Phlegmon and Fistula

 

Phlegmon and Fistula - no, they're not characters from a Baroque opera by Haydn, a Commedia dell'Arte farce, or an ancient Greek poem. Phlegmon and Fistula are brand new words in my vocabulary. They put the "complicated" in complicated diverticulitis.

I've thought a lot about whether to write about my medical adventures. Is it interesting to anyone but me? Who wants to bore friends and relatives with endless details about an illness?

Plus, my complaint is not a pretty one.No major illness is, when you get down to the details. Although Puccini and Dumas transcended the horrors of tuberculosis to make it the romantic stuff of novels and opera, I can't see how to pretty up colon disease.

But I have reasons for writing.

One reason is to let people know about it. Lots of people in my generation may face this situation. Colon disease, and particularly diverticulitis, is mostly caused by the way we choose to live - diet.

The other reason is - writing is just how I deal with things.

So - fair warning. I'm writing about it. If you don't like it, don't click on the "Read More" link.

Working without a net

After my CAT Scan in the Emergency Room, the doctor explained to me that the images showed infection in the colon wall and a phlegmon in my lower abdomen. "What's a phlegmon?" I asked. "And how do you spell it?"

I'm sure ER doctors try to deliver bad news in language that's as sanitized as possible, especially when speaking with their patients on a gurney in a public hallway, rather than in a private room. I had only just met my doctor under the awkward social occasion of emergency treatment, so it's understandable she was still being polite. "It's an infectious mass," she explained.

The next doctor I spoke to, representing the Internal Medicine team, was a little more descriptive. "It's a big ball of infectious matter," she said.

The representative from the General Surgery team was a little more forthcoming. "It's a collection of pus."

The second morning, I was visited by the rest of the Surgical team, led by Dr. C.

As he explained my condition and listened to my questions, Dr. C. sat down in the chair beside my bed, pulled aside the coverlet, and, with his ball-point pen, drew a detailed diagram of my innards on the bedsheet.

The darkly cross-hatched mass at the center represents the location where the infection set in, forming a phlegmon.

Phlegmon is a very generic term - referring to a mass of infection no matter where it occurs. But one can imagine if the inflammation occurs in one's critical plumbing - your "blackwater" system, as it were - this is going to be pretty nasty, indeed.

Dr. C. used blunter language than the other doctors - the phlegmon, he said, was "a big ball of pus and fecal matter."

I have no doubt that as we become more acquainted, he will dispense with the euphemism and revert to the simple Anglo Saxon four-letter word in current common usage.

What are the possible outcomes of having a glob of really nasty infectious goo inside your gut?

One thing that can happen is peritonitis. The peritoneum is the lining of the abdomen. As with produce on a styro-tray in the grocery, the peritoneum shrink-wraps your organs to protect them from outside contamination and hold them in place.

If something bad happens inside the shrink-wrap, it can infect the whole package.

Since the era of modern surgery, there have been several notable deaths recorded from peritonitis, but the one that strikes me as rather poignant is that of the American writer Sherwood Anderson. who died in 1941 while on a cruise ship to South America. An autopsy revealed that he had swallowed a toothpick - from an olive in his martini - which perforated his colon, causing peritonitis.

What a way to go

Other famous people - Rudolph Valentino, Enrico Caruso, and Harry Houdini - died of peritonitis from complications of appendicitis.

Another bad thing that can happen is that the infection can spread beyond the area enclosed by the peritoneum, infecting another bodily system. Just like mold spreads from one orange in a bowl to another, the inflammation can spread to another organ.

What does the laundry service think of this?

The breach, or passage between the two areas is called a fistula. Infection in your bowels can contaminate the urinary tract, the reproductive organs, or even pass outside the body through the skin. Dr. C's drawing shows scarey passages reaching toward the bladder, the ascending colon, or the skin.

Sorry, are we grossed out enough yet?

But it's not really gross when you think about it. Phlegmon and fistulae are the defense mechanisms of our bodies. Pus is just a bunch of white blood cells dispatched like soldiers to the battlefield of infection. A fistula is just our body trying to move that junk outa there however it can.

The good news is that none of these bad things happened to me.

Like these heating ducts encased in insulation, a layer of membrane, blood supply and nerve cells encased the part of my gut where perforation occurred, containing the phlegmon and preventing its spread.

I was also lucky they caught it in time - no fistulae or abcess formed for me.

Now, I'm undergoing antibiotic treatment to reduce the infection. I have to follow a strict diet temporarily to avoid stressing out my system. Once the area is "cooled down" (as the surgeons say), they will perform a surgical procedure called a colectomy, which means cutting out the damaged part of the colon and re-attaching the good parts together.

Yes, I'm in for an education, and my vocabulary is going to expand - it will probably be pretty gross, too.

But I'm a fortunate person, really.

Phlegmon and Fistula are the complications of serious infection, and haunt every critically ill person. But some people are more vulnerable than others. If you google "fistula" the first thing you'll find is heartbreaking. The most common incidence of fistulae today is among third-world women who are victims of brutal rape or untreated complications of childbirth. What I'm going through is nothing compared to these victims.