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Crohn's Disease
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Posted 1/19/2009 11:25 AM (GMT 0)
I have Crohns disease and have done for 23 years. I have a perianal fistula and saw the surgeon on the 30th December. I am havina a Colonoscopy next Tuesday which I am petrified of and have just received a letter to say that I am then going to have a EUA + Seton Insertion and fistula plug. Can anyone explain what a EUA is I am really scared
Posted 1/19/2009 11:35 AM (GMT 0)
I'm so sorry, Taz... but welcome to Healingwell.

I don't know if an EUA is the same as an I&D (Incision and Drain), but I have had several setons. I hate that doctors don't take the time to explain this stuff to us...

The Colonoscopy is nothing to be horrified about... I don't know what the normal protocal for your area is, but in my experience I am knocked out and don't feel a thing. Usually the worse thing about it is the prep you have to chug before hand, but even that stuff has come a long way in the last few years.

You need to sit down with a colo-rectal surgeon before ANY of this goes down. You need to be informed, and you need to feel secure with the treatments that they're throwing at you. Remember, the docs and surgeons are YOUR employees, darn it - make them work for those fat checks. Don't let them weasel out of that office until your questions are completely answered. I'm fond of making docs draw what the seton will look like, etc, which drives them NUTS, but oh well. It's MY butt. I deserve to know. You should feel the same. Demand some answers. And don't proceed with anything you're not comfortable with.
Posted 1/19/2009 12:57 PM (GMT 0)
Hello Tazbunny,

Welcome to the forum! If you have an abscess and fistula, then opening the abscess and cleaning it out is normal procedure. The seton will help it all heal. But I am concerned about the plug. Did you ask him for a plug?? I have not heard of a plug procedure until everything is healed. Doing it now doesn't sound right to me. Remember that surgeons in private practice get paid by the procedure. So they like to do procedures. (Surgeons working at university teaching hospitals are paid a salary so they don't care if they do procedures). The question is whether the plug is that what you need. Is he experienced with Crohn's?? This is very important because we don't heal like others do. I agree with Patientspiders that you should not agree to anything until you understand it. There have been a number of recent posts on abscesses and setons and I suggest you read them.

I hope it all goes well with you!!
Posted 1/19/2009 1:27 PM (GMT 0)
Thanks for your kind words the plug is pig gut and I am well scared
Posted 1/19/2009 1:44 PM (GMT 0)
Hi Taz,

My colo-rectal surgeon said the plug works better in non-Crohns, and only has about a 50% success rate in Crohn's (about 80% successful in non-Crohn's). If it doesn't work, it just pops out and you can try again. But there is a risk of abscessing if it doesn't work. If your surgeon isn't experienced with Crohn's, he propably thinks the plug has a higher chance of success. Please just talk to him or his nurse assistant and get as much information as you can. That said, please don't ignore your abscess. I did that for way too long and ended up getting quite sick.

It is so hard to sort all of this out when you are not feeling well! I got quite sick and ended up getting a doctor who was clueless about Crohn's. After that bad experience, I went to another doctor at a university and she diagnosed me with Crohn's and set me on the path of healing. Your doc knows about setons so that is good. My first doc was pathetic!

Let us know how it goes!
Posted 1/19/2009 1:57 PM (GMT 0)
http://www.medscape.com/viewarticle/503224_4


I have had several pig graphs (for other issues) and they are fine.

Posted 1/19/2009 1:58 PM (GMT 0)

Hi Fallscolors

Thanks for that my head is just screwed up at the moment can you please explain what a Seton Insertion is?

Taz 

 

Posted 1/19/2009 2:23 PM (GMT 0)
Hi Taz,

A seton is actullay quite simple. It is a thin plastic tube (like thin spaghetti) that is inserted through the fistula's opening in the rectum and comes out the other opening. The doctor ties both ends together so you have a loop. My doctor jokingly suggested I think of them as unusual body piercings (!). The seton keeps the fistula open so infection/puss can drain from the abscess. Without a seton, the fistula can close unevenly and you can get another abscess. After I got my first seton, the whole area got so much better. And I felt much less toxic after the abscess was cleaned out. So while setons are wierd and annoying, they really help you out.

After things calm down and the infection is all gone, you can try to fix the fistula. A fistulectomy is when they cut it all open and let it heal. If the fistula is too high in the rectum and a fistulectomy would leave you incontinent, then the plug is an option as well as the advancement flap procedure (70-80% chance of success in Crohn's).

We've had a several discussions about setons recently, and I suggest you look back through about a week's worth of posts and find them. Good information about what to expect from the abscess procedure and living with setons.

Take care!
Posted 1/19/2009 2:33 PM (GMT 0)

Hi Fallscolors

So do you have to live with it in there forever? I also have a hole in my bowel

Posted 1/19/2009 2:41 PM (GMT 0)
Not necessarily, and this is your best chance at healing the entire thing. Bear in mind it will take alot longer then normal wounds to heal, because the idea is to heal from the inside out. It might take more then once to get this fixed, but it is your best chance at it.
Posted 1/19/2009 2:49 PM (GMT 0)
I don't want to have it done once let alone several times, I am not in any pain and can't understand why they want to do it
Posted 1/19/2009 2:52 PM (GMT 0)
Because it can cause a severe infection.

It is just generally inadvisible to have any holes in your body that are not suspost to be there...

Posted 1/19/2009 3:03 PM (GMT 0)
I agree with MMMNavy. I let an abscess go way too long and it nearly went septic. I could have died. Abscess are not something you can ignore. Believe me, no one wants to go through any of this. But if it gets us better, then be brave and do it. Again, just make sure your doc explains it all to you and you understand it.
Posted 1/19/2009 7:15 PM (GMT 0)
Hi Taz and welcome to Healing Well . I see you have had crohn's for a long time and as mentioned above the seton seems to help lots of people and I agree you need to ask lots of questions about it. Let us know how your scope goes. Wishing you the best. lol gail
Posted 1/19/2009 7:24 PM (GMT 0)

EUA I  believe is Exam Under Anesthesia.

Hope that helps and best of luck on the procedure!!

Posted 1/20/2009 8:29 AM (GMT 0)
Thanks for all the replies, I will let you know how I get on

Posted 1/20/2009 8:58 AM (GMT 0)
For heavens sake. These rotten doctors.

Yes, Taz, EUA is Examination Under Anaesthesia. You'll be asleep; they'll probably have a little look up your rectum with some fibre optics (similar to what they do for a colonoscopy); do whatever they need to do with your fistula; and then you'll wake up.

I'm so sorry you were upset by this technical term. The doctors should have explained it to you, and you have every right to be upset that they didn't.

I'm really aggravated on your behalf. Please do let us know how you go.

All the best,

Ivy.
Posted 1/22/2009 11:21 AM (GMT 0)
Thanks Ivy

 What I am concerned about is this Seton Insertion it sounds really horrible and no one medically has explained it to me, sound from what I have read that it coud be in me for years, if the pig gut takes

Melissa mad

Posted 1/22/2009 11:27 AM (GMT 0)
Melissa, have you signed a consent form yet? If not, make a point of NOT signing the form until they sit down and explain it to you. Make them draw pictures, show you a bit of pig gut, *anything* to give you a better idea of what you're going through.

It's your body. It's your signature on the consent form. You have a right to be properly informed about your procedure.

One thing to remember about setons is that they are your friends. They keep the fistulas open and stop them from clogging up and abscessing. Abscesses are horrible, painful things. You can live with a seton. An abscess is agony.

I hope it helps you to know that.

Ivy.
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