11/101. Gracilis transposition in complicated perianal fistula and unhealed perineal wounds in Crohn's disease.OBJECTIVE: To assess the efficacy of transposition of gracilis muscle in the treatment of chronic recurrent fistulas and unhealed perineal wounds after proctectomy in patients with Crohn's disease. DESIGN: Retrospective study. SETTING: Academic clinic, united states. SUBJECTS: 7 patients with Crohn's disease: 3 had unhealed perineal wounds and persistent sinuses; 2 had had several attempts to repair rectovaginal fistulas; 1 had a rectourethral fistula; and 1 a pouch vaginal fistula. INTERVENTION: Transposition of the gracilis muscle. MAIN OUTCOME MEASURE: Healing. RESULTS: Mean follow up was 18 months (range 3-30). All patients operated on for unhealed perineal wounds had healed completely within 3-6 months. The patients with a rectovaginal fistula and a rectourethral fistula had both healed by 1 month postoperatively. Two fistulas recurred, and the small pouch-vaginal fistula remained but was asymptomatic. CONCLUSIONS: Transposition of the gracilis is a viable option for the treatment of persistent sinus and unhealed perineal wound after proctectomy for Crohn's disease. It could also be an option before proctectomy for patients with other types of Crohn's-related or complicated fistulas for whom other treatments have failed. A larger series will be required before a definite conclusion can be drawn.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
12/101. Demonstration of a recto-vaginal fistula with the ultrasound contrast medium Echovist.The demonstration of a recto-vaginal fistula in a patient with Crohn's disease is described. The patient was examined by vaginal ultrasound using the contrast medium Echovist-200 (SHU 454, Schering AG, berlin). This agent had not been used before under these circumstances and proved to be successful.- - - - - - - - - - ranking = 0.38461538461538keywords = fistula (Clic here for more details about this article) |
13/101. 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.- - - - - - - - - - ranking = 0.38461538461538keywords = fistula (Clic here for more details about this article) |
14/101. Delayed presentation of a congenital recto-vaginal fistula associated with a recto-sigmoid tubular duplication and spinal cord and vertebral anomalies.Tubular duplication of the recto-sigmoid colon is a rare entity. Associated anomalies including fistulae to the genitourinary tract may be found. A baby girl was found to have duplication of the recto-sigmoid colon, anomalies of sacral vertebra from S1 to S5, and solitary right kidney. The septum of this duplication was divided using staplers. Because of a history of stool coming from the vagina, a meticulous examination perioperatively was performed, but no fistula could be found. Further extensive investigation failed to show any fistula. At the age of 10 she was operated on for a tethered cord. At age 14, she experienced passage of a small amount of liquid stool per vaginum. A recto-vaginal fistula was found. Via a posterior sagittal incision, the fistula was closed by a transrectal approach. She remained asymptomatic for 16 months until the fistula recurred. Using a perineal approach, a very short fistula between the vagina and the rectum was closed. The closure was reinforced by a vaginal flap. Four months later, she remains without signs of recurrence.- - - - - - - - - - ranking = 0.8461596718942keywords = fistula, urinary (Clic here for more details about this article) |
15/101. Fistula-in-ano after episiotomy.BACKGROUND: In the past 2 years, we treated three women with fourth-degree lacerations or episiotomy infections presenting with persistent pain and drainage not responding to standard treatment. CASES: These women were referred for evaluation 5 weeks, 3.5 months, and 2 years postpartum. After diagnosing fistula-in-ano, we treated them with fistulotomy and curettage, which resolved the problem. CONCLUSION: When a patient presents with pain or drainage at her episiotomy site, fistula-in-ano should be considered.- - - - - - - - - - ranking = 0.15384615384615keywords = fistula (Clic here for more details about this article) |
16/101. Complex obstetric fistulae--two case reports.Two cases of complex obstetric fistulae are reported. Poor assessment and mismanagement of labour were revealed. The resulting fistulae were vesico-urethro-rectovaginal and vesico-cervico-vaginal. Plastic repair using a modified Martius graft was used in case 1. Considering the young age of the patient, transplantation of the ureters into the rectum or colon was deemed undesirable. The patient's endurance over a period of ten years, with seventeen attempts at repair ultimately was rewarded by achieving both vesical and rectal continence. Repair using the transvaginal route was successful at the first attempt in case 2.- - - - - - - - - - ranking = 0.46153846153846keywords = fistula (Clic here for more details about this article) |
17/101. Surgical treatment of the radiation injured bowel.Over the last 10 years, 9 patients treated by surgical procedure for radiation injuries of the bowel were studied with the following conclusions: The damage to the small intestine caused by external irradiation leads to adhesion of the bowel, perforation and postoperative anastomotic dehiscence if the irradiated bowel is used in the anastomosis. Surgical treatment for the small intestine is resection of the damaged loop. In order to determine the extent of the resection it is important that during the operation fibrosis and obstruction of vessels in the submucosa and subserosa is examined by biopsy. On the other hand, rectal ulcer and/or rectovaginal fistula is chiefly caused by intracavitary application plus external irradiation. For these lesion Hartmann operation or colostomy is performed, and the postoperative course is uneventful.- - - - - - - - - - ranking = 0.076923076923077keywords = fistula (Clic here for more details about this article) |
18/101. Complete vaginal prolapse: an unusual presentation of anovestibular fistula.An adolescent girl with an anovestibular fistula presenting as a complete vaginal prolapse and large-bowel obstruction is reported. The prolapse was reduced manually after repeated bowel washouts and a divided high sigmoid colostomy. The patient is awaiting posterior sagittal anorectoplasty. Possible etiopathologic factors of the prolapse are discussed. A vaginal prolapse in a patient with an anorectal malformation has not been reported previously in the English literature.- - - - - - - - - - ranking = 0.38461538461538keywords = fistula (Clic here for more details about this article) |
19/101. 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 = 0.46153846153846keywords = fistula (Clic here for more details about this article) |
20/101. Spontaneous rectovaginal fistula and repair using bulbocavernosus muscle flap.Spontaneous fistula between anorectum and vagina is extremely uncommon. Successful repair depends on etiology, location and the expertise of the surgeon. We report two cases of spontaneous stercoral perforation resulting in rectovaginal fistula (RVF). Both occurred in bedridden patients with fecal impaction. One patient was successfully repaired with a bulbocavernosus (BC) flap interposition. Flap interposition prevents vaginal stenosis in repair of multiple RVF.- - - - - - - - - - ranking = 0.46153846153846keywords = fistula (Clic here for more details about this article) |
| <- Previous || Next -> |