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Crohn's Disease Forum » Surgery » Fistulas, Fissures and Abscesses » Cyst, Abscess, or hopefully nothing?



 
12-20-2014, 11:23 AM   #1
theOcean
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Cyst, Abscess, or hopefully nothing?

Feeling a bit paranoid after my experiences last year, as I'm sure anyone in this section can relate to.

I'm in remission and have been for over a year. I had a fistulotomy in May 2013, had drainage stop with Humira in December 2013, and my seton removed in July of 2014 this year. There's a small hole still but zero drainage and there hasn't been any in almost a year.

I'm giving this as background just in case it's relevant.

For the last two days, my right side where my fistulotomy scar is (perianal) has been tender. It's done this before for a day or two and then gone away, and I hope that's the case again. But it hurts when I initially sit down, or apply pressure. Walking/standing is comfortable and so is laying down. I don't notice any discomfort using the washroom. It doesn't feel particularly warm -- it seems about the same as everything else. The skin is darker but I think that's just scar tissue, so it's difficult to tell if there's visible inflammation.

And it's the weekend -- plus right before Christmas -- so I'm a little panicky. I'm supposed to go away with my SO's family to Hawaii on the 26th, and if I have anything I don't know if I can or want to still go. I absolutely don't want to end up in an American hospital with their fees.
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Diagnosis: Fistulizing Crohn's, 2011 (originally Dx as Ulcerative Pancolitis)
Past Medication: Pentasa, Remicade, Prednisone, Imuran
Current Medication: Humira (biweekly), 100mg 6mp
Unrelated Medication: 36mg Concerta, 75mg Pregabalin
Currently: In remission!
12-20-2014, 04:31 PM   #2
DJW
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Oh I really hope it's nothing. I understand you not wanting to end up in hospital. Can you talk to the nurse or even get it checked out at an urgent care clinic?
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12-20-2014, 04:45 PM   #3
theOcean
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Very much considering it. I don't want to clog up the ER if it's nothing, but I'm terrified it might not be. My hospital is Mt. Sinai, so I can at least trust them to know about these extraintestinal manifestations...

The pain got a bit worse overnight, and now I can feel it when I'm turning in bed or walking and I don't like this.
12-20-2014, 07:30 PM   #4
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Are you still on Humira?
12-20-2014, 07:45 PM   #5
Sailorluna
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It certainly sounds like something. does your colorectal surgeon have an after hours call center? Mine does and the surgeons take turn being on call. It might be worth a try? Do you have a fever? If so you should consider just going in to the ER.
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12-20-2014, 09:11 PM   #6
theOcean
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@around the corner: Yes, I'm still on Humira and 6mp. Without even the 6mp, I start getting cramps again.

@Sailorluna: They don't have an after hour centre... but they are situated in Mt. Sinai hospital, so honestly, I would just have to got to ER if I wanted to talk to someone. I don't have a fever or any symptoms of infection, which gives me some hope that it's hopefully only a cyst instead, but I'm not sure.

I have a doctor's appointment with my GP on Monday and I'll ask her to examine it then, but I'm antsy about waiting already. She was the one to realize I had an abscess/fistula before, and treated me for a cyst previously years back, so she'd hopefully be able to recognize what's going on, at least. Then I'd obviously also contact my GI.
12-20-2014, 09:41 PM   #7
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@TheOcean Hope everything works out!
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12-21-2014, 12:20 AM   #8
theOcean
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@Jay Woodman: Thank you very much! I hope so, too.

Just had a sitz bath, though I'm noticing that heat doesn't really seem to affect anything at all, one way or the other. Increasingly thinking (hoping!) that it's a cyst. I was trying to inspect it afterwards, and could visibly see that around where this pressure-filled bump is (which I'm very suspect of) there's also two little lines in my skin. When I tried to touch them, I could feel some unevenness, like it was maybe a cut or a scab or... something in the skin.

I'm prone to fissures (yay, unexplained chronic constipation for over a year), but this doesn't look like one to me. I've had one cyst in the past because of an ingrown hair, and was wondering if it was maybe that or something that just got infected...

Still feeling pretty paranoid about this, but leaning away from abscess and more towards cyst at this point. --That said, I'm also still in no way a medical professional, so who knows how right that is. It's a small comfort in the meantime, though. Still no symptoms of fever or infection outside of acute pain/small pressure-filled bump in that area, though.

