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Abdominal abscess

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Posted 2/11/2011 11:26 PM (GMT 0)
Turns out I developed an abscess in my abdominal wall since starting Remicade. From the ultrasound report, it's about the size of a golf ball about 1cm below my skin. It's tender, but aside from that and a lump I've got no symptoms.

Anyway, this opens up a whole new part of CD for me. Can anyone tell me what I could expect from this thing and what my doctor might recommend to get rid of it?
Posted 2/12/2011 12:16 AM (GMT 0)
I thought that you had a fistula to your abdominal wall? Is that still the case and the end has grown to a big abscess? I would imagine they might put you on antibiotics and perhaps insert a drain. Has your GI discussed starting you on Remicade in the future?
Posted 2/12/2011 12:27 AM (GMT 0)
Yep. A CT caught the fistula into my abdominal wall. My doctor put me on Remicade. So I've done the first two loading doses of Remicade.

I just finished a course of Flagyl and Levoquin.

My doctor wanted to do another CT scan, but I didn't want to since I JUST had one. So I had an ultrasound that said it looked like I had an abscess.

I didn't really get a chance to talk to my doctor about the abscess...I was leaving my Remicade infusion and showed him a lump that developed on my right side while he was between patients.

Supposed to see him again next Friday, but I was just curious about the procedures for treatment. Because honestly, a ball of pus hanging out in my abdominal wall does make me a little nervous!
Posted 2/12/2011 12:42 AM (GMT 0)
Sometimes an abscess can "wall off." Basically the body's defense mechanisms work to control the infection. However with a fistula leading to it, it's more likely that with no outlet to to outside, the intestinal contents are pooling up there at the end.

I guess I am surprised that your doctor wanted to wait a week before seeing you. Have you been running a fever? Is the lump painful when you move about or are bending over patients? If you begin running a fever, contact the doctor right away. If the lump begins interferring with your work, see if you can move up your appointment.

Sorry about these developments...
Posted 2/12/2011 1:32 AM (GMT 0)
tooth:

You definitely need to get to the Dr. An abdominal abscess sometimes need to have a CT guided drain installed. It's usually in for about a week and flushed every day. Where is the fistula emanating from. I'm guessing for part of you intestine. You don't want to leave the abscess too long as it can rupture causing sepsis.  

Posted 2/12/2011 1:50 AM (GMT 0)
I always thought an abscess was untreatable with antibiotics since the medicine can't get to it due to the "wall" around it. They usually are cut and drained. Like others said contact your doctor ASAP if you start showing signs of infection (fever, chills, etc...)
Posted 2/12/2011 2:02 AM (GMT 0)
In my case, the abscess (size of a grapefruit) caused me severe pain for over a month before I was diagnosed. Once they caught it on the CT, it was surgically drained and left open to heal. I developed the fistula after the fact (i think). My understanding was that they don't like to leave the abscess there ready to burst at any time... but obviously, it can exist for a long time without bursting...

I have been on Flagyl and Cipro to try to reduce the potential infection, then Humira to try to heal the fistula. It sounds to me like they are trying the medical route first via antibiotics, etc. I think that is definitely the way to go... any surgery can lead to fistulas with Crohns (or Not!), but why take the risk.

I hope your abscess heals soon!

Sudsmom
Posted 2/12/2011 4:43 PM (GMT 0)
So far it's been no fevers, no pain (unless I palpate it to see if it's getting bigger), and nothing out of the ordinary with it. Since my last infusion, I'm feeling great and the only real thing is the lump on my side that's just there....

And my doc didn't get the ultra sound report yet. I have access to the hospital's system so I read it because I wanted to know what's going on with me. Usually I print it out and fax it over early, but unfortunately I got really busy yesterday and just didn't get a chance to do it.

I'll give him a call on Monday to see if he thinks I should go get it drained before I see him...what's that procedure entail? Are you admitted for it or is it outpatient? How long are you down for?

Guess I'll get myself on Flagyl again and just start obsessively taking my temperature. Haha...should be a fun weekend.
Posted 2/12/2011 4:55 PM (GMT 0)
In my case, they admitted me and put me out to drain the abscess the first time, since they weren't absolutely sure what they would find (I have had many prior surgeries, so my bowels are a mess, lots of adhesions, etc). Then I was in the hospital for about a week so it could start healing from the inside out (they left it open and packed it daily - it was about 4in by 4in and 3in deep). Once it started filling in and I could move around (and my husband was trained on packing it :), I went home.

The second time, there was no abscess, just a fistula that would not heal. The surgeon scraped down subcutaneously trying to clean out all the infection, although there was no fistulagram, so we didn't know where the tract went. That was an outpatient procedure (for which I was happy to be completely out of it!). Went home with packing (no drain) and waited for it to heal from the inside out.

It really depends on the location as to whether they keep you overnight.

Good luck!
Sudsmom
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