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Crohn's Disease Forum » Surgery » Strictures & Obstructions » Less than 5mm, might need resection


10-18-2015, 03:42 PM   #1
Bippy
 
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Less than 5mm, might need resection

Hi .... Not sure I should be on this post as I do not have any bowel inflammation ...now. I had an operation in 1967 to remove several feet of small bowel at the ileum and rejoin it to the colon. In those days it was a huge slice along the bottom of my abdomen ... No laparoscopy then.
After several months on bland foods and meds, I "lost my melds while on vacation" and decided to switch to high fiber foods and things went ok ... So I have been off all meds for 40+ years. Even the colonoscopies show no inflammation. BUT the anastomosis from the original surgery has become dangerously narrow ... Under 5mm and 1.4cm long and surgeons are recommending I cut it out and rejoin the pieces before I have a blockage. Even tho the original problem back in 1967 was called regional ilietus it's all under the heading of Crohn's today. I have a surgery consult in 2 days and not sure whether to wait for symptoms or take care of it now while I'm healthy.
10-18-2015, 05:21 PM   #2
Clash
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Bippy, it is most often the most beneficial to have the surgery before it becomes emergence surgery due to obstructuon. I would state all my questions and concerns to the surgeon and go from there. Good luck.
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C age 19
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10-18-2015, 06:24 PM   #3
Bippy
 
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Thanks Clash. Sounds like good advice. I certainly don't want to experience a blockage and emergency surgery. I've had two surgeons give different options ... One said even though I was ripe for a blockage at anytime I should wait for symptoms and I think this doc I'm seeing Tuesday will tell me the complications under an emergency surgery far exceed any potential complications if I'm fully cleaned out and healthy at the time of surgery.
10-18-2015, 08:45 PM   #4
Jennifer
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Hi Bippy welcome to the forum! I moved your post into it's own thread here.

Are you a candidate for a strictureplasty? I'd ask your surgeon about it. Balloon dilation isn't permanent so I can see why they would opt for a resection but it's possible you'll run into the same issue years down the road so I was wondering if a strictureplasty would be possible to open up the narrowing instead.
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Diagnosis: Crohn's in 1991 at age 9
Surgeries: 1 Small Bowel Resection in 1999; Central IV in 1991-92
Meds for CD: 6MP 50mg
Things I take: Tenormin 25mg (PVCs and Tachycardia), Junel, Tylenol 3, Omeprazole 20mg 2/day, Klonopin 1mg 2/day (anxiety), Restoril 15mg (insomnia), Claritin 20mg
Currently in: REMISSION Thought it was a flare but it's just scar tissue from my resection. Dealing with a stricture. Remission from my resection, 17 years and counting.
10-18-2015, 09:09 PM   #5
Bippy
 
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Location: Tampa, Florida
Thanks Jennifer. Too much scar tissue for a balloon. Thanks for your input. Appreciate it.
10-20-2015, 02:27 PM   #6
Bippy
 
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Thanks for the info. I am now scheduled for surgery at the Tampa VA hospital on Jan 13 to remove the scar tissue stricture and reattach it. Since the originally surgery is more than 40 years ago, the surgeon said that was unusual. Now I'm looking at a 7 day hospital stay but that sounds better than waiting for an obstruction.
10-20-2015, 03:13 PM   #7
fuzzy butterfly
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Good luck Bippy hope all goes well. Let us know how you get on. Hugs n support coming your way ...
10-20-2015, 08:23 PM   #8
manilamaria
 
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Hi .... Not sure I should be on this post as I do not have any bowel inflammation ...now. I had an operation in 1967 to remove several feet of small bowel at the ileum and rejoin it to the colon. In those days it was a huge slice along the bottom of my abdomen ... No laparoscopy then.
After several months on bland foods and meds, I "lost my melds while on vacation" and decided to switch to high fiber foods and things went ok ... So I have been off all meds for 40+ years. Even the colonoscopies show no inflammation. BUT the anastomosis from the original surgery has become dangerously narrow ... Under 5mm and 1.4cm long and surgeons are recommending I cut it out and rejoin the pieces before I have a blockage. Even tho the original problem back in 1967 was called regional ilietus it's all under the heading of Crohn's today. I have a surgery consult in 2 days and not sure whether to wait for symptoms or take care of it now while I'm healthy.

Wow you are a boy wonder to not have active inflammation for 40 plus years!!! I envy you. Well my daughter has 10 to 12 cm of stricture in her terminal ileum and they have been wanting to cut it out. She is only 14 years old though. Her doctors have told me to take it out. My friends/family who worked in surgery told me NO. Just because of her age and the chances of repeat surgery. My thinking is that it will be harder to put everything back that they took out in that small space. As long as she has no obstruction symptoms, we will hold out until she is older. Good luck, and i hope to hear from you again.
10-21-2015, 01:07 PM   #9
Bippy
 
