When is the right time for Surgery

Hi , Been living with Crohns for the last 17 years.  My main problem with the illness is Obstructions, I suppose I've had around 15 partial obstructions which have resulted in me being in so much agony for around 6 hours. Many times I'm also Sick. Eventually it passes and im back to feeling completely normal.

However since my last obstruction in March which resulted me spending 7 days in hospital something is so different and I'm confused why.... When I was admitted I was given morphine and put on a steroid drip and placed on a course of Prednisolone - 60mg tapering 5mg every week. But after a few weeks I noticed that I had this horrible distended - bloated - hard feeling all over my stomach which wouldn't go away... Since March I've been up and down on my steroids and have risen my Imuran dose from 100mg to 150mg and now since the beginning of August to a whopping 200mg!!  I also have been taking the whole time 3000mg Pentasa. My blood tests show No signs of inflamation.  Could this mean its time for surgery to remove my stricture, did anybody have the same symtoms before surgery? Having this really uncomfortable feeling for 7 months have really got me down. I'm seeing my consultant again in 4 weeks time but I don't just want him to send me away again for another 2 months feeling like this. Does anybody have any idea what tests I could have done to confirm now is the time for surgery...  All I would like is to spend more than 30mins not thinking about my belly and the pain the whole time...

Thank you for anybody who replies.

Hi Spiceman:

It sounds to me like your stricture is starting to close and you are heading for surgery. You need a colonoscopy and/or a CT enteroklysis to evaluate whether your stricture is limited to one segment of bowel. If it is and if you aren't responding to steroids and imuran then you have probably run out of medical options and it is time for a surgical consult.

Hi Gail. My GI doctor has told me that I've done very well with the illness so far. Meaning I've had no operations since I was Dx when I was 18, now im 36. He also said that 80% of Crohns patients will oneday have a operation at somestage of their lifes.. He refered me to see him again in 8 weeks time and if things have not imroved he will consider a small bowel follow through. He aslo said that staying given up from smoking is better than any drug he could give me. He also refered me to a dietitian so I could follow a low fibre low residue diet.

Hi Yes I was told that quitting smoking can be the best thing for CD I know the low residue helps and especially if your blocking. Hope things get better soon for me I just couldn"t go on the way I was and it needed to be done promt toe. Will be keeping a eye out to see how you do . lol gail

I had a bowel resection when I was 17 and about ten years later I started have similar symptoms....partial obstructions and on two exceedingly painful times, full obstructions. My Crohn's wasn't causing an issue, I had an anastomosis at the resection site that was causing the obstructions.

Like a previous poster mentioned, my quality of life started to wane. I was always worried about an obstruction, the run to the ER (where one must convince the triage nurse that this is not gas pain, not a "tummy ache", and I need pain meds NOW).

I had a plumbing problem. No amount of meds was going to make that stricture go away...it'd needed to be removed.
Angela

I am sure I've had at least partial obstructions. My problem is that I will not go to the ER until I just can't ebar the pain anymore. That is usually 2-3 days of agony. I am perhaps too stubborn. But, after living with this for 30 yrs, I can usually tell if it'll come about by itself. My blood doesn't show inflammation either. I have been on my dr for 3 yrs now. He kept telling me the sed rate doesn't shwo inflammation, so go home and bascially deal with it. Finally time came for a sbft. He told me my stricture has become smaller than a very thin pen, and I ahve deep inflammation in it. This inflammation does not show in the sed rate.

Do not let him blow you off! Insist on a sbft and/or colonoscopy. This is your body! You live in it. My belly swells badly. I gurgle alot. I am so limited on what I eat it isn't funny, and almost anything can send me reeling in pain. I am having surgery. Plus the surgeon just told me I have 2 strictures. My GI lead me to believe I had 1.