1/18. Rectal duplication.Duplications of the alimentary tract are of a great rarity, particularly so in the rectum. Because of its rarity, the difficulty of making a correct diagnosis and of selection of proper approach for treatment, this entity bears a special significance. The present case report deals with a female newborn who presented with imperforate anus and a rectovestibular fistula and a mass prolapsing at the introitus. Complete excision of the mass was carried out through the perineal approach and the child then underwent, a PSARP for the correction of the rectal anomaly. histology confirmed the mass to be a rectal duplication.- - - - - - - - - - ranking = 1keywords = anus (Clic here for more details about this article) |
2/18. A rare anorectal malformation: a very large H-type fistula.A very large H-type rectovaginal fistula was observed in a 9-year-old girl. The diameter of the abnormal opening was about 15 mm. The fistulous tract originated from the stenotic segment 1 cm above the pectinate line of the anus and was connected to the back wall of the vagina. The patient underwent posterior sagittal transrectal surgery with a protecting colostomy. At present, she has good bowel function and sphincter control without recurrence of the fistula.- - - - - - - - - - ranking = 1keywords = anus (Clic here for more details about this article) |
3/18. Two orifices in the perineum of a girl with imperforate anus: possibility of uterovaginal agenesis associated with rectovestibular fistula.The authors describe 4 cases of rectovestibular fistula associated with uterovaginal atresia. The diagnosis of the associated uterovaginal atresia was missed in the neonatal period in all 4. It was diagnosed in 2 cases at puberty while investigating for amenorrhea; the other 2 were discovered during the repair of anorectal malformation in early childhood. A variety of techniques were used successfully for vaginal reconstruction. The authors believe that the incidence of such an association is very similar to that of imperforate anus with rectovaginal fistula and therefore suggest that if there are 2 orifices in the perineum of a girl with imperforate anus, it could be either a rectovaginal fistula or a rectovestibular fistula with uterovaginal agenesis. They recommend that all such neonates have an endoscopy or a magnetic resonance imaging done to distinguish between the 2 conditions. This distinction is of importance because the latter would require a concomitant vaginal reconstruction procedure along with anorectoplasty.- - - - - - - - - - ranking = 6keywords = anus (Clic here for more details about this article) |
4/18. MURCS association and rectovestibular fistula: case report of a patient treated with one-stage posterior sagittal anorectoplasty and sigmoid loop vaginoplasty.MURCS association is rare, first described by Duncan in 1979, including nonrandom association of Mullerian duct aplasia or hypoplasia (MU), renal agenesis or ectopy (R), and cervicothoracic somite dysplasia. A 5-year-old girl was admitted to the clinic with a complaint of anteriorly located anus. Physical and radiologic examination of the patient found MURCS association with anorectal malformation (arm) of rectovestibular-type fistula. She had multiple vertebral anomalies, left renal agenesis, vaginal and uterine agenesia, with a normal female 46,XX karyotype. Posterior sagittal anorectoplasty (PSARP) and sigmoid loop vaginal reconstruction was performed as a one-stage operation for the treatment of vaginal agenesis and arm. There were no complications in the postoperative period. This combined one-stage operation can be used easily in the treatment of some components of the MURCS association such as vaginal agenesis and arm as an associated anomaly.- - - - - - - - - - ranking = 1keywords = anus (Clic here for more details about this article) |
5/18. Congenital H-type anovestibuler fistula.The congenital H-type fistula between the anorectum and genital tract besides a normal anus is a rare entity in the spectrum of anorectal anomalies. We described a girl with an anovestibuler H-type fistula and left vulvar abscess. A 40-day-old girl presented symptoms after her parents noted the presence of stool at the vestibulum. On the physical examination, anus was in normal location and size, and had normal sphincter tone. A vestibuler opening was seen in the midline just below of the hymen. A fistulous communication was found between the vestibuler opening and the anus, just above the dentate line. There was a vulvar abscess which had a left lateral vulvar drainage opening 15 mm left lateral to the perineum. After the management of local inflammation and abscess, the patient was operated for primary repair of the fistula. A protective colostomy wasn't performed prior the operation. A profuse diarrhea started after 5 hours of postoperation. After the diarrhea, a recurrent fistula was occurred on the second postoperative day. A divided sigmoid colostomy was performed. 2 months later, and anterior sagital anorectoplasty was reconstructed and colostomy was closed 1 month later. Various surgical techniques with or without protective colostomy have been described for double termination repair. But there is no consensus regarding surgical management of double termination.- - - - - - - - - - ranking = 3keywords = anus (Clic here for more details about this article) |
