Crohn's Disease Forum » Surgery » Simple fistula with no external opening

07-03-2016, 07:00 PM   #1
Join Date: Jul 2016
Simple fistula with no external opening

Hello there,

I was diagnosed with a simple, Crohn's-associated intersphincteric fistula 3 years ago via an MRI of the pelvis. During that time I have been on Humira (every two weeks) for quite some time. My GI subsequently raised my Humira dose to weekly and put me on a course of Cipro and Flagyl. In a matter of weeks, my fistula was asymptomatic to the point where I thought it had closed. I was in remission.

Just a few days ago, I started to feel slight discomfort in that region again and I immediately knew it was that same fistula acting up again with very small amounts of discharge. These were my only two symptoms, and are definately not as bothersome as my symptoms were when I was first diagnosed with the fistula 3 years ago. I did another MRI with the following report:

"Low-lying right off midline intersphincteric fistula with internal opening at 7:00 position, 12 mm away from the anal verge, extending distally about 7 mm from the anal verge with high signal edema at the right perineal region at 7:00"

In other words, it's that same fistula but with no external opening this time. I went to my GI with the report (who has added Imuran with my Humira a few days ago after a follow-up colonoscopy that revelead a few small ulcers at the ileocecal valve, which were asymptomatic to me). He advised to go see a colorectal surgeon and get his opinion on that matter, the first time he has ever done in the past 5 years since I was first diagnosed with Crohn's.

So I did just that. My surgeon looked at the MRI report, the scans and did a thorough rectal examination on me. He confirmed that indeed there was no external opening, and that the discomfort I was feeling was as a result of discharge and swelling from the internal opening. He strongly advised me against surgery and said that my condition was very stable and at near-remission at the moment and I quote: "If the external opening has closed then there is a good chance that Humira-promoted fistula healing is at work and now that your GI has added Imuran, there is an extremely good chance that the simple fistula will close".

And that was it. I continued to stress that it was causing me discomfort. He said that he could proble the tract and "puncture" it through the closed skin and proceed with fistulotomy, but strongly advised me against doing so as it would cause me even greater discomfort, not to mention the risk of recurrence and incontinence.

What is your opinion on this matter guys?

Crohn's Disease Forum » Surgery » Simple fistula with no external opening
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