Is this a partial blockage?

I've had my J Pouch for just over two years and I've had 3 incidents that have been identical in nature and I'm curious if it's possible it's a partial blockage or not. The first incident was last September, the second about a month ago and the third last week. The first incident I went to the hospital but had no answers and they guessed it was a blockage. This is what happens... I get initially hit with severe abdominal pain and nausea. The pain feels like someone is standing on my stomach, it's not a sharp pain, more of a pressure pain. The pain and nausea lasts for several hours and are severely uncomfortable. I pass very little stool during this time, what I do pass is generally very watery. When the pain and nausea subside, I generally feel run down but then begin to feel really sick as the day goes on and I end up developing a fever. The fever has been as high as 103. That lasts for one or two days and will then break. I would of went to the hospital last week but I was out of town working and it wasn't an option for me. All three occurrences have had the exact same symptoms and hit me the same way every time. What does this sound like? Is it normal to have a fever that high if it is a blockage of some sort?

Thanks!

Original Post

Kona, it could be a blockage, but the fever from a blockage usually takes longer to develop, and is often associated with a severe condition in which the bowel gets tightly trapped (“strangulated”). You might also have something going on with your gall bladder or pancreas. Has your regular doctor had a chance to try to figure this out between episodes? There might be evidence of an underlying problem. Or it might just be a blockage.

Thanks for your reply Scott. My first incident with this when I went to the ER, the pain had gone away by the time I was checked in and the xray had showed nothing. They actually admitted me to the hospital over the weekend because they thought my jpouch was fluid in my abdomen and needed drained. When I finally got to see my surgeon after the weekend he got it all straightened out, he was not happy. They weren't able to determine what it was and assumed it was probably a blockage, it was the first time it's happened to me. The second time he wanted me to go to the ER and again by the time I able to go, the pain had subsided. I called his office and the nurse said to watch the fever carefully. If I wasn't trapped in work last week I would of immediately went to the ER as soon as I felt that all to familiar pain. I'm hoping if it happens again I can get in soon enough for an xray to show something

I think you may be expecting more of an X-ray than it will be able to deliver. For that matter you may be expecting more of your surgeon than he can deliver. If this were my situation I’d bring the story to a good gastroenterologist who might be able to take a step back and think more broadly. There may be blood tests that would be revealing even after the pain has passed.

My surgeon wanted me to go to the ER to run some tests during the last episode and I couldn’t make it. My GI and my surgeon work very closely hand in hand. I’m hoping when I see my surgeon next Friday he may be able to shed more light on what happened and will definitely be heading to the hospital if this rears it’s head again

I think it sounds like a gall bladder attack. I felt like i was dying when I had mine (had to have it out eventually), and it would come and go so randomly. I’d suggest getting a CT scan if you can, when you see having the symptoms. Could be non- pouch related. 

Thanks for your reply Bubba, when did your attacks occur? I'm reading it's common that the attacks happen after a meal, especially a fatty one? None of my symptoms have hit me following a meal, like last week, it was more than 12 hours later. Looking up an attack, some symptoms fit and others don't seem to. The belly pain, lack of appetite, fever and nausea definitely do. It mentions "explosive" diarrhea but I pass very little if anything during my attacks. Is there a test that can check for gallbladder issues?

A gall bladder assessment usually starts with a simple ultrasound study, looking for stones and dilated ducts. Stones alone don’t prove anything, but they can turn out to be a source of trouble. An ultrasound doen’t need to wait for the next episode.

I now have an appointment with my GI next Thursday and still with my surgeon this Friday, hopefully we'll be able to run some tests. It was also suggested on another board that maybe it was pancreatitis that hit. That also has abdominal pain below the sternum, right where mine hits, nausea, fever of at least 101+, and blood pressure issues. The blood pressure may explain why I feel so horribly weak during these episodes.

 

I don't have a pouch but I can tell now when I am getting one and head it off.  I get a certain feeling in the same spot know exactly what it is.  

So. My point is if you have the same feeling everytime. You'll know.

Richard .

(not much of a point. Just personal observation) 

I got my CT and HIDA scan and it showed my gallbladder not functioning properly. It was "abnormal". There were no gallstones. So, my surgeon wants to discuss removing it etc. I'll see him in a couple weeks after a trip I have coming up. Once I understand exactly what's happening and if there are no other alternatives to correct the issue I'll see about having it removed by him.

Every so often I get this severe “attack”, I believe it’s a blockage and I try to fast for the day (maybe a piece of toast Or two & ginger ale) My surgeries occurred in 2011 & my gall bladder was removed in 2013. It’s a dull consistent pain and my mid section is very tender. I keep going to the bathroom “bile” so there’s movement but the pain does not subside. I still have residue from veggies I’ve eaten such as raw carrots & tomatoes & green beans. If I do not chew well I swear they disrupt my flow. Also, I held my bathroom in yesterday for a # of hours so that could have contributed. It’s not a kink in the bowel as I’ve had that happen & lay flat with a heating pad & it passes but this sort of inflammation lingers. Maybe it’s fluid around the pouch. I’ve gone to the ER in the past several times & nothing is really done except for the gall bladder years ago but that pain was higher under my ribs to the right. Today’s pain is mid below belly button.

Saw my surgeon yesterday. My gallbladder isn't contracting and releasing bile normally but he said in theory, when they gave me the drug during the x-ray to contract it, the symptoms of the attack should of happened but didn't. He's sending me to my GI for an endoscopy more than likely. He's still stumped on the high fever that follows the attacks. Removal has been postponed. He said removing is more risky with me as things have been "moved around" due to previous surgeries, so it's wait and see till my next appt.

I haven't seen my GI yet but was looking over the results from the HIDA scan. "A homogenous distribution of radiotracer was noted throughout the liver. No focal photopenic defects were noted. Activity was noted within the gallbladder at 35 minutes post injection. Activity as noted in the bowel at 15 minutes post injection. Normal drainage of activity was noted from the liver. Subsequent sequential imaging was performed following IV administration of 1.6mcg of CCK. The gallbladder ejection fraction was 3% which was well below the normal range consistent with biliary dyskinesia."

"Markedly abnormal gallbladder ejection fraction 3% consistent with biliary dyskinesia"

Saw my GI yesterday and he also brought in another GI to go over my "attacks". He does feel it's a bile duct blockage of some sort. He was asking if I had liver enzymes checked at all which I haven't. He also asked if my urine had changed color during the attacks but I never really paid any attention. He feels there's another issue beyond my gallbladder ejection at 3% being the cause of the attacks as they are so far apart. The fever, he explained that he thinks bacteria is being pushed back into my bloodstream during the attacks and that's what my body is trying to fight. I did have salmonella issues many years back which was brought up. If you're a carrier for salmonella, the cells live in your gallbladder. At this point, there is no plan for removal. He gave me a prescription for a few tests that if I have another attack, I'm to bring that script to the ER for those specific tests to be run while I'm symptomatic and go from there.

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