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Location: Tampa, Florida
Really sorry to hear about your 14 year old daughter. I had just exited the Air Force at 22 when I had my first operation in 1967. Surgeries back then aren't as streamlined and advanced as they are today. They did have scalpels back then :-) but the scar looks like a chainsaw across my lower abdomen but under the fold so it was hidden all these years by shorts.
At the time I had several feet of infection and they removed all of it .. plus the ileum, scum, appendix, and connected all of it to the Large Bowel. I did't have a stricture .. but totally inflamed and it hemorrhaged so I needed an emergency operation.
I don't want to wait again .. so that is why I agreed to surgery in Jan but surgery of any type for a 14 year old girl (or boy) would be a traumatic undertaking. As you and your family make the surgery decision, it may make sense to look at the short term results and quality of life rather than dwell on what might happen in 5 years out. My Jan surgery in 2016 vs my original 1967 surgery is unusual, I get that. But only God can say when a 2nd surgery may or may not be needed.
I wish only the best for you and your daughter. God Bless.
10-21-2015, 05:13 PM   #10
Jennifer
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Wow you are a boy wonder to not have active inflammation for 40 plus years!!! I envy you. Well my daughter has 10 to 12 cm of stricture in her terminal ileum and they have been wanting to cut it out. She is only 14 years old though. Her doctors have told me to take it out. My friends/family who worked in surgery told me NO. Just because of her age and the chances of repeat surgery. My thinking is that it will be harder to put everything back that they took out in that small space. As long as she has no obstruction symptoms, we will hold out until she is older. Good luck, and i hope to hear from you again.
Manilamaria, I had my resection when I was 17 and it put me into remission (been in remission ever since and I'm 33 now). If it's needed then it's needed, age doesn't play a role. You definitely don't want to wait for there to be a full obstruction but definitely treat with medication first if it's active inflammation. If it's scar tissue then no medication will help so if she does start to have symptoms of recurring partial obstructions then you may want to consider a strictureplasty (if she's a candidate), balloon dilation (this is not permanent and it will shrink back down) or a resection if necessary. Again though, age doesn't have anything to do with whether or not it's needed. Best of luck to you and your daughter.
10-31-2015, 11:31 PM   #11
tincho_lavie
 
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I wen through a surgery last Monday. It was a planed regular surgery, The stretched area was 2mm wide, but I could still eat and live "normally". I only avoided long fiber food like lettuce or onion, but I used to have occlusions about once every two month so we decided to continue with the surgery.
01-11-2016, 08:09 AM   #12
Bippy
 
Join Date: Oct 2015
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Happy New Year folks. Well, Wednesday is my surgery day at the Tampa VA to remove the anastomosis that was created in 1967 after several feet of the ileum was removed due to infection. The surgical site is now narrower than 5mm so preventative surgery is needed to prevent a blockage. The surgeon is going to do a side to side anastomosis not end to end that was done in 1967. By putting the ileum next to the colon ( my secum and appendix came out in 1967) and suturing it like that it will restore the pathway to above the average 2cm diameter up from the current <5mm and should prevent a further stricture.
Those of you with a similar condition may want to explore the side to side or end to side with your GI doc and surgeon.
I'm told to expect 7 days in the hospital but the surgeon said it could be less. Gotta pass gas first. Not looking forward to the recovery but I'd rather go thru that than another blockage.
01-11-2016, 01:06 PM   #13
fuzzy butterfly
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Hope all goes well n best wishes for a speedy recovery. Hugs 💕
01-11-2016, 08:37 PM   #14
Bippy
 
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Thanks!!
01-12-2016, 02:25 AM   #15
Jennifer
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Good luck with your surgery and I hope you recover quickly! Keep us posted.
01-28-2016, 07:05 PM   #16
Bippy
 
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Well ... Here we are, late January. My surgery was on Jan 13. Laparoscopic ... They removed the stricture and about 6" of the small vowel and fastened it to the side of the large bowel .. Also needed to remove about 6" of that too. It was a side to side anastomosis. So my stricture that narrowed to under 5mm is now about 6cm so it's very doubtful it will return. They didn't find any inflammation or cancer (yea!!) and we are still waiting for the biopsy results. They had me up,and walking the first night. My stomach blew up to a very hard feel ... Looked pregnant ...all the gas buildup. Took a couple days to pass gas ... On a pain pump for about 5 days and then on Percocet. I was in the hospital 7 days and stayed on Percocet at home until last Monday. I'm really sore and some leakage thru my belly button (normal) but improving every day. Actually drove today. I'm retired so work isn't a problem.
For those of you reading this .... Many have had multiple surgeries. I guess I've been fortunate in that regard. Just 1967'and 2016.
Check with your surgeon about the side to side surgery technique vs and end to end repair. According to my surgeon the typical diameter of the small bowel is about 2cm. The side to side gave me 6cm, drastically reducing the need for a redo in the future.
Good luck to everyone. And thank you to those that commented on my prior posts.
Bippy (Rich Cohen - Tampa, FL)
01-28-2016, 08:43 PM   #17
ronroush7
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I had a resection in 2010. I am not sure of the procedure they used but they took 6 cms also.
01-29-2016, 01:31 AM   #18
fuzzy butterfly
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Hi Bippy thanks for the update. I'm so glad it all went well ☺. Hope you can keep well now and go from strength to strength. Best wishes 💖
01-29-2016, 08:16 AM   #19
worriedboy
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Thank you so much for reporting back.. really, it's so good to hear that your surgery went well and that you are recovering well !
I hope I can learn from your story, how to find the strength and the courage.

All my best to you.
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