Going to see my SO's family tomorrow, and then: doctor's on Monday, thank goodness. Hopefully it doesn't get any worse in the meantime.
12-22-2014, 10:25 AM   #9
theOcean
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A little panicked today, because I called my GI just to see if their office was possibly open -- and it isn't. It's closed until early January.

I see my GP later today, so now I guess she's the only one I can count on unless she sends me to the ER.
12-22-2014, 04:04 PM   #10
theOcean
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Saw my GP and she's sending me to the ER and thinks I have a (thankfully) small abscess. Hoping I don't need surgery/fistulotomy/seton desperately. I don't ever want to go through that again.

Stopping at home and getting my phone charger, and then my mother is taking me to the hospital. I'll be able to update from mobile.
12-22-2014, 04:35 PM   #11
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I hope it's dealt with quickly so you can get away.
12-22-2014, 05:10 PM   #12
theOcean
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I hope so, too. Waiting and feeling antsy in ER. The triage nurse said that they're unfortunately super busy.
12-22-2014, 06:37 PM   #13
Sailorluna
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Good luck!
12-22-2014, 08:07 PM   #14
theOcean
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Just saw the GI doctor in emergency and he said he's going to send a surgeon over my way to see what they say. No elevated white blood cell count so no active infection, which is good. Hopefully this is getting treated early enough. Something is definitely happening there, though. He's hoping he can just treat me like a non-IBD patient and just make an incision and give me antibiotics and send me on my way, but it's up to the surgeon.
12-22-2014, 09:53 PM   #15
Sailorluna
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is it a colorectal surgeon? Be wary of letting a general surgeon work on you.
12-22-2014, 09:59 PM   #16
theOcean
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Yeah, my hospital specializes in GI so pretty much all the surgeons are colorectal. I'll make sure though if they ever... see me...
12-22-2014, 10:27 PM   #17
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Saw the surgeon and she wants me to get imaging done, either a CT scan or an MRI. She has a feeling I have the start of an abscess but that it may actually be too small to do anything to yet, short of giving me antibiotics. Obviously imaging will reveal what it actually is, though. She's meeting with the senior surgeon now.

She's thinking I may not have to stay overnight yet, but we'll see.
12-23-2014, 12:44 AM   #18
theOcean
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No imaging tonight. Surgeon is optimistic it's a small abscess that is hopefully not fistulizing and I hopefully won't need a seton, but we need to wait on an MRI for that, first. (Relieved it's an MRI I'll be getting since that's so much less invasive.)

On the other hand, I may be in the hospital over Christmas and I'm legitimately sad and getting weepy over it now that it's sinking in.
12-23-2014, 04:40 AM   #19
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Any updates? Have you been admitted?
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12-23-2014, 09:08 AM   #20
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I've been admitted, yes! Around 3AM I finally got into a semi-private room. My roommate also has Crohn's, though she isn't here for it. We're able to talk about it though, which is nice.

I'm not supposed to eat in case they can get me into surgery. I just filled out an MRI form and we're waiting for that first to see what we're dealing with. Desperately hoping everything happens quickly and that I can be home soon if all goes well. (As long as I don't have another fistula, at least. My not being in flare and having no elevated white blood cells gives me hope, though.)
12-23-2014, 12:18 PM   #21
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Had my MRI and I'm back to the waiting game. Hoping that if I need a procedure it can happen today.

Otherwise, my family is going to come and visit me, and my mother is going to bring me my Humira since it's my injection day.
12-23-2014, 06:27 PM   #22
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Hope all is well. Those visits aren't fun. Hope it's just small things to deal with.


12-23-2014, 07:12 PM   #23
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So sorry that you are going through an admission especially this time of year. I hope they give you some answers and management quickly.
12-23-2014, 07:27 PM   #24
theOcean
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Thank you. I just spoke to one of the surgeons and I'll be operated on tonight. She confirmed the abscess I have is small and easily treated, but also noticed some fistulizing. They're going to try and remove the fistula if they can (as long as it wouldn't damage the sphincter) and otherwise I might have to suffer through another seton.

I'm hoping I won't have to deal with a seton again more than anything else. I cried a bit to my nurse about it already.

At the least, the surgeon seemed confident that I should be home tomorrow.
12-24-2014, 09:44 AM   #25
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Just thinking of you, hope everything went well.
12-24-2014, 12:53 PM   #26
theOcean
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I'll start with good news, then: I'm happily home!

