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Elective bowel resection 20cm terminal ileum

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Crohn's Disease
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Posted 1/18/2015 5:11 AM (GMT 0)
Hi
I have been advised by my doctor to have a bowel resection because of scar tissue as a preventative measure.
Some background: diagnosed in 2000 and didn't have much problems except for an obstruction in July 2013 that I had to go to hospital for. Following that experience I started on on 6mp 100 mg and remicade (infleximab) for a year. My blood tests have shown no sign of inflammation and that I am responding really well to the medication. However I continue to have symptoms of loud gas (internal) with pain and occasional diahrea But not symptoms that are like my original flare strong cramping etc. they feel different almost like bad PMS overall my health has improved but because I'm not feeling 100% still my Gi sent me
For a MRI which showed a portion for the bowel ( same spot as previous obstruction ) with strictures and narrowing and bad scar tissue build up around 10-15 cm which has pretty much stayed the same this past year compared to my previous scan. He recommended I have surgery to remove the infected area as there is a chance I can end up in emergency surgery with an obstruction.

Just wanted to hear from others of any similar experience and to be reassured that I am making the right choice for surgery and it's possible side effects rather then living with the risk that I might need emergency surgery some time down the track. I am also concerned that maybe the discomfort I am feeling now could possibly be related to the medicine I'm on and not the crohns....
Thanks
Posted 1/18/2015 9:00 AM (GMT 0)
Yes, you probably have no choice. If the docs are certain that it is scar tissue, then the meds are never going to work. It's not an "infected area" though...it is scar tissue. The good news is that if you have the surgery, you may be able to get off the big guns meds for awhile. You might have some time to wait...it depends on how narrowed the area is, but surgery is probably inevitable.
Posted 1/18/2015 9:19 AM (GMT 0)
Thanks
curious to hear the options for medication post surgery as all I've been advised so far is that I need to stay on remicade as chances are it will come back otherwise and also a chance your body won't respond as well or may become immune to it if there's a break.
Posted 1/18/2015 4:50 PM (GMT 0)
This article may be useful for you:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773313/
Posted 1/20/2015 2:12 AM (GMT 0)
Thanks so much
Appreciate your advice
Posted 1/21/2015 8:11 PM (GMT 0)
Ask about a strictureplasty (sp?) instead of resection. This will preserve bowel and take care of the scar tissue. Any loss of bowel can have long-term side effects and having Crohn's, I would want to preserve as much as possible, as there is always the chance you will need another surgery down the road (hopefully not though!).

Also, after an 18 month break from Remicade, I developed antibodies and had a bad reaction to it. I don't know how long it will take to develop antibodies or if you even would, it's all individual. In my opinion, I believe in a top down treatment approach (big guns first), especially if you have moderate-severe CD, but that's just my opinion. Your CD can progress unknown for years while you are taking Imuran or 6MP without you even knowing it, so if I were you I would go back on some biologic shortly after surgery. Might have to be something other than Remicade (they usually want you off of it for 8 weeks prior to surgery) though. JUST my opinion though - everybody is different. Good luck!
Posted 1/21/2015 10:29 PM (GMT 0)
Thanks myrne
I actually can't have the other option we did discuss it although I only had 15 cm removed so still have lots left!
Currently 2 days after surgery and my GI said I should stay on remicade and 6mp as the combination seems up keep remicade working long term. I have read about having a break but believe in staying in whatever it takes to stop it from reoccurring.
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