Courtesy of CrohnsAnonymous.com
According to CrohnsDisease.com, about 80% of people with Crohn’s disease will have a perianal abscess at least once. However, like ostomy’s, who wants to talk about that, right? It might be the best-kept secret in the Crohn’s disease community. But if it’s part of your disease, you have to find a way to accept it and move on with life. If you have had one of these, you may know what I mean.
Personally, I have been put under the knife well over 20 times in 11 years due to perianal Crohn’s disease, not counting the small bowel resection surgeries. Somewhere along the line, I stopped caring what other people thought about it. In hindsight, I’m glad all of that happened because it fueled my curiosity about medicine. Yes. It sounds like an exaggeration. I assure you, it is not. I’ve got a bit of evidence here in my medical chart, from which I will share some of the highlights.
• Reader, I feel that I must warn you that the following includes details from a real surgical procedure, contains rather graphic material and is probably not suitable for children, or anyone with a weak stomach. There is a good reason that perianal/perirectal abscess/fistulae aren’t commonly discussed in the Crohn’s/IBD community. So, unless you truly are curious, or you or someone close to you is in a similar situation, looking at having a similar surgery, or have been through similar procedures, it is probably best you not read it. •
Operative Notes/Discharge Summary
Date of Admission: 01/28/08
Date of Operation: 01/28/08
Date of Discharge: 01/30/08
1. Crohn’s disease
2. Right perirectal abscess
1. Crohn’s disease
2. Large right buttock abscess
1. Crohn’s disease
2. Right ischial rectal abscess
1. Incision and drainage of abscess with cultures
2. Anorectal examination under anesthesia
3. Rigid proctoscopy
General endotracheal and local infiltration…bupivacaine…
Description of Procedure (surgeon):
The patient is a 19-year-old young man with Crohn’s disease which has affected the ileocecal region and the anus and perianal regions. In June of last year, he underwent anorectal examination under anesthesia with drainage of abscess, debridement and delineation of fistulae tracts and placement of draining noncutting setons. For a period of time, he did very well but he was readmitted in the wee hours of this morning with a large right ischial abscess. Unasyn was begun and plans were made to bring him to the operating room for definitive treatment.
Description of Procedure (hospital):
General endotracheal anesthesia was established and the patient was placed into the prone jackknife position on the operating table.
Hospital Course (hospital):
The patient was admitted, made n.p.o. and I.V. fluids were started. *Patient Controlled Analgesia (PCA) (I.V.) Dilaudid (hydromorphone) was also started for pain control. Unasyn was started as an I.V. antibiotic. Later that same day he was taken to the operating room where he underwent the following procedure…
*Patient Controlled Analgesia (PCA) is a device that delivers a doctor prescribed, pre-set dose of pain medications like Dilaudid, morphine, Demerol and fentanyl directly into the patients vein via I.V. that the patient controls by pressing a button when the patient needs a dose of pain medication. After the button is pressed, a set lock out time must pass before the patient can press the button again, delivering more medication. This is now being used more often than I.V. “drips” when it comes to pain control because PCA Pumps are less likely to cause over medication issues, such as sedation and other adverse reactions.
(CONTENT WARNING: THE FOLLOWING CONTAINS GRAPHIC MATERIAL)
The abscess was fairly large and deeply located in the right ischial rectal fossa somewhat posteriorly. When the abscess was incised, a fairly large amount of dark, bloody malodorous pus under pressure was decompressed. The anterior perianal region which had been the site of the most severe previous Crohn’s involvement is very well healed and no longer inflamed. The draining noncutting setons, which are currently in position, appear to be just submucosal and quite shallow at this point. They do not appear to involve muscle tissue. The left buttock was normal and uninflamed. Rigid proctoscopy to 15 cm showed mild inflammation of the mucosa as manifested by areas of mild patchy erythema. There was no mucosal edema or granular appearance. No ulceration. No mucusy discharge and no friability.
[End of operative report/discharge summary]
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