Cases reported "Rectal Fistula"

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1/6. Postanal sinus: single or different etiologies?

    Experience with five patients who presented with a postanal sinus (PAS), all of which appeared to have a similar etiology at first hand, is reviewed. All patients were female and presented with a perianal fistula located in the midline posterior to the anus between the internal and external sphincter. All patients had a similar history and age at presentation (the 1st decade of life), which increased our assumption of a similar etiology. Further examinations revealed no internal connection to hollow organs or other pelvic structures, proving that the fistula was a sinus in all cases. One patient had a scimitar sacrum. In four cases the sinus was excised transanally, in one through a posterior sagittal approach. All patients had normal anal function postoperatively. Histologic examination was performed in all cases and showed results ranging from various types of epithelium to dermoid and epidermoid cysts, dismissing the theory of a similar etiology. In our opinion, a PAS can be a presenting sign for a variety of retrorectal developmental pathologies and should be differentiated from fistula-in-ano.
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keywords = sacrum
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2/6. Currarino syndrome: proposal of a diagnostic and therapeutic protocol.

    BACKGROUND/PURPOSE: The Currarino syndrome (CS) is a peculiar form of caudal regression syndrome (CRS) characterized by the association of hemisacrum, anorectal malformation (arm), and presacral mass. The authors analyzed retrospectively their series, and they propose a multidisciplinary diagnostic and therapuetic protocol that until now has not been introduced. methods: A series of 6 patients with CS is presented. Five of them were treated initially in other centers. None of them had an early diagnosis. All presented associated anomalies; in 50%, Hirschsprung's disease (HD) and other dysganglionoses were present. One patient died of a presacral ectopic nephroblastoma. RESULTS: Depending on the expressivity, 3 types of CS can be identified, complete, mild, and minimal. Dysganglionoses and HD can be considered part of CS. A multidisciplinary diagnostic and therapeutic protocol is presented. Main points are sacrum x-Ray, molecular genetic diagnosis, radiologic evaluation of every member of CS families, magnetic resonance (MR) evaluation of patient spine and pelvis, suction rectal biopsies, and search for associated anomalies. CONCLUSIONS: This protocol could give a valid contribution to the treatment of CS, allowing an early diagnosis and proposing a rational timing of multidisciplinary surgical procedures. early diagnosis and treatment are essential to avoid morbidity and mortality from an undiagnosed presacral mass.
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keywords = sacrum
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3/6. Total colonic aganglionosis.

    A rare complication after ileorectostomy for total aganglionosis of the colon is demonstrated. Eight years after the operation fistulae between rectum and sacrum appeared. Other cases from the literature are mentioned.
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4/6. Sacral hemangiomas and multiple congenital abnormalities.

    Five infants with sacral hemangiomas and a particular constellation of congenital abnormalities are described. Three of the five infants had an imperforate anus associated with a fistula. Three of the five had renal anomalies; four had bony abnormalities of the sacrum, and three of these also had a lipomeningomyelocele. Four had skin tags, three of which were in the genital and sacral areas. Two of the five also had abnormalities of the external genitalia. This constellation of defects associated with a sacral hemangioma has not been, to our knowledge, elaborated previously.
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5/6. Covered anus with anocutaneous fistula: the muscular sphincters.

    A rare specimen of a covered anus with anocutaneous fistula obtained from a newborn female baby was subjected to macroexamination and microexamination to determine the anatomy of the sphincters and the levatores musculature. The internal sphincter and the deep voluntary sphincters, albeit slightly modified, were well developed but the sphincters in the perineum were absent or rudimentary. The pelvic muscles were present even in the absence of the sacrum up to and including the second sacral vertebra.
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6/6. Anterior sacral meningocele. A presentation of three cases.

    Anterior sacral meningoceles are congenital lesions that consist of a spinal fluid-filled sac in the pelvis communicating by a small neck with the spinal subarachnoid space through a defect in the sacrum. The three patients with this disorder presented here had characteristic symptoms snd physical findings: chronic constipation, a pelvic mass, and almost unmistakable roentgenographic changes, but diagnosis was delayed from 11 months to 21 years in all three. After prolonged and complicated treatment, the primary lesions have been surgically eradicated and function is generally satisfactory.
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