Topic Explanation:

The discussion centers around experiences with small bowel fistulas and the procedure known as a fistulogram. The original poster, who is 3.5 months post-abdominoperineal resection (APR) with a permanent colostomy, is dealing with a fistula following a ruptured abdominal abscess. They express fear about the prospect of more surgery and seek advice and support from others who have had similar experiences.

Advice and Insights:

1. Fistulogram Procedure:
- The fistulogram is a straightforward procedure performed by an interventional radiologist using a fluorescent dye and a CT scanner. The dye is injected into the fistula to trace its path.
- The procedure is generally not painful and does not require sedation, although "waking sedation" might be used if necessary.
- The process is quick, taking about 10 minutes, with more time spent on preparation and waiting.

2. Managing Fistulas:
- Fistulas can be managed with drains to prevent fluid accumulation and reduce infection risk. Regular bloodwork is important to monitor for infections.
- Total parenteral nutrition (TPN) is used to provide bowel rest, allowing the fistula to heal by minimizing intestinal activity. Patients are advised to consume low-residue foods or avoid eating altogether if possible.

3. Surgical Considerations:
- Timing of surgery is crucial, and it is important to avoid operating when there is an active infection. Patience and thorough research are advised before proceeding with surgery.
- The decision to undergo surgery should be well-informed, considering the risks and benefits, and should not be rushed.

4. Emotional and Lifestyle Impact:
- Living with a fistula and its complications can significantly impact lifestyle and emotional well-being. Support from family and friends is crucial.
- The loss of previous lifestyle and independence can be challenging, and it is important to find ways to cope with these changes.

5. Support and Encouragement:
- Sharing experiences and providing emotional support can be beneficial. It is important to stay hopeful and trust in the decisions made regarding treatment.
- Encouragement and empathy from others who have faced similar challenges can provide comfort and strength.