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Dr. Chip
Dr. Chip, Board Certified Physician
Category: Medical
Satisfied Customers: 31220
Experience:  20 yrs. in practice, includinge surgery, general medicine, addiction medicine and pain.
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My son was diagnosed with Crohns colitis last July and had

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My son was diagnosed with Crohns colitis last July and had a small bowel perforation. He had a laparotomy and a small bowel resection with formation of end ileostomy. He had Prednisolone steroid tablets then but has not had any medication since then. His blood tests have all been ok to date. The hospital is considering reversing his ileostomy soon before he goes to university for 3 years in September 2014. He had a colonoscopy in January which showed moderate to severe pancolitis and a few pseudopolyps He had an MRI of the small bowel which showed no Crohns and his CT scan of his abdomen and pelvis were clear. Should he have treatment for the pancolitis in the colon before they reverse him and they have said most of the tablets are taken by mouth and would not reach the colon until he is reversed. Do you agee? And do you think he will recover from the operation before September or should he wait until summer holidays (3 months) 2015 and hope they can get the colitis in remission first as the biopsies showed active inflammation. Thank you
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. Chip replied 3 years ago.
Hi. First off how is doing overall with eating and things like abdominal pain or cramps? You said the hospital was considering the reversal--do they have any misgivings about doing that?
Customer: replied 3 years ago.

No pain or cramps, no problems with ileostomy. He is eating well but avoiding too much fibre and not eating fruit but plenty of meat etc. He has put on about a stone and a half (sorry not sure what this is in kg) since last July and is in the normal weight for his height. He is 18 years old. He was on iron tablets for a while up to last November but the last 3 blood tests were all normal, iron, vitamins etc and he has had no pills since then. He drinks plenty. The surgeon has asked the gastroenterologists whether reversing it will worsen the pancolitis in the large bowel and if there is any treatment they can give him before the op. We have an appointment with the gastro on 6th May so will see what they say but would like a second opinion as it will be our decision. It is difficult because he will be moving away from home in September to go to uni and this is his last chance to go because he deferred last year as he was too ill to go. His would dehisced when he came home and we had the district nurses out for 2 months after. Also the letters he has had recently say pancolitis and not Crohns. Can they be 100% sure which it is.


 

Expert:  Dr. Chip replied 3 years ago.
Just one more question--was the colon biopsied in January?
Customer: replied 3 years ago.

First one was done when he was in hospital July 2013 showed severe segmental mucosal inflammation from distal sigmoid to T1. Small single deep ulceration next to dentane line otherwise rectum spared. Proximal SC, DC, Caecum and TI were severely inflamed with pseudopolps, bleeding on contact ulcerations.


 


Second colonoscopy done 6th Jan 2014 with 4 biopsies which says moderate to severely active pancolitis with a few pseudopolyps.


 

Expert:  Dr. Chip replied 3 years ago.
OK. In my opinion I would reverse the ileostomy. I think that will be successful and with no evidence of small intestine Crohns at this time it should function properly, After that they can use the medication to treat the colitis. I see no reason why he shouldn't begin his studies this September after that.
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