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10 replies

Any thoughts???

P Pouch4WfMember
So we are back to the emergency room.

Quick history, takedown about 5 months ago. Only major complications were between 2nd and 3rd surgery. Wife developed abscess with high fever and abd pain. Abscess was drained twice, and eventually just treated with abx. Abscess was thought to NOt to have been caused by leak, but rather contamination during surgery.

Past two months....first had some low grade fever, joint pain and slightly increased diarehea. Treated with Cipro for one month and diarehea improved but other symptoms did not. Thought to have been pouchitis. After discontinuing Cipro, diarhea got worse. Scope done one week ago and pouch looked "pristine". No signs of any issue.

Symptoms past week have gotten worse and now include abdominal pain and nausea/vomiting . No real fever. Waiting on labs, but everything till now has been negative.

We were scheduled for a mri enterogeaphy, abd ultrasound and scan of gallbladder. CT scan may be coming now that we at ER, but most docs up until now have not suspected abscess.

Any thoughts or ideas out there?? Is Crohns after Jpouch surgery almost always found in the pouch?? I guess anything is possible.

Dan
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Jan DollarJan DollarModerator, RN, retired
Sorry to hear this. Yes, anything is possible and gallbladderis not an uncommon cause of her symptoms. Imaging will help sort it out.

In regard to post op Crohn's, no it is not always found in the pouch, but terminal ileum is the most likely spot if it does occur. The joint pain may be leading you to think of Crohn's, but IBD associated arthritis is not unique to Crohn's. It can and does occur with UC, sometimes decades post colectomy. I am one of those.

Good luck and I hope they get to the bottom of this soon and it does not turn out to be abscess related.

Jan Smiler
P Pouch4WfMember
So initial results from scope is that there were ulcers at the ileo-pouch anastamosis. GI was not sure why they weren't seen 7 days ago. I figure they either weren't there or the doc, who is IBD specialist wasn't impressed and failed to mention.

Will wait for docs to decide if this is IBD, pouchitis, infection related.

I am leaning torwards some type of infection non-inflammatory related. She is Cdiff neg, but does have history. Are there other persistent bugs like Cdiff that can cause systemic symptoms, be surpressed by 1 month of Cipro, and come back with a vengeance ??
Jan DollarJan DollarModerator, RN, retired
Lots of bacteria are known for antibiotic resistance. Heard of MRSA (methicillin resistant staphlococcus aureus)? It should not be a problem with Cipro though. E. coli is a problem though, as Cipro resistant strains are out there now.

I just am not buying the symptoms she had with low pouchitis findings. Maybe if there was inflammation seen higher up... Let us know how things progress.

Jan Smiler
P Pouch4WfMember
GI now saying no pouchitis, and pouch still looks very good. Running a cortisol stim test. Wife has had pretty incredible sensitivity to steriods over the years and even though she's been weaning from 5mg to 1mg over past 4 months, they want to rule out withdrawal syndrome. If that comes back negative, we'll be going home with Cipro and no explanation.

Dan
P Pouch4WfMember
So did a cortisol stim test.. Baseline reading that was done at noon was 2.3 . Apparently this is very low for anyone at noon, definitely for someone under stress at a hospital. 30 and 60 min were normal.

Needless to say we will be following up with an endocrinologist .

She has had morning cotisols in the past few months that are normal. Her major complications in the past have been adrenal issues, abscess and stricture. Time to completely rule out these, before assuming there's a Zebra out there.

Thanks for the thoughts Jan,

Dan

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