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Hi, all. After having an abscess removed, it appears as if I developed another one. I had a "special" (?) procedure where a doctor uses a CT Scan to find collection of infectious material and uses the xrays to insert a needle to excise the fluid for testing, etc. My surgeon was expecting this doctor to leave a drain in since he felt I had a pretty good collection of not-so-nice stuff, but he only took out a little bit. I'm not sure we solved this latest abscess issue.

However, this takes me to an important decision point since I've had several abscesses, is it best for me to nix the pouch and go with a permanent end ostomy. The abscesses have certainly created lots of inflammation/pain and quality of life has been a bit tough in recent months. I know I felt better with an Ostomy and okay with it, but I understand an ostomy doesn't mean abscesses are guaranteed to disappear, I may have more issues. But I think that an ostomy is a good option.

I assume several of you have been at this crossroads and I appreciate your input. I will be discussing this further with my surgeon and Dr. Shen. I don't mean to take away hope for anyone, but wanted to document the issues that I'm having. Thanks!
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My personal preference would be to make a good effort to save your J pouch, especially if you were pleased with its function prior to your current situation. Dr. Shen and others at Cleveland Clinic are a good choice for necessary medical support. If it is determined that your pouch cannot be saved, you have the options of an end ileostomy and a K pouch or BCIR. When faced with this choice, I selected to go for a BCIR since I adamantly did not want the bag. I wish you the best of luck.
Two sides to every argument, for sure. And only you know what your limits are for what you are willing to put up with. Unfortunately, perianal/rectal abscesses can tend to be recurrent. If you had a crystal ball, you'd know how many recurrences you'd have before this was done. But, it is just one of those unpredictable things. Dr. Shen will be able to give you more guidance about what the risk ratios are in your case. These things can be painful and distracting, so I can understand wanting an end to this merry-go-round.

As for alternatives, there are basically only two: ileostomy or continent ileostomy. I suppose you could opt for a diverting ileostomy while you are finishing up treatment for the fistula and these abscesses. That could give your butt a rest while this mess gets healed up. Then maybe one more chance for the pouch before giving up on it. But, that's a fair amount of rigmarole, and perhaps you are just tired of it all...

It sounds like your surgeon and the interventional radiologist did not communicate too well for your surgeon to be suprised by what the radiologist did or didn't do. I did have one of those abscess drains put in via flouroscopy guidance. Kept that thin in for about a month and that abscess did not return. However, that was a presacral cavity abscess, not a rectal tissue abscess.

No wrong choices...

Jan Smiler

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