Crohn's Disease Forum » Surgery » Fistulas, Fissures and Abscesses » Scheduled for seton placement in two weeks

03-18-2014, 05:27 PM   #1
Join Date: Mar 2014
Location: Indianapolis, Indiana
Scheduled for seton placement in two weeks

Hi guys,

I've been lurking for a few weeks now. I was diagnosed with Crohn's in 2006 at the age of 20. Bounced back pretty quick with prednisone for a short time and remained on asacol for a few years. Switched to sulfasalazine in 2008 or 2009 as it was cheaper. In 2011 I had the bright idea to stop taking medicine and adopt a primal/paleo diet as I had read that those could put crohn's into remission. I would go months eating right and then fall back into bad eating habits. Did this on and off for a few years with no noticeable flares.

In October of 2013, my crohn's flared up as bad as it had been since I was first diagnosed. Resumed taking my sulfasalazine and took prednisone for a short bit. Had a colonoscopy in November and inflammation was present throughout, but not super bad. Continued to eat whatever I wanted and combined with stress from work, my crohn's continued to flare. Took some more prednisone in January of 2014.

Then in mid February, I had a painful BM and blood. Didn't think much of it since I probably had anal fissures every few years. This went on for a week. The blood stopped but something didn't feel right down there. Was very sore anytime I moved. A few days after that I was in intense pain after every BM. Throbbed so bad I had to lay down after every BM (luckily it was the weekend) and I couldn't even fall asleep the pain was so intense. Had to just lay there and suffer for a few hours. I was worried it was hemorrhoids.

I went to my GI and after taking a look he said it was a fissure. Gave me some steroid suppositories. Felt pretty good a few days later. Then I started noticing some leakage in my boxers when I'd go to the restroom at work. Wiping after a BM would take longer than usual, it seemed like there was extra liquid coming from somewhere else. In my head I'm thinking, "you're crazy, there's only one hole, it's probably just leaking down from the fissure or stuff left over from the suppository." Then I hit up google, read about fistulas and abscesses, and thought, "fuck, this is me."

Went back to the GI. They were able to get some liquid to come out and told me yep there's a fistula and referred me to a surgeon. So last week I go the surgeon. It felt like an assembly line. I was really put off my the whole experience. He attempted to do a rectal exam but I was so inflamed down there I couldn't tolerate the pain. He aborted after a minute or two but did say that he saw the fissure, abscess, and a fistula. Scheduled me for a seton placement three weeks from the visit (I had work commitments this week, so I scheduled for early April). He also prescribed me some Cipro. The cipro came with two pages of literature about side effects and possible death. No thanks to that.

I'm on day 2 of the SCD intro diet. I will be committed to this. I'm wondering if there is any harm by holding off on the seton placement and not taking the cipro. It's a hassle being a man wearing a woman's pad, but I'm getting used to it. There is occasional pain when having a BM (can't tell if there is something in the fistula or if it's just the skin stretching where the abscess/fistula is, sometimes it's dull, sometimes it stings badly, sometimes I feel nothing after a BM). I don't like the idea of surgery, but will do it if necessary. I don't want to get a crazy infection down there. The cipro literature scares me even though I see plenty of people on here saying they take it with no problems. I guess I just want to give this diet a month or two to see if my Crohn's improves at all (and I'm aware that I'll need to adhere to it strictly for years before expecting huge results).

Am I taking a stupid risk by not taking the cipro and considering delaying the seton placement even longer than I already am (3 weeks from surgeon visit)?
03-18-2014, 10:03 PM   #2
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Trysha's Avatar
Join Date: Aug 2009

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Welcome to the forum.

If you are unhappy about the cipro why not ask for an alternative such as one of the cephalosporins
The first time I had cipro, within a week of finishing the course I had a severe anaphylactic reaction and was hospitalised for a week. It was extremely bad,so that is now in big red letters on the front of my hospital file.
The surgeon needs to cover you with a broad spectrum antibiotic in order to protect you from infection.
You may be perfectly OK with cipro and even if something happened they can take appropriate action to minimise risk.
To delay things is a bit risky like playing with fire but it is your choice---like a rock and hard place!
Good luck with your decisions though.
I do understand your trepidation.
Feel better soon
Hugs and best wishes
03-18-2014, 10:52 PM   #3
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Join Date: Jan 2014
Location: Toronto, ON, Canada

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I was put on both cipro and flagyl and they both really help bring down inflammation from the fistula. I was on both of them for eight months with no side-effects.

Personally, I really wouldn't delay putting in the seton, ESPECIALLY if you decide not to go on cipro, because it will likely just get worse. I thought mine was a hemorrhoid too, so I didn't see a doctor about it for way too long -- and landed myself in the hospital and nearly died because my fistula got so bad. Apparently it was maybe a day away from bursting on its own. That night they took me in for surgery to get a seton placed, and within a week or so I was able to sit again, and it only continued to drain and improve from there.

So. Personally, I would recommend either taking the medication or getting the surgery, if not doing both. Definitely wouldn't recommend putting either of those off.
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!
03-21-2014, 06:25 PM   #4
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Join Date: Jun 2013
Location: Canada

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I've been on and off Cipro for years with no side effects. Have two setons in place now after dealing with fistulas for years.

The fistula isn't going to heal on its own. Remicade might do it but since you are leery of Cipro, I imagine you really don't want to go down the biologics road. The Cipro will help the abscess and prevent any further infection.

I'd do both and if you decide not to, make sure you seek medical attention if you get a fever or chills.
Diagnosed in with Crohn's in large and small bowel in 2000.

Seton placement (2) and fistulotomy December 2013. Setons removed July 2014.

Laparoscopic Right Hemicolectomy July 2016, 25 cms removed

Current meds: Entyvio every 4 weeks, Flagyl and Cipro 500 mg twice a day

Previously: Remicade, Humira, Simponi, Pentasa, Sulphasalazine, Entocort, Stelara, Methotrexate, Prednisone, Imuran
04-03-2014, 10:46 PM   #5
Join Date: Mar 2014
Location: Indianapolis, Indiana
I had my seton placement today. Surgeon didn't find an abscess which I thought was odd. He just noted in his findings "complications related to anal fissure, complications related to anterior midline fissure". Curettage and cauterization of anal fissure were listed with seton placement on the procedures performed list.

Is it normal to not even get a chance to discuss the surgery with the surgeon after the procedure? I guess he discussed some things with my mom as I was in recovery, but all I got was a brief discussion with the nurse after and I was on my way out the door. This was the first surgery I've ever had, but it all seemed really rushed. Hopefully the medical bill reflects their efficiency lol.

All in all, not a bad experience but I know it's early. Pain started to settle in hours later after the anesthesia wore off, but the pain medicine is taking care of that at the moment. We'll see what tomorrow brings.

Crohn's Disease Forum » Surgery » Fistulas, Fissures and Abscesses » Scheduled for seton placement in two weeks
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