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Drumond DG, Condé CDMS, Chebli JMDF, Chebli LA, Esperança SD, Speck NMDG. Combined clinical and radiological remission of rectovaginal fistulas using fractional CO2 vaginal laser: a case series and medium-term follow-up. BMC Res Notes 2023; 16:371. [PMID: 38115124 PMCID: PMC10729484 DOI: 10.1186/s13104-023-06666-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Despite the advances in surgical and clinical approaches, there is no consensus regarding the best line of treatment from rectovaginal fistula (RVF). Faced with a challenging scenario in the approach of RVF, the fractional CO2 laser receives attention as a possible form of treatment. OBJECTIVES A single-center, prospective, open-label study evaluating the effectiveness and safety of laser therapy for RVF treatment. SUBJECTS AND METHODS The total of 15 patients was recruited at the Juiz de Fora University Hospital between August 2018 and July 2022. Inclusion criteria were presence of clinically suspects RVF of any etiology confirmed by pelvic magnetic resonance image (MRI) and gynecological examination. Five fractional CO2 laser sessions with monthly interval followed by complete evaluation through clinical examination and pelvic MRI were performed for all patients after the completion of treatment. Analysis of sexual function before and after the treatment was performed using Female Sexual Quotient (FSQ). RESULTS The evaluation through physical examination showed no persistent inflammatory signs in the vagina for all patients. Additionally, 10 of out 15 (67.7%) patients achieved clinical remission of RVF symptoms, while 33.3% patients reported significant improvement. Of note, five patients who did not have previous sexual activity returned to regular sexual activity while seven patients who have baseline sexual activity had improvement in their sexual function as assessed by the FSQ. Three out of four ostomized patients had their ostomy reversed and remained without complains. All six patients with RVF secondary to Crohn's disease reported a marked improvement in symptoms and sexual function. In seven (47%) patients radiological remission was confirmed by pelvic MRI. CONCLUSION CO2 fractional laser can be considered a promising and safe therapeutic alternative for the management of RVF.
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Affiliation(s)
- Denise Gasparetti Drumond
- Department of Surgery, Faculty of Medicine, Universidade Federal de Juiz de Fora, Rua Doutor Waldyr Lorentz, 11, Juiz de Fora, MG, CEP: 36.037-752, Brazil.
| | | | - Júlio Maria da Fonseca Chebli
- Department of Medicine, Faculty of Medicine, Inflammatory Bowel Disease Center, Universitary Hospital, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Liliana Andrade Chebli
- Department of Medicine, Faculty of Medicine, Inflammatory Bowel Disease Center, Universitary Hospital, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
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Lau AWK, Parker C, Van Den Bosch R. Image of rectovaginal fistula caused by a rare complication of ring pessary. ANZ J Surg 2023; 93:738-739. [PMID: 35895007 DOI: 10.1111/ans.17950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Anthony W K Lau
- Department of General Surgery, South Canterbury, Te Whatu Ora-Health New Zealand, Timaru, New Zealand
| | - Catherine Parker
- Department of Obstetrics and Gynaecology, South Canterbury, Te Whatu Ora-Health New Zealand, Timaru, New Zealand
| | - Rene Van Den Bosch
- Department of General Surgery, South Canterbury, Te Whatu Ora-Health New Zealand, Timaru, New Zealand
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Giuliani A, Romanzi F, Di Sibio A, Calvisi G, Lombardi L, Marchese M, Di Staso M, Schietroma M, Carlei F, Romano L. Hypovolemic shock after pelvic radiotherapy. A rare combination leading to a devastating complication. Ann Ital Chir 2019; 8:S2239253X19030822. [PMID: 31310243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Radiotherapy currently plays a key role in pelvic malignancies' management. Excellent outcomes have been reported on its association with chemotherapy for the treatment of the anal carcinoma. Despite that, the combined use of chemo- and radiotherapy and the high doses administered seem to be strongly associated with early and late onset side effects. METHODS We reported a case of a 72 years old woman, affected by anal squamous cell carcinoma. She underwent chemotherapy, and then radiotherapy, with good results. RESULTS During a regular MR control, the patient developed anaphylactic reaction to Gadolinium, and after that a rectosigmoid ischemia with total necrosis of the posterior rectal wall was diagnosed and surgically treated with Hartmann procedure. CONCLUSION In our case we faced with the rapid and severe degeneration of pelvic anatomy determined by the sum of vascular alterations following hypovolemic shock and pelvic tissues alteration after radiotherapy. It seems essential not to underestimate the exponential outcome of a similar unusual combination of events. KEY WORDS Anal carcinoma, Hypovolemic shock, Pelvic radiotherapy, Rectal necrosis.
