were 100% OK.   Am just hoping that if they decide to remove the adhesions they don't damage my pouch. 

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