Incomplete colonoscopy due to to looping and severe pain

[Myg]

I have Crohn's and latelly I have developped diarrhea and abdominal pain. I was previously in remission. I had a colonoscopy performed by a very reputable GI specialized in IBD and for the first time the colonoscopy could not be totally performed. I was sedated w/ midazolam and fentanyl. I have never experienced this kind of pain before and none of my previous colo was painfull or complicated. My GI uncountered a first looping at the sigmoid/descending colon and then looping at the mid-transverse colon and could not go further. No biopsy was performed and of course no observation upstream to the looping part (my CD is usually at the cecum/terminal ileum). I do not understand how after 1.5 years (last colo) my colon could change so much to the point that no colo was possible... My GI wanted to re-perform the procedure under general aneasthesia which I refused. Following the colo I had bleedings for 5 days and severe pain which was resolved with percocet. Then, my GI said he wanted to wait and see if any of these symptoms would resolve by themselves and he let in the dark (but he told me again that it was the first time that he was not able to finish the test). I am now scared to death to have to redo the procedure sooner or later. I just cannot imagine myself to have to go through that again, and it looks like my GI too... PS: the SMFT was normal but that it generally the case and only the colo was able to find the ulcerations.
Do you have any idea why the looping, the pain? Any suggestions of what I could do?
In advance, thanks for your help.

[Kevin Pho, MD]

Erin, PA has kindly answered your question in her comments below and I agree with her assessment.

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.

Thanks,
Kevin, M.D.

[Myg]

PS: My GI did not give me another appt or any follow-up, and then I am a "little" stuck about what I should do even to control my diarrhea and other symptoms... I am very hesitating to call him back. Few days after the colo when we talked he seems still upset by not being able to finish the test on me, and told me to call him ONLY if my symptoms were not resolving by themselves... Otherwise he wanted to put me back on high dose steroids (which I do not want to do w/o confirmation that something is really wrong (i.e. flare-up). I cannot tolerate remicade (developped vasculitis and lupus like syndrome) and 6MP or Imuran...Any idea, coments?...

[GI.PA]

Some thoughts ...

Things can change in the colon.  If you have had IBD for several years, even if symtoms were in remission, inflammation and scarring can occur.

Your IBD was contained to the cecum/small bowel but such difficulty during exam may indicate progression of the disease to more of the colon, making it inflammed and prone to spasm during evaluation.

If you diarrhea is not improving, you need to not hesitate to follow up soon with your GI.  Some options (may or may not have been persued in the past) would be Entocort (www.entocort.com) a type of steroid that very little stays in the blood stream, the majority of the meds go to the colon and then are immediately broken down by the liver...safely profile is better).  It seems to treat the right side of the colon better than the left and might be an option.  Pentasa (a type of Asacol or 5-ASA product) seems to have a better small intestine and right colon distribution.

You really do need another colonoscopy if things are not behaving.  Discuss your concerns with your GI about procedure and post procedure pain.  If general anesthesia is used, you should be asleep (just like surgery).  I would insist that measures be take that can allow you to be admitted overnight for observation since you had such a terrible time with pain after the last procedure (If you feel fine, you should be able to go home insead, but better plan for the worse case senerio).  Do not let your fear of another colon exam prevent you from going to your GI..you may worsen to the point requiring hospitalization and perhaps surgery (and in crohn's you are likely to re-flare where the two ends were put together).

GI.PA
Gastroenterology Physician Assistant

[Myg]

Thanks for your comments. I have experience w/ entocor (still have some here at home...) but it did not really work.. and prednisone was the only one powerfull enough to tame the beast. And, yes I know that steroids long term are really not a good idea, but I just cannot function w/o them even if right now I was able to tapper to 5mg/d.
You are right by saying that I need to redo the scopy, but I am a "little" deaf to any reason right now... I have still nightmares about the last colo, and nothing could bring me back there... and my doc office is right there. I am trying really hard to persuade myself to call but even that I just freak out. I think I will have to wait to be in real medical mecessity (meaning that I could not take it anymore!) to push myself there. Oh well, I guess I'll have to put myself together... one day or another...
Thanks again for your help,

MyG

[nursejoy54]

A related discussion, Painful colonoscopy was started.