It turns out that the abscess in my pelvis is a fairly major problem. Sufficiently major that it’s got to be fixed. The margins of the abscess are already impacting on my left ureter, and very close to both the main artery and the nerves that run to my left leg.
The general recommendation for someone in my situation would be to take down my anastomosis, resolve the abscess, and give me a permanent colostomy. And indeed, the surgeons still feel that this is potentially the best option for me. Except that (a) I’m really not keen on this idea, (b) my general health is very good, and (c) I’m very happy with my current quality of life, even with the problems the abscess is giving me.
So my surgeon feels that it’s worth one last gamble to see if we can resolve the abscess, keep my anastomosis intact, and avoid the colostomy. He’s warning me that the prognosis is poor, and that it probably won’t work … but it won’t make matters worse, it might work, and even if it doesn’t it will make the subsequent surgery to install a colostomy (which is going to be very difficult because of all my earlier surgery) much easier and safer. The downside is that I’m signing up to some extra surgery, a very new and relatively untried treatment regime, and potentially an extra year of fighting with my health, to perhaps still end up on a colostomy. But if I have to fight for something, I figure that my health has to be right at the top of the list.
Apparently most anastomosis leak a little initially, and form small abscesses which heal up of their own accord. In my case, the leak has got smaller, but the abscess behind it has steadily got worse. The suspicion is that my leak is still leaking a little, but it’s now too small to let the abscess drain properly, so my body never gets on top of the infection and so it continues to grow.
So the plan is to make the leak between my bowel and the abscess bigger, and to drain the abscess through that “hole” while putting me on a course of strong antibiotics to reduce any infection. To help drain the abscess and promote the best healing, the surgeons are going to imbed a device called an endosponge (only Google this if you’re really fascinated) in the abscess. This will irritate the lining of the abscess as well as draining off any exudate, preventing excessive scar tissue formation, and helping the abscess to heal from the inside back out. Once the abscess is opened up, the endosponges are fitted and removed endoscopically, which is just as well, as they need changing every 3 days or so. The first week or two this will need to be done under general anaesthetic, but for the subsequent 4-6 weeks that I need to use them, it can be done as part of an outpatients visit.
While this is going on they will need to defunction my bowel again, so I’ll have to go back onto a temporary ileostomy again.
So in summary, if all goes to plan, I’ll go into hospital, be put on a temporary ileostomy, have the hole into the abscess surgically enlarged, and with the help of these endosponges have the abscess drained & reduced. I’ll then remain on the temporary ileostomy until the abscess has fully healed, and the anastomosis is (hopefully) intact again. At that point we can reverse the ileostomy, and see if the anastomosis holds up. If it does then I should at that point be fully healed.
At any step of the way, if something doesn’t work as we’ve planned then it’s highly likely that the surgeons will move me straight from the temporary ileostomy to a permanent colostomy. Not my ideal outcome, but it will at least be a final resolution.
So whatever happens, this will bring my treatment to a conclusion. It’s just not clear yet what the conclusion will be, or exactly how long it will take. But I’m tentatively scheduled to get started by being admitted for surgery on the 4th of April. Realistically I’m going to be off work for a month, then probably working only part time from home until I’m free of the endosponges, at which time I ought to be able to resume more normal work patterns.
Here we go again…