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My ER Visit

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Crohn's Disease
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Posted 9/29/2019 3:51 PM (GMT 0)
From Friday morning I experienced intermittent abdominal pain lasting for over 12 hours, which is unusual. So I called a RN, who told me to go to the nearest ER department. So I arrived at the hospital that evening (one of the top three in the USA). The ER doctor immediately ordered an abdominal CT Scan. Knowing I will be exposed to a lot of radiation, I reluctantly complied. But what I saw from my emergency CT Scan Report and what I heard from the attending Physician Assistant really changed me for ever.

The latest CT Scan does not mention a word about multiple strictures in my small intestines. That's strange, because I know I have six strictures from a CT Scan Report done a few years ago at another leading hospital (one of the top 30 in the nation). Can those fibrotic strictures go away on their own? Or is the CT Scan report doubtful?

No obstruction or partial obstruction whatsoever. But the CT says inflammation in ileum and colon. But wait a minute. I had a colonoscopy last year reporting perfect colon and terminal ileum, confirmed by biopsies.

This is unreal, because I was seriously considering small bowel surgery to remove the 6 strictures in small bowel.
Posted 9/29/2019 8:07 PM (GMT 0)
Did you drink oral contrast and have IV contrast for the CT scan?

If not, it could easily miss a lot of things, especially smaller strictures in the small bowel.
Posted 9/29/2019 9:08 PM (GMT 0)
I had intravenous (IV) iodine-containing contrast medium for my emergency CT Scan. I had specifically asked if I needed to drink oral contract, and the doctor told me no, IV contrast is all they need to see clearly. The CT machines is made by Siemens. Again, this major teaching hospital is ranked top three in the USA and shouldn't they know the appropriate contrast materials for the scan? I am not talking about a rural hospital away from a big metropolitan area.

Post Edited (EruditePaul) : 9/29/2019 3:27:18 PM (GMT-6)

Posted 9/29/2019 10:58 PM (GMT 0)
None of that matters. ERs typically don't include oral contrast for abdominal/pelvic CT scans. And without oral contrast, strictures can be missed. (They can even be missed *with* oral contrast sometimes. But *without* oral contrast, they're more likely to be missed.)

ER docs aren't trained in diagnosing and treating Crohn's disease. They're trained in diagnosing emergency medical situations and keeping you alive in the short term.
Posted 9/30/2019 5:26 PM (GMT 0)
Paul, if this were me I would get a copy of cd the Scan is on & go see my gi. Have him review this information. It is possible for inflammation to show up this late, keep in mind this disease is sneaky & can be brewing without us knowing it.

Take care.
Posted 10/1/2019 12:11 AM (GMT 0)
Understood. I think the emergency CT Scan was not necessary, given its lack of accuracy. But I am wondering if the radiologist can see small bowel dilation (if any) in emergency CT Scan with only IV contrast.
Posted 10/2/2019 3:38 AM (GMT 0)
Strictures can be really tricky to show up on imaging. The one I had years ago did not show up on anything. Taking the results back to your GI and discussing it would be your best bet.
Posted 10/9/2019 8:39 PM (GMT 0)
I went to see my GI at the same hospital where I made the ER visit. He is not only a regular GI, but a top-notch IBD specialist. The CT Scan done at ER without oral contrast does not provide enough details, so my strictures do not go away on their own. They are still there. How about new inflammations in ileum and colon as revealed by the ER CT Scan? That's mostly likely BS which I can safely ignore. Although the ER CT Scan does not show dilation, it does not mean my strictures are getting better, because oral contrast will show dilated segment. The reason is my bowel did not have enough food/contents to cause dilation at that particular point in time. The ER Scan is not completely useless, because it is useful in diagnosing or ruling out bowel perforation and obstruction in emergency situation. Because most likely I do not have active inflammation, if I have resection surgery today, that may well be the only one I will need for the rest of my life or at at least 15+ years (I understand nothing is guaranteed in life. only educated guess). The difference between emergency and elective procedures is post surgery complication and recovery time. Everything is pretty much the same. I believe "knowledge is power" and "sharing is caring".
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