The surgery went fine. They weren't able to remove the fistula, so that has a seton in it -- he also talked about "unroofing" two sections of it because I think bacteria/inflammation was gathering there. The seton is a very small one, though, so the surgeon said I hopefully won't have to deal with it for long. It's in a pretty small tract.

He also drained the abscess I had, which has packing and nothing else. I'm supposed to get in touch with wound care tomorrow to get it changed, and have been armed with an arsenal of oxycodone to combat any pain that might cause. (It was excruciating with my previous fistula, but this is a one-inch abscess.) The surgeon mentioned it's communicating with something and that showed up on the MRI, but it was too inflamed to tell. He says because of that, I'll probably have to get another seton in the next half year or so.

Now that I'm home, I have to debate on what I want to do re: the trip I was supposed to leave for on the 26th. It would involve eleven hours of flying on an uncomfortable plane, and then getting to Hawaii and being uncertain of my resources, plus shifting responsibility to my boyfriend's parents. We got a preemptive letter from the surgeon explaining my circumstances in case I need to cancel the flight, and I still need to think about it. Given the discomfort I would imagine having, plus the length of the flight and contending with public washrooms, I'm a little apprehensive.

In the meantime, I'm just going to try and focus on enjoying Christmas Eve with my family tonight.
12-24-2014, 12:58 PM   #27
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I am glad you are home and I think it is wise to focus on your family tonight instead of worrying. Merry Christmas!
12-25-2014, 02:49 PM   #28
theOcean
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Merry Christmas!

I had a lovely day yesterday, though think I'm having some trouble passing BMs right now -- which doesn't surprise me, given the surgery I just had. I'm on Linzess and took some Restoralax last night, so I'm sure that'll help.

I canceled the trip to Hawaii. I knew I absolutely couldn't do it -- I just felt bad about not being able to go with my SO, who was looking so forward to it. He's been wonderfully understanding about it, and so is his family now that I've let them know. Now all that's left is to hash it out with the insurance companies and the airlines. We have documentation and a letter from my surgeon explaining my situation, so everything should be okay. My mom suggested we could use the refunded money for a trip for my SO and I when I'm healthier again.

I've started going to a clinic for wound care, so the process of healing begins. They said the tissue all looked really healthy, though. No signs of infection, and even very little pus since I caught everything so early. Thank goodness for being so neurotic about my health after my last bout with my fistula. The new seton doesn't hurt at all, either, which is a plus. Just the area where the abscess was, which I'm sure will improve quickly.

I hope everyone is having a wonderful holiday and doing well! My family will take great care of me, I'm sure. And I'm confident this recovery will be much faster than my last one. All I need to do is make sure I get ahold of my GI and my surgeon (who I'm thinking of switching from) once they're back. If anyone knows any good Toronto colorectal surgeons, let me know!

Last edited by theOcean; 12-25-2014 at 05:11 PM.
12-25-2014, 08:53 PM   #29
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Aww I'm sorry you had to cancel your trip, but totally understandable in the circumstances. As you say you can have another trip when you are well enough to enjoy it - it's always nice to have something to look forward to.

At least you caught it early. I always think the increased vigilance we have can pay off! Wishing you some rapid healing and a (relatively) uneventful follow up.
12-26-2014, 02:57 PM   #30
theOcean
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@Muppetgirl: Thank you so much! I'm still pretty sad about the trip -- we had a pretty tearful and sad night last night, and my SO left early this morning without me -- but I'm trying to focus on better things for now, and getting better. I'm going to be sending my SO emails every day to try and make up for things.

I'm actually doing pretty well, and it's definitely been because of catching things so early and not being in flare this time. Jokingly suggested getting regular MRIs to my SO and now we're almost considering it, since I have fistulizing Crohn's. Definitely can't wait to see my GI soon!

Sitting is slowly getting less painful, and I prefer to be up and walking, though I'm still a bit hunched and slow when I walk to compensate for the discomfort.

BMs are pretty painful. I feel them in my abscess, even though they don't pass from there. Sitz baths are a blessing right now. I notice a huge difference when I take them, and try to after every BM.

I think the strangest thing to adjust to in all of this is where my seton is. I was so used to the positioning of my old one that I keep forgetting this one is different. I still barely ever feel it, which is great. It makes me realize just how exceptionally bad my fistula was that I had in 2013. That said, this all does seem to be part of the same fistula -- it was a complex one with many branches, so that this happened isn't very surprising. I think I got a better surgeon this time, though. The one I want to switch from causes me such horrible, crippling anxiety. I may ask my GI about that, as well.
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