Fistula / abscess seton surgery

Hi all,

So my GI check out a tender patch near anus a few weeks ago and determined it was bad, so he sent me to have an MRI. After reviewing the results he referred me to a rectal surgeon who I just saw. He thinks I need a Fistulotomy to look around, drain the abscess, and, if he finds the fistula, he will put in a Seton. He said the Seton would be in there at least 3 weeks to a couple months, but some patients have it for a indefinitely.

It is either I get it done with Wednesday or wait until December. He seems to think waiting is a bad idea because the abscess is leaking and could get infected. I am starting antibiotics today.

I am not comfortable with "and if we find something..." and waking up with a Seton. I cant find another rectal surgeon for a second opinion anytime soon (they all seem to be booked until next year).

My question. Is this typical protocol? How long can I expect to be out of work? Obviously this is short notice, so I need to tell my boss today to get Wed off. Is it hard adjusting to having a Seton if he does find the opening?

Thanks guys!

--Dan

I agree with your doctor that is better to go ahead and get it taken care of the sooner the better

This is typical protocol. Along with a drug like Humira or Remicade to assist in fistula tract healing.
See if you have an abscess it most certainly must be drained and remain draining. I'm assuming you are a Crohn's patient? If you are, the abscess likely has a fistula tract connected to your anus/rectum and if not drained with seton placement you could create a sort of explosion down there of fistula tracts all over. Not good. A seton is no big deal, I have had mine in for almost 4 years! Unfortunately I can't help with the fistulotomy, that is necessary? You must have a fairly superficial abscess. That fistulotomy will probably be the most painful part of your surgery and maybe for a week or 2 so after max.

Thanks for the feedback! The Wednesday spot got filled, so it looks like Friday now. Since my appointment the abscess has started to drain (probably from his probing). How much blood / fluid is too much? when I got home from work today and checked things out there was a lot of blood to cleanup.

MamiDoll, you are correct, I have crohn's / perianal disease. I have been on Remicade for about a year now. These last couple of years have been the toughest so far. Before my most recent flare I went almost 8 years symptom free taking asacol and 6mp, so a lot of this (e.g. biologics, fistulas, etc...) is new territory for me.

Anyways, do you just get use to seton to the point of not noticing? I just cant imagine it. I guess that's where most fears come from...the great unknown!

Thanks for the support.

Hi Tabs!
I guess the blood and fluid loss depends on the size of your abscess. If I remember it is quite a bit in the beginning and subsides after a couple months to a drop or two if your seton is doing what it is supposed to. You'll be best to wear a pantyliner to avoid a mess. :I
Yes you got it, you won't even feel the seton is there. After a couple months you will need to remind yourself to be cautious with it when wiping after bathroom breaks and washing in the shower. That's how non existent it is "after a while". It is a tiny and thin string that keeps the fistula tract open and draining. The seton is really is not painful at all though. The incision and draining of the abscess or fistulotomy is the most painful part of the process.

Hi all,

Thanks for the feedback and advice. The surgery went smoothly, however, I didn't receive the best news at my followup today.

Apparently, My fistula is pretty bad. My surgeon could not put a Seton in because the tract was so long and their too much scaring. He says all the scaring is very common for crohns's patients. However, if he does not see improvement ("drying up") over the next four weeks we will need to consider more complex solutions.

All that being said, it does feel better down there since the pressure has been released. I still cant figure out what cause the fistula other than its just another nasty symptom of crohns. My Remicade treatment has done wonders for my overall health, but nothing seems to work in the rectal area. Nothing. I have tried suppositories and steroid enemas to no avail. I sometimes wonder if that scraping around led this.

Anyways, I will stop complaining now...

Thanks again.

Tabs said:

Hi all,

Thanks for the feedback and advice. The surgery went smoothly, however, I didn't receive the best news at my followup today.

Apparently, My fistula is pretty bad. My surgeon could not put a Seton in because the tract was so long and their too much scaring. He says all the scaring is very common for crohns's patients. However, if he does not see improvement ("drying up") over the next four weeks we will need to consider more complex solutions.

All that being said, it does feel better down there since the pressure has been released. I still cant figure out what cause the fistula other than its just another nasty symptom of crohns. My Remicade treatment has done wonders for my overall health, but nothing seems to work in the rectal area. Nothing. I have tried suppositories and steroid enemas to no avail. I sometimes wonder if that scraping around led this.

Anyways, I will stop complaining now...

Thanks again.

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Tabs, how are you doing now? Did things improve for you?