Fistula in Small Intestine, now abscess too big to operate??

Over the course of 3-5 days, I developed a fistula and a 3x4 cm abscess in my small intestine. The reason I went to to the hospital was for remicade/mp6 treatment, but now it seems I will be unable to start treatment without the abscess taken care of first.

Apparently 3x4 cm is too big to be drained specifically in the small intestine--can anyone confirm? I imagine it gets complicated down there

1. The doctors want to use antibiotics to shrink the abscess, so the plan is to give me a PICC line tomorrow or Fri for 3 or 4 weeks, and hope the abscess shrinks with the antibiotics. If it does, I start remicade/mp6 treatment soon after to try and get into remission.
2. if antibiotics don't shrink the abscess, the next option given to me is surgery, where 30 cm of my small intestine (including fistula and abscess) are removed. I really want to avoid this drastic option too!

Realistically, are these the only options I have?

I am nervous to do a PICC line with antibiotics as it may not even work on the abscess and I have to do surgery anyway. I guess in that case, at least I can say I tried.

Any insight or advice someone can offer, would be great appreciated.

i_eat_constantly said:

Apparently 3x4 cm is too big to be drained specifically in the small intestine--can anyone confirm? I imagine it gets complicated down there

1. The doctors want to use antibiotics to shrink the abscess, so the plan is to give me a PICC line tomorrow or Fri for 3 or 4 weeks, and hope the abscess shrinks with the antibiotics. If it does, I start remicade/mp6 treatment soon after to try and get into remission.
2. if antibiotics don't shrink the abscess, the next option given to me is surgery, where 30 cm of my small intestine (including fistula and abscess) are removed. I really want to avoid this drastic option too!

Realistically, are these the only options I have?

I am nervous to do a PICC line with antibiotics as it may not even work on the abscess and I have to do surgery anyway. I guess in that case, at least I can say I tried.

Any insight or advice someone can offer, would be great appreciated.

Click to expand...

Sorry to hear about the abscess. They can be extremely painful. As for the size and not being able to drain, it seems odd to me. I had a 6.5 cm x 6 cm abscess in my small intestine two years ago. I had a CT guided drain put in and also had a PICC line put in. I had both for about 6 weeks. It finally went away, it really seemed like forever. The PICC line was not so bad to be honest, the drain from the abscess was more of a complicated thing to wear (and keep hidden).

From what I understand, most all abscesses need to be drained and you will also need IV antibiotics. I am confused as to why they cannot drain it, especially since it worked with mine. Maybe it is in a trickier spot, mine was also in my small intestine (terminal ileum). It could be in an area that they cannot hit with the drain, then that could make sense. I always ask a ton of questions, I would ask for the reasons why (besides the size-that doesn't make sense). Ask if location is also an issue.

I hope all goes well.

i did, they do not provide too much context but say it is difficult to reach and is not one concise sack to be drained. if it was perhaps bigger they could potentially drain it, apparently, but that would also be riskier and i do not want it to burst

i hate that it cannot be drained, now i need a picc line for 4 weeks and to be fed intravenously to avoid crohns complications of the abscess through food.

My son had a psoas abscess with fistula emanating from the terminal ileum. His abscess was 7x5cm and was able to be drained but it would be somewhat dependent on where it sits. Even it was suitable to be drained the drain would have to stay in until either the fistula healed or surgery was performed as a fistula means the abscess will reform unless being continually drained.

Unfortunately the options you have been given are the only options you have as you are in a catch 22:
1. The doctors want to use antibiotics to shrink the abscess, so the plan is to give me a PICC line tomorrow or Fri for 3 or 4 weeks, and hope the abscess shrinks with the antibiotics. If it does, I start remicade/mp6 treatment soon after to try and get into remission.
The abscess can’t be drained so rather than drainage and antibiotics you only have the choice of antibiotics. Since an abscess is deemed a severe infection when it comes to biologics you can’t start them.

2. if antibiotics don't shrink the abscess, the next option given to me is surgery, where 30 cm of my small intestine (including fistula and abscess) are removed. I really want to avoid this drastic option too!
Again, because the abscess negates the use of biologics it will be harder to heal the fistula, add to that that fistulas originating in the ileum are difficult to heal via meds, and while ever the fistula is there it will keep feeding into the abscess…
Abscess…no biologic…fistula feeds abscess…abscess doesn’t shrink…no biologics…fistula doesn’t heal…and round it goes. Only option left is surgery.

Good luck! I hope the abscess does indeed respond the antibiotics!

Dusty. xxx

i should add its not a neatly encapsulated abscess, and it literally formed 2-3days before i went into the hospital (both fistula and abscess). im hoping that has a role

I am hoping the antibiotics work for you. To be honest the PICC line is not that bad, I purchased a sock and cut the foot end off and used it to cover the PICC line most of the time. The IV fluids and no food seem harder to me. I wish you the best. Keep us posted.

An update:

The hospital was a nightmare, they kept me sitting around for 9 days because no one was there over Thanksgiving holiday.

Eventually, I received the PICC line, and yes, it really isn't bad at all. The first week I felt very fragile, but after the 2nd week (presently), I now feel pretty normal when I'm not connected. I do whatever, though I can't be my usual physical self, lifting things, running around and going to the gym.

As far as the infusion, I do 12 hours a day and start antibiotics/TPN at midnight. By the time I wake up, I take out the line by noon couple hours later. The rest of the day I'm free. I like this much better.


This aside, I think my body is reacting to the antibiotics, as the pain and bulging where the abscess was isn't there anymore. An MRI will confirm this, so I'm not singing hallelujah yet.

So my next steps are either a) remicade/mp6 combo for treatment or b) getting a stoma and then months down the line, a surgery.

Has anyone had experience with a stoma and then resection? My doctor didn't initially tell me this, it was only recently presented and I really hate the idea, however necessary it is.