6/18. Perineal canal: an uncommon entity with good prognosis.This article reports two patients with perineal canal (anovestibular fistula) who were treated at Dept. of Pediatric Surgery, LTMG Hospital, Mumbai. Both the patients had normal anus and a fistula between the anal canal and the vestibule. They were treated by vestibulo anal pull through procedure. The pathogenesis of this condition and the pertinent literature is reviewed.- - - - - - - - - - ranking = 1keywords = anus (Clic here for more details about this article) |
7/18. Endorectal pull-through with posterior sagittal approach to the repair of postoperative rectourethral and rectovaginal fistula.BACKGROUND/PURPOSE: Rectourethral (RUF) or rectovaginal fistula (RVF) is a troublesome complication after anorectal surgery because of dense adhesions around the fistula. The authors applied a new technique for the redo surgery. methods: Case 1 is Hirschsprung's disease in a 1-year-old boy who underwent modified Duhamel's procedure and had RUF. Case 2 is rectovestibular fistula in an 11-year-old girl who had anterior sagittal anorectoplasty complicated by RVF. Case 3 is multiple urogenital anomalies including rectovesical fistula in a 4-year-old boy in whom transvesical repair was unsuccessful. The colon was mobilized as far as possible at laparotomy. The rectum was opened via a posterior sagittal approach leaving 1 cm of the anal canal. Extended endorectal mucosectomy was performed to the dentate line, and the fistula was closed from inside of the rectum. The remaining mucosal cuff was everted out of the anus and the intact colon was pulled through the rectum and anastomosed to the cuff extraanally. RESULTS: The postoperative contrast enema showed no recurrent fistula, and defecation was not impaired. CONCLUSIONS: Endorectal pull-through of the intact colon can spare troublesome mobilization of the fistula and can prevent the recurrence of fistula. Rectal incision via a posterior sagittal approach provides a direct view of the fistula.- - - - - - - - - - ranking = 1keywords = anus (Clic here for more details about this article) |
8/18. Mucinous adenocarcinoma arising in rectovaginal fistulas associated with Crohn's disease.BACKGROUND: Crohn's disease is a chronic inflammatory disorder characterized by focal, transmural inflammation of the intestine. Gynecologic involvement, including rectovaginal fistula formation, is frequent. Case #1. A 53-year-old female with a 30-year history of Crohn's disease and numerous perirectal fistulas developed a foul smelling, purulent drainage from her rectum and a mucopurulent, bloody discharge from her vagina. A lower vaginal lesion biopsy demonstrated a low-grade mucinous adenocarcinoma. Case #2. A 42-year-old female with a 15-year history of Crohn's disease developed drainage from her vagina. physical examination revealed an enlarging mass involving the posterior wall of the vaginal vault that connected to the anus by a fistula tract. A biopsy revealed mucinous adenocarcinoma. CONCLUSIONS: Malignant transformation of persistent rectovaginal fistulas is a potential complication of Crohn's disease.- - - - - - - - - - ranking = 1keywords = anus (Clic here for more details about this article) |
9/18. Urogenital sinus, rectovaginal fistula, and an anterior stenosed anus--another cloacal variant.The persistent cloaca is one of the most complex and challenging developmental malformations. It is a rare anomaly occurring only in the female newborn and is represented by the association of urogenital sinus with an anorectal malformation (arm). Each case is probably unique. We report here one such case of cloaca with the VATER association-tracheoesophageal fistula (TOF) with a urogenital sinus, rectovaginal fistula, and an anteposed stenosed anus, along with preaxial syndactyly of the right hand. The spine, renal, and cardiac systems were normal. Interim management was directed towards repair of the TOF and a right transverse defunctioning colostomy. Despite thorough radioendoscopic preoperative investigations, the complexity of the cloacal anomaly was not delineated until surgery. This case is a rather rare combination of an intermediate form of the cloacal-arm spectrum. Such patients present with many diagnostic and therapeutic problems. Interval surgery should be directed towards decompression of the affected organ systems, and definitive surgery must be carefully planned and, whenever possible, done in a single stage with simultaneous multisystem repair to correct all significant malformations related to the cloacal complex.- - - - - - - - - - ranking = 5keywords = anus (Clic here for more details about this article) |
10/18. Anorectal-vestibular fistula without an imperforate anus in female infants: report of three cases.An anorectal-vestibular fistula without an imperforate anus in female infants is a rare clinical condition. This report is based on a series of 3 female infants who had fistulous communication between the bowel and the vestibule coexisting with a normal anus. Redness of the external genitalia over the labia major was the initial symptom in all 3 cases, and a suppurative discharge of pus mixed with stools was also found at the orifice of the fistula. Based on our experience, initial surgery with a double-barrel colostomy followed by a sequential fistulectomy might be safe and curative. We also review the related literature for the pathogenesis.- - - - - - - - - - ranking = 6keywords = anus (Clic here for more details about this article) |
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