Possible stenosis at anastomosis

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susie0915
Posts: 847
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Possible stenosis at anastomosis

Postby susie0915 » Wed Aug 08, 2018 8:39 am

I had my 6 month check at my surgeons office and saw the nurse practitioner for the first time. She did a digital exam and felt my anastomosis with no problem. She then used the scope and said it would not go in as easily once it hit the connection sight. She didn't want to force it and wondered if there was some narrowing in that area. She had no problems with her finger, but suggested I make an appointment with the surgeon and she will talk to him as well to get his input. Since she had never seen me, she doesn't have anything to compare. She also said that the angle of my anatomy is different and the scope is not flexible which makes in harder to insert. I had been told by my pelvic floor physical therapist that the angle of my anatomy was different from the norm. I have had no changes in bowel function or any pain. I do daily enemas but have not noticed any changes in evacuation or administering the enema. She called this morning and said she spoke with the surgeon and he said he could see me and he was fine waiting until September 17 since that is his first appointment right now and I don't seem to be having any symptoms. I saw him six months ago and he never mentioned it, and had a ct scan in May with no mention of anything abnormal in the bowels or at the anastomosis sight. Everything was unchanged from previous scans. He did mention to her that he remembered I may have some mild stenosis. I was wondering if anyone has experienced this. Thanks everyone.
58 yrs old Dx @ 55
5/15 DX T3N0MO
6/15 5 wks chemo/rad
7/15 sigmoid/scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. surgery,early ileo rev, c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod
7/17 no change lung nod
10/17 Clear pel/abd CT
11/17 CEA<.5
1/18 CT/Lung no change in 4mm nodule
5/18 CEA<.5, clear CT pel/abd/lung nod no change

Lee
Posts: 5680
Joined: Sun Apr 16, 2006 4:09 pm

Re: Possible stenosis at anastomosis

Postby Lee » Wed Aug 08, 2018 2:18 pm

Hi Susie,

When you saw the surgeon 6 months ago, did surgeon do a digital exam and/or the scope? My advice, yes follow up with the surgeon, butt if you are not having problem, don't try to fix it.

Good luck,

lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

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susie0915
Posts: 847
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Possible stenosis at anastomosis

Postby susie0915 » Wed Aug 08, 2018 3:13 pm

He did both. I do have an appointment with him in September. I spoke with the nurse practitioner this morning and she said she spoke with him and he said waiting until September is fine. I really don't have any new symptoms since I saw him six months ago, and nurse this morning said she really isn't worried but wanted to have him check since this was the first time she saw me. Unless I have any problems come up I will wait to see what he says in September. Thank you for your input.
58 yrs old Dx @ 55
5/15 DX T3N0MO
6/15 5 wks chemo/rad
7/15 sigmoid/scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. surgery,early ileo rev, c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod
7/17 no change lung nod
10/17 Clear pel/abd CT
11/17 CEA<.5
1/18 CT/Lung no change in 4mm nodule
5/18 CEA<.5, clear CT pel/abd/lung nod no change

MissMolly
Posts: 560
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Possible stenosis at anastomosis

Postby MissMolly » Wed Aug 08, 2018 5:35 pm

Susie:
Stenosis of your anastomosis site may be amenable to a type of balloon dilation.

Balloon dilation is pretty much as the name implies. A thin canula/tube (with a small deflated balloon/air pillow at the distal tip) is inserted through the anus and advanced to the area of intestinal narrowing. Pressurized air is then released into the tube, causing the balloon to inflate. As the balloon inflates, equal pressure is exerted on the wall of the intestine, slowly expanding and stretching the narrowed segment of intestine and restricting scar tissue.

A stent cage can be placed, if needed, to sustain the opening.

Balloon dilation is also used to widen the opening to an ostomy stoma. Scar tissue can be a problem in the 2-3 inches of intestine directly behind a stoma, causing a localized narrowing. The mechanics of surgically creating a stoma the intestine can also result in restricted flow (sometimes making a sharp curve in direction) that can be corrected with balloon dilation.

I just wanted to ease concerns that you may have. There are options other than additional surgery.
Karen
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.

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susie0915
Posts: 847
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Possible stenosis at anastomosis

Postby susie0915 » Wed Aug 08, 2018 6:13 pm

MissMolly wrote:Susie:
Stenosis of your anastomosis site may be amenable to a type of balloon dilation.

