colonoscopy results: stricture at ileum

I have a stricture also,not sure where at though,I have a scope in January,and the plan is to widen the stricture in hopes that the Imuran and Humira has decreased the inflammation enough to widen the stricture,I have had it for at least two years,we'll see.I get too anxious before my scopes,very nervous,so in about a week,I'll be starting to freak out,aggghhh!!

Good luck to you

I'm in a similar position. My last colonoscopy about 2 years ago showed a stricture in my terminal ileum. It was inflamed enough that they couldn't get the scope through, but my GI treated me with an increased dose of Imuran (3 pills/day) and Entocort (3 pills/day), as well as a warning that further drugs or even surgery may be necessary in the future.

Fast forward to December 13th when I had another colonoscopy - I still have inflammation, and they still couldn't get the scope through the stricture. He called it a partial obstruction and recommended that I have surgery. My symptoms are gas/bloating, diarrhea after eating (though not too frequent), and iron and B12 deficiencies due to reduced absorption (which lead to a bit of tiredness).

I have been in much worse shape before, and don't find my symptoms unmanageable at the moment. I was expecting to be put on stronger medication (Remicade) rather than having surgery. After a lot of research, discussions with the surgeon and my GI, as well as many sleepless hours thinking through the pros/cons, I have decided to go in for surgery in the New Year. I personally felt that while I could decide to go the Remicade route, I wasn't comfortable with the potential side effects, and in my mind, I would just be delaying the inevitable. Since my disease is limited to a specific area, the surgery will be simple, and should cut out all the active disease. I can then significantly reduce my meds (will only have to be on a maintenance dose of Imuran) and won't have to worry about what I eat when I go out with friends or worry about the diarrhea and gas/bloating afterwards.

I did spend time trying to push the meds option with my doctors, but in the end realized that surgery though inconvenient in the short-term, is likely the best longer-term solution for me. Good luck with everything!

hmmm...very interesting reading all of this.

I was experiencing bloating/gas and occassional pain and saw my GI. He sent me for a SBFT and found out I had developed strictures in my terminal illieum. My crohns has been localized to about 12 inches there since diagnosed in 1995 and has not spread but has now developed the strictures.

Note: I was hositalized in June for a partial blockage. I was admitted and got through that issue with antibiotics, iv steriods and entocort once I got home.

Anyway, my GI told me that at this point the entocort nor the Remicade is going to help THIS issue (strictures) and that the only option I had if my symptoms were to get any worse was surgery. (He continued that w/strictures you are at higher risk of developing partial blockages.) He said he wanted to prolong surgery as long as possible. He asked me how I was feeling and I told him I was feeling pretty good at the time. He said to just let him know if things started to get more difficult for me, and if so, he would have to schedule me for surgery.

It has been since right after Thanksgiving that I had the test and so far I still feel pretty good. I have been watching my diet very carefully and continue to take my methotrexate and remicade.

After reading about what skitt wrote about possible preforation, peritonitis and  possible bacterial overgrowth, I wonder too if I am just prolonging the inevitable and just putting myself at a higher risk of other complications.

I too thought it was a good question to ask, how long have people gotten through with holding off on surgery? I mean since my GI (whose opinion I respect) has told me he would like to hold out for surgery, as long as possible. But now I wondering if I'm doing the right thing?

Anymore comments out there? Maybe it's time to schedule an appt. w/my GI and talk about these possible issues.

My daughter was diagnosed with a stricture in March 2006. She is doing fine now on Entocort and plans to avoid surgery as long as she possibly can. 

For people whose quality of life is low because meds are not working and natural remedies are exhausted, it probably makes sense to consider surgery. It might also make sense to consider sugery if side effects of meds are too toxic.

Our reasons for taking a pass on surgery: first and foremost, meds and diet are working with no side effects. Some others: surgery tends to lead to more surgery; crohn's symptoms can show up within months, days, hours or even immediately after surgery; clinical trials have shown patients with resection are less likely to respond to some of the meds being trialed; and any surgery can cause complications.   

The following link will take you to a pretty good discussion about surgery for Crohn's:

http://www.ccfa.org/info/surgery/surgerycd

The following link mentions perforation is rare in Crohn's Disease:

http://www.gastroresource.com/GITextbook/En/Chapter10/Default.htm

The following link corroborates perforation is rare: "Spontaneous free perforation is an uncommon event in the natural history of Crohn's disease. It occurred in 21 of 1415 patients (1.5%) admitted with Crohn's disease to The Mount Sinai Hospital between 1960 and 1983. The mean duration from onset of Crohn's disease to occurrence of perforation was 3.3 years. Ten patients had small bowel perforation, ten patients had large bowel perforation, and one patient had simultaneous perforation of both ileum and cecum. The incidence of perforation in disease segments of small bowel was 1.0% (jejunum 6.0%, ileum 0.7%), and in the colon, 1.3%. Besides the 21 patients with spontaneous free perforation, an additional nine patients had spontaneous free rupture of an abscess into the peritoneal cavity. The mean duration from onset of Crohn's disease to rupture of abscess was 8.5 years. All 30 patients had surgery within 24 hours of perforation or rupture. All 21 patients with spontaneous free perforations survived, as did all but one of the nine patients with perforated abscess. The cornerstone of the treatment of ileocolonic lesions perforating into the general peritoneal cavity is proximal diversion with delayed reconstruction of intestinal continuity whenever possible. With perforation of the small bowel, primary reanastomosis is possible in selected patients."

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1492891

Hi Guys, Newbie here. Couldnt pass by without replying because this subject has my name written all over it. My first colonoscopy was over 5 years ago. My GI could only get about 1/2 way through because of a stricture in my transverse colon. He thought it was inflamation and we would have to try again. waited 4 years for my next colonoscopy because I just couldnt stomach that Go Litely again. During that colonoscopy doctor couldnt get past the stricture again, he called it a fibrotic stricture and ballooned it as much as he could, but still couldnt get thru. I did have one blockage before my first colonoscopy, but it passed waiting in the emergency room...havent had one since. Since the ballooning I feel pretty darn good. I do know after surgery with Crohns, there is a pretty good chance of reoccurance so I just dont want to mess with it. I keep thinking gee, if I make it another 5 years who knows what advances could be made. It's time for me to renew my Asacol again, and I'm hoping I can put my doctor off again. Maybe if I had a lot of pain it would be an easier decision to go forward and fix the stricture, but I'm feeling pretty good and my gut feeling (no pun intended) says dont mess with it. Sorry for the long post, but something I dont understand. I go to the bathroom fine, sometimes "D" sometimes not. How come everything comes out fine, but they cant get in?

Thanks Gigi, but my stricture is in the large intestine right by the first bend, one straight shot and it's out of there...so to speak.  so everything isnt formed by then?  Hate to sound stupid, but I really want to understand.