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Gastroenterology (Expert Forum)
Fistula Question
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Fistula Question
by William III, Sep 24, 2006 12:00AM
History- 1982 diagnosed with Hystiocytic Lymphoma. Lower bowel resection to remove tumor from the terminal illium area. Removed approximately 1/4 of the colon, followed by intensive chemotherapy and radiation treatment (4000 rads). Cancer free until this year.
1990 small bowel resection from complication of first surgery. Bowel kinked causing an obtruction and had to be surgically repaired.
2006 Admitted to hospital for partial intestinal blockage 6 weeks ago. 4 weeks ago had surgery to remove the lateral sigmoid colon, leaving a bypass colostomy (hopefully temporary). The pathology indicated a thickend bowel (caused from prior radiation treatment) with a stage 2 mucinous adenocarcinoma in the center. The bowel removed had 4 cm negative margins and the cancer was approx 4 cm. All lymph nodes, the liver, and surrounding tissue are negative. All blood work looks good and normal.
Obviously, I am most likely looking at more treatment, but a surgical problem is gumming up the works. I have developed a 5mm hole where what is left of my colon was re-attached down by my rectum. The rectum area tissue was healthy but the colon has possible radiation damage. A catheter was fished into the fistula and is connected to an external leg bag. A surgical bag is impossible due to the proximity of the colostomy. There is about 20ml of very cloudy liquid discharge in a 24 hr period. I am told this catheter will most likely remain in for 4 weeks. After a path is formed the catheter will be pulled and the fistula is supposed to drain until it heals itself (3 mos).
Is this standard practice? Are there any other options available? Is a Surgisis AFP plug an option for me? Is there any surgical procedure that can be done without completely opening me up again? I very much need this to be succesful so the colostomy can be reversed and for treatment to proceed.
Thank you in advance for any help you or others can give.
1990 small bowel resection from complication of first surgery. Bowel kinked causing an obtruction and had to be surgically repaired.
2006 Admitted to hospital for partial intestinal blockage 6 weeks ago. 4 weeks ago had surgery to remove the lateral sigmoid colon, leaving a bypass colostomy (hopefully temporary). The pathology indicated a thickend bowel (caused from prior radiation treatment) with a stage 2 mucinous adenocarcinoma in the center. The bowel removed had 4 cm negative margins and the cancer was approx 4 cm. All lymph nodes, the liver, and surrounding tissue are negative. All blood work looks good and normal.
Obviously, I am most likely looking at more treatment, but a surgical problem is gumming up the works. I have developed a 5mm hole where what is left of my colon was re-attached down by my rectum. The rectum area tissue was healthy but the colon has possible radiation damage. A catheter was fished into the fistula and is connected to an external leg bag. A surgical bag is impossible due to the proximity of the colostomy. There is about 20ml of very cloudy liquid discharge in a 24 hr period. I am told this catheter will most likely remain in for 4 weeks. After a path is formed the catheter will be pulled and the fistula is supposed to drain until it heals itself (3 mos).
Is this standard practice? Are there any other options available? Is a Surgisis AFP plug an option for me? Is there any surgical procedure that can be done without completely opening me up again? I very much need this to be succesful so the colostomy can be reversed and for treatment to proceed.
Thank you in advance for any help you or others can give.
Doctor's Answer
by Kevin Pho, MD, Sep 25, 2006 12:00AM
, Sep 25, 2006 12:00AM
I am not a surgeon, so my insight into this question is limited.
The treatment course as described is reasonable. I am not not familiar with the Surgisis plug, so I cannot comment on that.
Given the extensive surgical history, it would make a laparaoscopic approach less likely.
If there is concern or questions about the recommended approach, a second opinion can be obtained - preferably at an academic medical center.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
The treatment course as described is reasonable. I am not not familiar with the Surgisis plug, so I cannot comment on that.
Given the extensive surgical history, it would make a laparaoscopic approach less likely.
If there is concern or questions about the recommended approach, a second opinion can be obtained - preferably at an academic medical center.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
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I am wondering if you are still out there. So sorry for all your health challenges. Hope you are okay today. What I am wondering is if you ever learned any more about the Surgigis AFP? I have been dealing with fissure/fistula problems for over a year now. The latest recommendation by my surgeon is to have the fistula plug surgery. He has indicated that it hasn't been around a long period of time and doesn't have much of a track record - good or bad ....? Can you shed any light on this?