Balloon dilation is pretty much as the name implies. A thin canula/tube (with a small deflated balloon/air pillow at the distal tip) is inserted through the anus and advanced to the area of intestinal narrowing. Pressurized air is then released into the tube, causing the balloon to inflate. As the balloon inflates, equal pressure is exerted on the wall of the intestine, slowly expanding and stretching the narrowed segment of intestine and restricting scar tissue.

A stent cage can be placed, if needed, to sustain the opening.

Balloon dilation is also used to widen the opening to an ostomy stoma. Scar tissue can be a problem in the 2-3 inches of intestine directly behind a stoma, causing a localized narrowing. The mechanics of surgically creating a stoma the intestine can also result in restricted flow (sometimes making a sharp curve in direction) that can be corrected with balloon dilation.

I just wanted to ease concerns that you may have. There are options other than additional surgery.
Karen


Thank you Karen. This is good to know. Hopefully when I see the surgeon, he will say it is okay as I have no symptoms. I know my anatomy is angles differently than normal and the nurse practitioner said the scope was rigid so not easy to adjust. She seemed nervous to try, she said she tends to be quite cautious. Which is fine by me. We will see next month when I see the surgeon, and hopefully no issues arise before then. I do daily enemas, but have not noticed any change in administering the enema or the evacuation process. I will pay attention to any changes that may occur. Thank you again for you input. It is so nice to have someone as knowledgeable as you to help us with all our concerns.
58 yrs old Dx @ 55
5/15 DX T3N0MO
6/15 5 wks chemo/rad
7/15 sigmoid/scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. surgery,early ileo rev, c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod
7/17 no change lung nod
10/17 Clear pel/abd CT
11/17 CEA<.5
1/18 CT/Lung no change in 4mm nodule
5/18 CEA<.5, clear CT pel/abd/lung nod no change

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Shana
Posts: 401
Joined: Sun Jul 30, 2017 9:45 pm
Location: Sonoma, CA

Re: Possible stenosis at anastomosis

Postby Shana » Wed Aug 08, 2018 6:20 pm

Hi Susie,

Hope all goes well when you see your doctor but it sounds like your personal anatomy is just a bit quirky (in a good way I'm sure!)
Anything new and outside the norm is always stressful.

I echo your comments, Karen aka Miss Molly is a treasured resource of information and reassurance to all of us!

Wishing you a restful and worry free week!

Shana
DX - 12/16
MSS - KRAS wild
Well-differentiated adenocarcinoma at splenic flexure
Stage IV CC with liver mets
5FU - Failed twice - 1/17 and 3/17
Irinotecan + Cetuximab: 8/17
Irinotecan and Erbitux ran it's course. CEA rising
Primary tumor invaded tail of pancreas and spleen. Liver mets major concern
Y-90 radioembolization on 9/17/18, liver enzyymes have dropped. 10 Radiation treatments to primary tumor completed too. CT scan Nov to assess overall situation...

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CRguy
Posts: 9615
Joined: Sun Feb 10, 2008 6:00 pm

Re: Possible stenosis at anastomosis

Postby CRguy » Wed Aug 08, 2018 11:22 pm

susie0915 wrote: I was wondering if anyone has experienced this. Thanks everyone.

Hey sista'
cannot speak to the specifics of your own SitRep ...
SO glad your docs are on it

... BUTT ...
having done a shitload of surgeries myself ... yes :shock:
strictures are a " normal " part of the body's healing mechanism
or at least shrinking and contraction of scar tissue .... :shock: :(

sorry it is what it is
BUTT it only means your body has done a kickass job of healing that site !!!!!!
and there are ways to deal with strictures .....

WORD !!!

Best wishes
CRguy
Caregiver x 3
Stage IV A rectal cancer/lung met
11 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

User avatar
susie0915
Posts: 847
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Possible stenosis at anastomosis

Postby susie0915 » Thu Aug 09, 2018 8:14 am

Thank you all for your input. I am feeling pretty good at this point so all I can do is wait to see the surgeon and what his findings are as well as his recommendations. I did have a bowel blockage 4 weeks after my resection so I do know what that will feel like. Right now no issues at all and hoping it stays that way. It is good to know that if there is a stricture that it is easily remedied and is quite common. Thanks again all.
58 yrs old Dx @ 55
5/15 DX T3N0MO
6/15 5 wks chemo/rad
7/15 sigmoid/scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. surgery,early ileo rev, c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod
7/17 no change lung nod
10/17 Clear pel/abd CT
11/17 CEA<.5
1/18 CT/Lung no change in 4mm nodule
5/18 CEA<.5, clear CT pel/abd/lung nod no change


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