Do I have an obstruction or something?

Well if the Pred is not helping, that means something is going on. I would take the doctor's advice and go back to the ER. Explain all that you have been thru, and that the steroids and other meds arent working and that you are still in extreme pain. I know hospitals suck, but sometimes they are a necessary evil. Good Luck and God Bless.

ngwen,

I had many of the same exact symptoms as you--sharp stomach pains that would comes and go, nausea (which for me, is extremely rare), and no improvement of the symptoms even after going onto 20mg of prednisone (usually, prednisone has me feeling back to normal in 2-4 days).

My surgeon and I believe, just based on these symptoms, that I have some type of obstruction. I also just feel that something "isn't right" in a way that is not a normal Crohn's flare. My symptoms only go away if I remain on a liquid diet--another clue that I probably have some sort of obstruction.

So anyway, you sound like you are in the same boat. I am having a barium enema to check out where the obstruction is (my colon is the only part that my Crohn's affects), and am scheduling my first resection surgery shortly after that.

My suggestions to you are: stay on a liquid diet (drink SlimFast or Ensure for calories and vitamins in the mean time), and get a CT scan or other test to see what is going on with your insides asap. If you feel any Really terrible stomach pains, you should go straight to the ER. If you stop passing stool or gas completely, you should go straight to the ER. Both could be signs that your obstruction is getting worse--and the worst thing that could happen is your bowel could perforate.

I really wish you the best. You can also google some symptom lists for bowel obstruction. This website differentiates the symptoms of small intestine vs. colon obstruction:

http://en.wikipedia.org/wiki/Bowel_obstruction

(I don't know if that is hyperlinked, you may have to copy and paste it into your web browser.)

Good luck.

The nausea, cramps, do seem to point to at least a partial obstruction. Possibly due to a stricture...a cat scan would help identify areas of narrowing.

My daughter's stricture tends to close partially during a flare. So contents of the small intestine get backed up and then the terrible pain starts, as the body initiates cramps to try to shove contents through the obstruction. Whenever these cramps start, in the case of an obstruction, there is always the danger of perforation. So if you have even a partial obstruction it is best to get the cramps and inflammation under control ASAP. 

35 mg of pred might not be enough - you might need more. 60 mg of Solumedrol via IV helped my daughter get out of a flare.  

If you do have an obstruction and it includes scar tissue, then meds cannot clear the scar. My daughter's stricture does include scar tissue, and therefore will never go away, but as long as the meds keep her free of inflammation, then the stricture poses no problem. 

However, in some cases, even when inflammation is down and Crohn's is inactive, a stricture can still pose problems. If too much scar tissue has built up, leading to obstructions that do not open up with reduction of inflammation, plus you find yourself reduced indefinitely to a liquid diet, then it becomes a quality of life issue, and perhaps time to consider surgery.      

It's great to hear you are doing better! Yes, cat scans can show both strictures and obstructions, but they are not foolproof.

In my daughter's case, her first visit to ER  included a cat scan that did show narrowing of the terminal ileum -- a stricture. She had had violent vomiting and cramps all day, but was still having BMs. For the cat scan, she drank something and was also injected with something. 

Her second visit to ER, when she flared after trying to taper completely off Entocort, also included a cat scan (they wanted to see whether there was an abcess - it didn't show any) that clearly showed the stricture plus ballooning of the small intestine before the stricture -- the ballooning is what happened when contents got backed up - part of the small intestine had to expand to accommodate them...that stuff has to go somewhere. 

My daughter has been on Entocort since July 2006. One pill a day since May 2007 and no side effects. She has been in remission all that time, so we're sticking with what works.

It's a good sign that you were able to eat dinner last night, because there's a greater chance the problem might be due more to inflammation than to scar tissue.

How long have you been on the azathioprine? (It's very powerful, but takes months to kick in.)

My daughter is in school abroad, this Fall term, so she decided it was too hard to continue with the SCD diet - because the Entocort has her in remission, and she never got D anyway, we couldn't tell whether the diet worked.

SCD stands for "Specific Carbohydrate Diet," developed for IBD patients. No sugar, fluid milk or grains, but honey, fruit, vegies (well cooked), meat (but not any processed food, like hot dogs), cheese and homemade yogurt (gets rid of all the lactose and is more powerful than store bought) are ok. You might want to check out the website, www.breakingtheviciouscycle.info, check out the introductory portion of the diet, and see whether it helps you. (The book, "Breaking the Vicious Cycle," is available on Amazon.com, where there are tons of testimonials for this diet.)

We get SCD multivitamins from www.lucyskitchen.com. They are not loaded with all kinds of additives, like most multis are.

Post Edited (njmom) : 10/16/2007 6:31:21 PM (GMT-6)