Cases reported "Rectovaginal Fistula"

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1/5. Erosion of an intraperitoneal chemotherapy catheter resulting in an enterovaginal fistula.

    BACKGROUND: With the pharmacokinetic advantages of intraperitoneal chemotherapy delivery and the increased popularity of immunotherapy and gene therapy, intraperitoneal catheters have moved to the forefront as a delivery system in cancer treatment. This delivery system, however, carries with it an intrinsic morbidity warranting attention in the often prolonged chemotherapy regimens demanded by cancer patients. CASE: In reviewing the literature of intraperitoneal catheter complications, there is no other cited case of a peritoneal catheter erosion into intestine presenting as an enterovaginal fistula. Our patient, diagnosed with persistent ovarian carcinoma, had a peritoneal Tenckoff catheter placed for chemotherapy. Many months after termination of the chemotherapy and 15 months after placement, she presented with bowel contents per vagina. A CT scan revealed an abdominopelvic abscess encompassing the detached catheter which embedded in the rectosigmoid colon, allowing direct communication to the upper vagina. The catheter was removed and the abscess was drained. CONCLUSION: Intraperitoneal catheters have a morbidity that persists after nonuse. Therefore, intraperitoneal catheters should be removed if they are not being used.
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2/5. 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.
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3/5. 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.
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4/5. Laparoscopic repair of high rectovaginal fistula: is it technically feasible?

    BACKGROUND: rectovaginal fistula (RVF) is an epithelium-lined communication between the rectum and vagina. Most RVFs are acquired, the most common cause being obstetric trauma. Most of the high RVFs are repaired by conventional open surgery. Laparoscopic repair of RVF is rare and so far only one report is available in the literature. methods: We present a case of high RVF repaired by laparoscopy. 56-year-old female who had a high RVF following laparoscopic assisted vaginal hysterectomy was successfully operated laparoscopically. Here we describe the operative technique and briefly review the literature. RESULTS: The postoperative period of the patient was uneventful and after a follow up of 6 months no recurrence was found. CONCLUSION: Laparoscopic repair of high RVF is feasible in selected patients but would require proper identification of tissue planes and good laparoscopic suturing technique.
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5/5. Tubular colonic duplication--review of 1876-1981 literature.

    Four cases of tubular colonic duplication are reported and 53 more are reviewed from 1876-1981 literature. Eighty percent of these patients had other anomalies, most notably genital and bladder duplications. Females outnumbered the males 37 to 20. Fifty per cent of patients of either sex had some form of fistulous communication. In no one was the anomaly incompatible with life. Based on the anatomy of distal ends of duplicated colon, the patients are divided in five groups, for each of which the incidence and nature of concomitant anomalies are tabulated. Because of their anatomic complexity, most patients with colonic duplication require clinical evaluation by multiple subspecialists. We have also suggested the sequence and extent to which they should be evaluated by radiologists.
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