Fistula, sinus tract or stitch abscess?

Tomorrow I hope a CT scan will settle this problem. *Before I begin I’m warning you that this post/topic is not for the squimish, so consider yourself warned.*

Chylous drainage from wound ~1 week after the incident

Chylous drainage from wound ~1 week after the incident

While I was in the hospital I had a small region in my wound that was draining a little bit and just not healing properly so they had to remove a few staples prematurely in an effort to pack that area and allow it to heal up. So when I got discharged after the almost month in the hospital, I was having to pack a little hole like thing in my wound, not a big deal I didn’t mind. When I got to my apartment this hole was maybe ¾ the size of a penny in diameter and was approximately 2 cm above my umbilicus medial to the stoma. Jargon for directly above my bellybutton next to the stoma. During my first like 12-36 hours at home I was noticing that my ileostomy flanges (the part attached to the skin) was getting really soaked in turn compromising the adhesiveness of the bag and causing leaks. So I was having to change my bag much more frequently then I had expected. Good practice if nothing else right? I thought it was what we stoically call “operator error” aka me messing up so I was super frustrated. Anyways a surgeon I know was growing suspicious of the opening and decided to probe the wound with a sterile q-tip that I had from the hospital. Okay I do not recommend you go doing stuff like this. I live walking distance to my hospital, my sister (a nurse with experience with ostomates) was there and this was done by someone who really knows what wounds.

With a bit of probing around the wound all of a sudden about 300 ml of green nasty fluid starts bubbling out of the wound, and  we couldn’t stop it. I can only describe it

Some scale

Some scale, for my medical friends. . . note granulation tissue beginning to grow back. This has been burned 4 times with silver nitrate and within 36 hours its back to pre-burn levels

as like gaseous discharge that wouldn’t stop and every movement I made seemingly made more fluid gush out.  My stomach was grumbling like crazy and every time it grumbled a whole lot of fluid came pouring out. It was time to get to the ER, quickly but calmly. In fact that’s a good lesson, try to stay calm in any situation like this. Move with a purpose but stay calm it makes things less stressful. The ER doc agreed that this was very characteristic of a fistula. A fistula is an improper connection between two regions of the body, in this case we thought fluid from my intestines was somehow draining from my wound. So I went ahead drank the contrast went and for a CT scan to confirm everyone’s suspicions. Now had it been a fistula we would have expected a whole bunch of contrast to light up like a light bulb from where the draining was occurring and also possibly some in the ileostomy bag. Results…Nothing but contrast in the bag but some fluid in the abdominal cavity possibly left over from my initial surgeries etc. Great, no evidence to suggest a fistula. So I got admitted and discharged 3 days later. The issue has remained unresolved ever since. The amount of discharge has decreased but I am still having to change my dressings on this thing constantly. We thought that since there was some fluid in my abdominal cavity maybe it was just a sinus tract draining that remaining fluid and it would close. Well we are like 10 weeks post op and its still going strong. Now we think that this may be a stich abscess in which case it is better that the crap is draining out then staying in.

Some greenish draining from the wound

Some greenish draining from the wound

Tomorrow, or I guess later today at this point, I get a CT scan which I am super excited about. It has been fascinating to track the volume of production and progress of my wound but it is really annoying to constantly change my dressings. This whole process has been a great opportunity to learn first hand about improper wound healing. But it’s time to figure out what the hell this thing is and determine what steps we can take to stop it. So I’m just trying to stay positive with this and use it as a learning experience. I will keep you all posted on what it is but in the mean time…suspense and some pictures.

Does anyone else have an ostomy wound problems? Hernias? Peristomal fistula problems? I know I cant be alone with this issue?

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3 thoughts on “Fistula, sinus tract or stitch abscess?

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