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Bowel obstruction...can I avoid surgery?

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Posted 7/26/2017 12:49 AM (GMT 0)
Im new to this forum. Im 37, dx w crohns at 19. Was in remission until 2 yrs ago. Started humira and went back into remission.

In the interim i would have attacks worse than labor pains. Would last 4 days each time w vomiting and unbearable pain and fatigue. At the tail end, i would have diarrhea. No pattern to the trigger of the attacks. Would happen every few months over the course of a few years.

FINALLY after months of tests, i was dx w a small bowel obstruction. My dr said they could not tell if the obstruction was inflammatory or due to scar tissue. He put me on entocort and "lets wait and see".

Im a wreck. Ive never had crohns related surgery. The thought of a resection terrifies me.

Has anyone had a similar experience?? Any advice?? Thank you so much!
Posted 7/26/2017 12:55 AM (GMT 0)
What test did they do to find the small bowel obstruction? An MRI (MR enterography) or CTE (CT enterography)?

Where is it? And how long is it?

Sometimes obstructions require a resection, but sometimes they "just" require a strictureplasty (I say "just" because it's still surgery, but a bit easier on you).
Posted 7/26/2017 12:58 AM (GMT 0)
What tests did you have done? An MRE should give you a good idea of what's going on.

If you have scarring and stricture to the point of obstruction, then the only alternative is surgery. Many here have had resections with great success.

I wouldn't wait too long, especially if you start feeling nauseous are start vomiting. If you don't have any BM's for days on end, and can't even pass gas, then it's time to get to the emergency department.
Posted 7/26/2017 1:17 AM (GMT 0)
I think starting the Entocort is a good idea. It is really hard to tell inflammation from scar tissue on scans. If the Entocort doesn't work and you get another obstruction, then it is probably time for either stricturplasty or re-sections surgery. I've been in remission since my surgery in 2014. I had a bowel obstruction that IV Prednisone wasn't helping and I had no choice, but I'm really glad to be on the other end of surgery. Most of the time they do it laparoscopically so it isn't that bad, and far better than obstructions.
Posted 7/26/2017 1:41 AM (GMT 0)
Thank you so much for your responses!

Over the course of two years ive had five CT scans. They showed nothing. I had a colonoscopy and endo two weeks ago. Just showed crohns in terminal ileum. A week later i had a small bowel CT enterography without IV dye (allergic). This is what report

Bowel:
There is abnormal cone-shaped configuration of the cecum with
submucosal fatty deposition, compatible with chronic inflammation.
Similar changes are present in the terminal ileum.


There is stellate configuration of the loops of bowel in the right
lower quadrant, with involvement of the cecum, several adjacent loops
of distal ileum in the right lower quadrant and sigmoid colon, best
seen on series 601B, image 52, associated with mild mesenteric
stranding. Proximal to this region, the bowel is dilated, to the
caliber of 3.7 cm, suggesting an element of obstruction.
Posted 7/26/2017 2:51 AM (GMT 0)
A couple of comments:

1. At your age, you should get MRIs instead of CT scans. Five CT scans, and now a CT enterography, is heading toward too much radiation exposure - and the subsequent *theoretical* long-term increase in cancer risk. CT scans are ok for older people and for occasional use. For somebody young with Crohn's, MRIs are better.

2. The CTE images aren't good enough to tell exactly what's going on there. What is it about the contrast that you are allergic to? I think they use a different IV contrast for the MRI anyway. I think you should get an MR enterography and hopefully better images so the radiologist can see more detail.

3. If you can't get better images and your condition continues to worsen, exploratory surgery is a possibility. That will let them know exactly what's going on.

4. Make sure you have a GI who is comfortable with treating Crohn's. And go ahead and find a good surgeon, whether you need one now or not.
Posted 7/26/2017 7:34 PM (GMT 0)
I don't think you need more testing. You have evidence of active Crohn's disease and a partial obstruction. You need to be on steroids and possibly biologics to see if the inflammation and obstruction can reverse itself, and if that doesn't work, then you need surgery. An MRI might be useful after treatment to see if things are improving. If you have horrible contraction like cramping and/or vomiting go to an ER right away. A bowel obstruction is a life threatening emergency. If your bowel bursts and you become septic, you can die from it. I agree you need an immediate consult with a colo-rectal surgeon.
Posted 7/26/2017 10:47 PM (GMT 0)
"suggesting ... obstruction" is true, but a CT enterography or MR enterography *should* be able to capture the narrowing with a pretty clear image(s).

The "stellate configuration", to me, raises the possibility of an intra-enteric fistula. That's why I'm thinking better imaging should be done.

But yeah, is the Entocort seeming to help? Or hard to tell, or too early to tell?
Posted 7/29/2017 3:54 PM (GMT 0)
Knock on wood, i have been on the entocort for almost 10 days, along w my usual humira and feel a million times better. I dont think i realized how lousy i was feeling. Im still nervous bc the "attacks" would happen about once a month. Watchful waiting. Thank you for all your responses
Posted 8/1/2017 1:21 PM (GMT 0)
Glad to hear you are doing better! If your doc wants to do a follow up scan in a few months, you might request an MRI this time instead of another CT scan. My guess is that the obstruction symptoms were more from inflammation which is why the Entocort is helping.
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