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Best test for determining location and degree of scar tissue?

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Crohn's Disease
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Posted 11/9/2010 1:49 PM (GMT 0)
I've been in remission from CD since about July of 2008. Periodically, however, I experience excruciating bouts of abdominal cramping. These last around 12 hours and it feels like somebody taking my bowels in their hands and slowly twisting and wringing them out like a wet rag, then slowly releasing, every 2-5 minutes. These bouts occur about once every 2-3 months.

My GI doc thinks that these cramps are caused by scar tissue, as there are no indications in my blood work that point to active disease. I usually have CRP numbers under 2, if not negative, and all other lab results show a thirtysomething man in perfect health. I have no other symptoms of CD: no D, C, fatigue, fevers, chills, weight loss (except when I don't eat after a cramping episode), etc. (in fact, abdominal cramping has always been my only symptom - were it not for that, I would never have known anything was wrong).

Now here's the rub. Recently, these cramps have been occurring about once a week and I believe it is time to find out once and for all what is going on because I prefer not to live with this issue if I can do something about it. I'll be seeing my GI doc this week and am hoping that he will order up some tests to get a good look at what is going on inside. Anybody know what the best test is for this issue? My CD strictures in the past were located in the jejunum and terminal ileum, as determined by CT scans and SBFT. If it is scar tissue causing the problems, who thinks it may be time to seriously consider surgery?
Posted 11/9/2010 2:31 PM (GMT 0)
In your situation I would ask for a new SBFT and, if that is not conclusive, perhaps the capsule endoscopy. I doubt your GI would consider surgery, even if there is evidence of some narrowing from scarring, unless you were at or on the verge of an obstruction. But step one is clearly to get a clear and accurate picture of where and how much scarring there is. Given the location of your disease, that means checking the small bowel first, as a colonoscopy would not be likely to reach the affected area.

Posted 11/9/2010 2:38 PM (GMT 0)
Small Bowel Series would show them. That's how they looked at mine and determined that I did in fact need surgery. I had almost two feet of small intestine removed because of my strictures. But I like you, felt great, had solid stools etc. but my CRP was 4.7! I had so much scar tissue that it had attached itself to my abdominal wall and I could actually feel the lump. I was told if I had swallowed a mardi gras bead that it would have not passed and I would have obstructed.. best not to go that route too long.
Posted 11/9/2010 2:50 PM (GMT 0)
I can tell you that I felt fine right before I suffered my obstruction that led to my emergency resection. So you don't have to flaring to have these issues occur. I would recommend another SBFT and CatScan with contrast to see whats going on. These painful episodes do sound like you are having at least a partial obstruction. Good luck~
Posted 11/9/2010 6:30 PM (GMT 0)
The upper GI barium Xray will show your strictures and fistulas.

I lived with a few obstructions a year until October 2009, then it was a partial obstruction every two weeks. After losing 20 pounds and 15 partial obstructions later, no amount of liquid diets and medications was going to end this cycle.

Had my surgery in September 24 2010, even though still cramping from it, I am very happy I did the surgery, no more obstructions, for now...
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