Perforations??

What causes perforations? Can this occur in the small intestine and colon? Is it usually from a stricture or blockage or obstruction? Know a stricture can be composed of scar tissue or inflammation but not sure about the others people refer to. Also some people say they did not know they had Crohn's until there intestine perforated? No symptoms or warning?

MBJOH just wondering if you were on steroids at the time? I have not suffered a free perforation, but the path report from my last surgery indicated a defect proximal to my anastomosis that was about to break through. At the time of my surgery I was on steroids (and a host of other drugs) just to keep me functioning until I could be operated on. My surgeon described my intestines as being the consistancy of wet toilet tissue from the steroids.

But typically perforations can be due to deep ulcerations that literally just break open the bowel or they can be caused by excessive pressure within the intestine, usually associated with a stricture/obstruction. Usually, instead of a free perforation, the body walls off the area of infection in an abscess, which often opens and drains as a fistula instead of as a free perforation into the abdominal cavity.

I perforated in the colon in 1993. I was on Prednisone and my third week of Methotrexate. My symptoms to begin with was a low grade fever and off and on severe sweats. When my gut let go I got "wish you were dead" groin pain, just like an obstruction. I could BM a little bit but not much. My family Dr. thought it was a reaction to the Methotrexate and just kept feeding me a regular diet and Tylonol Codienes for the pain. After 3 days he sent me 350 miles to see the DR. that prescribed the Methotrexate. Now perforated for four days, I was in horrible pain, my belly was distended like I was pregnant. When I got to the hospital, I went into shock before the emergency surgery to resection and clean up the Gangrene and Peritonitis. I actually watched the surgery from above. My fever approached 106 and I spent a month on an ice water mattress in the ICU.

Too much information?

Dave D

I'm just glad you survived. I can only imagine your pain. I have suffered septic shock from abscesses twice and that was bad enough. It is amazing to me Dave that you were able to stand the pain for four days. Isn't it incredible what we can tolerate? Actually, scary is a better word. I have tolerated far too much pain and misery in the course of this disease. Sometimes it has been because I thought I could just will myself to not be sick, other times it was because I allowed others to determine how sick I was, even when intuitively I knew. All these examples just remind me that we really need to trust what we know to be true.

Dave, it sounds like you walked much too close to the edge and MBJOH I wonder if it is possible that, in retrospect, you might have been minimizing how sick you really were in the months leading up to the perforation? We sometimes can get really good in rationalizing our misery, especially when the slippage is incremental and over time. We just keep adjusting and adapting to a new norm as the disease slowly worsens. What do you think?