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Colorectal Diseases

Crohn`s fistula

05/13/2009

Question:

I have a 28-year history of Crohn`s with multiple resectional surgeries. About two years ago I developed a perianal abscess which then turned into two and then into two fistulas, one of which is complex.

I had draining setons in for almost a year, tried Remicade,and as a last try I had the Surgisis Plug last September which failed. I then swore off doctors for good and have done nothing further even though the plug surgeon said I need to see a GI doctor to get my Crohn`s in control or risk having my colon removed. Oh, please!!! I have no symptoms of Crohn`s currently other than the fistulas and diarrhea 5-7 times a day which is my normal.

I have learned to deal with the pain by taking OTC Motrin and deal with the continuous discharge of pus and blood.

The surgeon who did the plug told me the complex fistula was an ischiorectal fistula and the track was "extremely long."

Questions:

1. Is a very long track of any significance? 2. Can I really do any harm by not treating the fistula as long as I do not get another abscess?

Thank you.

Answer:

It sounds as if you are unhappy with the advice you have received. In such a situation it is always a good idea to have another opinion. The symptoms of Crohn's disease are widely varied, and include fistulas, abscesses, and drainage. Medical treatment of the inflammation is the best first step, and may lead to fistula healing after the seton is removed. Untreated inflammation can result in strictures, intestinal obstruction, and abscesses- all of which may indeed ultimately require surgery to remove the colon. An untreated Crohn's fistula is prone to develop undrained infection and increasing complexity of the fistula. A long tract is evidence of the difficult nature of the fistula, and makes it much more difficult to heal with or without surgery.

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Response by:

Janice Frederick Rafferty, MD Janice Frederick Rafferty, MD
Professor of Surgery
Chief of Colorectal Surgery Division
College of Medicine
University of Cincinnati