Juvenile Fistulotomy / Ulcer

[Gentle Ben]

My son, Ben, 12 years old, excellent health, no symptoms of Inflamatory Bowel Syndrom (syndrome), developed an absess (abscess) near his rectum.  It was lanced over 3 weeks ago.  It was not healing with antibiotics, sitz baths, etc, so our doctor recommended surgury to determine if there was a fistula.  There was and he had surgury last Friday...as a side note he also developed a small ulcer near the rectum also.  He is on metronidaole 250 mg, sitz baths 2-3 times daily, stool softeners and tylenol for pain.  His appetite is deminished somewhat and he has lost about 5 lbs.  He walks around the house and we take slow walks in the neighborhood...his bowel movements are infrequent and very painful (one every 2-3 days) they are soft / normal color / no blood.  His wound is draining a yellowish to clear puss and we are concerned he is not healing quick enough.  The doctor did a blood test - white / red blood cells are normal, no signs of anemia, his "C reactive test was 1.84, higher than normal.  The doctor wants to do a barium swallow test to check for irritable bowel syndrom (syndrome), but we are waiting to see if his incision will heal more and the pain will deminish befor we put him through any more discomfort.

What can we do to help this heal, lessen the dranage, and improve his overall bowel function (lessen the pain)?  How long is normal for one of these problems to clear up?  We are trying not to worry about IBS or Chrone's but it is a concern.  We have an appointment to see a Children's Gastroentorologist in the early part of May (we are very rural and travel to the cities is required)  Maybe its going to take a long time...no one hear is willing to give us a benchmark or "normal" time frame.

[Kevin Pho, MD]

Surgeon has provided good advice in his comments below and I'll reprint them here - since comments don't get saved:

"abcess (abscess)/fistula formation can happen at any age, even in babies. It's good to be sure there's no other explanation, but most often, when it's a single event, it "just happens." I'd have waited around 6 weeks before deciding the fistula wasn't going to go away on its own. In any case, it's typical to be fairly uncomfortable for many days after the operation. Taking warm baths can help with comfort. It sounds still well within the expected amount of time to heal. He should also, if necessary, take something to keeps his bowel movements soft and easy while healing; mineral oil, etc. Keep his surgeon up to date on how he's doing."

A C reactive test is a marker for inflammation - there would be many reasons why this can be elevated.  The fact that there was a recent infection and surgery could be a reason.  I'm not sure if the barium swallow test would test for irritable bowel syndrome - more likely a barium swallow followed by a small bowel series would be done to look for inflammatory bowel disease (i.e. Crohn's disease).  

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.

[surgeon]

abcess/fistula formation can happen at any age, even in babies. It's good to be sure there's no other explanation, but most often, when it's a single event, it "just happens." I'd have waited around 6 weeks before deciding the fistula wasn't going to go away on its own. In any case, it's typical to be fairly uncomfortable for many days after the operation. Taking warm baths can help with comfort. It sounds still well within the expected amount of time to heal. He should also, if necessary, take something to keeps his bowel movements soft and easy while healing; mineral oil, etc. Keep his surgeon up to date on how he's doing.

[Gentle Ben]

My son's condition has been slowly improving, with easier bowel movements, eventhough slightly painful, and somewhat loose.  The team of doctors (Children's, Minneapolis) feel that the CT scan indicates a thickening in the small intestine wall near the large intestine opening....they are recommending / scheduled a colonoscopy on Monday to further confirm or rule out Chrone's Disease or another form of IBD....your comments or suggestions on this tests outcomes would be appreciated.  They removed him off of his IV fluid today as his intake is up...the bowel prep will start this evening late.  Thank you!!!

[surgeon]

if there's a suspicion of abnormality in the location you describe, it's worth pursuing for a definite answer. CT scan is less accurate than a direct look with a scope.

[Gentle Ben]

I have a follow up question.....my son's diagnosis was "they think he might have Crone's.  My question is:  Can you recommend a way to cover the incision the surgeon made during his fistulotomy.  It is appx 2" long and runs from close to his anus, angular away on his buttocks.  When he has a bowel movement the pain is tremendous when the soft, solid or liquid stool touches the incision area....HELP PLEASE  We know this is going to take awhile to heal, however, I know he would at better and his bowel movements would be more regular if it was'nt so painful....we have tried topical lydocane jelly, but that only works after the fact....I'm looking for some covering for prior to the BM.  THANK YOU!!!!!

[1MoonBB]

I don't know much about fistulas, fistulotomy and fistulectomy...but I, myself have just had a fistulotomy with hemhorroid banding and excision of skin tags.  Can someone explain the recovery process from fistulotomy with rubber band draining seton?  My body is going thru some changes and I don't know what normal means any more.

Thanks

[JimJ]

I had a fistulotmy with the rubber band seton(3 in 2003). The first was in my right buttock. They put the rubber band in. Nothing unusal about that, didn't even have any pain. The second, they put a rubber band in on the LEFT side, and completely opened the fistula on the right. It was early september 03 when they opened the fistula up on the right. It's been over 8 months, and I'm still wearing bandages in my underwear to catch any "leakage"(both from the band on the left and since they made a cut into my sphincter on the right when they opened the fistula, occasionally i have a small "accident". It's a very long recovery from my experience, however, I have found it alot easier to deal with that my total colectomy that I had 3 years ago(J pouch surgery, I had Ulcerative Colitis). I should note, the doctors think there's a possibility I have Crohn's disease, however, I don't have the time right now to drive 5 hours to the Cleveland Clinic for the testing.

[tfinster]

I would very much like to talk to you. My son is 13 and going through the same thing. He is having a fistulotomy today and perhaps seton surgery, depending on what they find. This seems to be very rare in children this age. I will post the outcome as soon as I can. Please let me know if we could correspond about this. Thanks!