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Parlakgumus A, Ezer A. LIFT Techniue for Simple Rectovaginal Fistula. J Coll Physicians Surg Pak 2017; 27:791-792. [PMID: 29185412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/29/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Alper Parlakgumus
- Department of General Surgery, Baskent University School of Medicine, Adana Teaching and Research Center, Adana, Turkey
| | - Ali Ezer
- Department of General Surgery, Baskent University School of Medicine, Adana Teaching and Research Center, Adana, Turkey
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Christopher A. The Deleterious Effects of a Vaginal Pessary in a Patient with a History of Radiation Therapy to the Posterior Vaginal Wall. Am Surg 2017; 83:e224-e225. [PMID: 28738918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Chidlovskii E, Deroux A, Bernard S, Couturier P. Cytomegalovirus colitis mimicking rectal carcinoma in an immunocompetent elderly woman. BMJ Case Rep 2016; 2016:bcr-2016-214694. [PMID: 27166009 PMCID: PMC4885349 DOI: 10.1136/bcr-2016-214694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cytomegalovirus (CMV) colitis is uncommon in immunocompetent patients, despite a high seroprevalence rate of CMV in the general population. CMV infection has been described in individuals with compromised immune systems: in AIDS, under corticosteroid and immune modulating treatment, with cancer or haematological malignancies. Its most frequent clinical presentation is a necrotising ulcerative form; pseudotumoural CMV colitis has been described as highly exceptional. We report a case of CMV colitis mimicking rectal carcinoma in an immunocompetent elderly woman. The immunosenescence and protein-energy malnutrition increase incidence and severity of infectious diseases in elderly individuals. Immunosenescence may affect all aspects of immunity; severe protein malnutrition modifies mostly cellular immunity, growing susceptibility to infections.
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Affiliation(s)
- Elena Chidlovskii
- University Hospital Grenoble Alpes, University Clinic of Geriatric Medicine, Grenoble, France
| | - Alban Deroux
- University Hospital Grenoble Alpes, University Clinic of Geriatric Medicine, Grenoble, France
| | - Sylvain Bernard
- University Hospital Grenoble Alpes, University Clinic of Geriatric Medicine, Grenoble, France
| | - Pascal Couturier
- University Hospital Grenoble Alpes, University Clinic of Geriatric Medicine, Grenoble, France
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Maconi G, Ardizzone S, Greco S, Radice E, Bezzio C, Bianchi Porro G. Transperineal ultrasound in the detection of perianal and rectovaginal fistulae in Crohn's disease. Am J Gastroenterol 2007; 102:2214-9. [PMID: 17680844 DOI: 10.1111/j.1572-0241.2007.01441.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Perianal and rectovaginal fistulae are common complications in Crohn's disease. Magnetic resonance imaging (MRI) and endoanal ultrasound are used for imaging perianal fistulae and abscesses, but both methods require expensive equipment and experienced investigators. Transperineal ultrasound may represent another method of detecting perianal complications in Crohn's disease. We investigated Crohn's disease perianal and rectovaginal fistulae using transperineal ultrasound and compared the findings with results of endoanal ultrasound as reference standard. METHODS A total of 46 patients with Crohn's disease and perianal and/or rectovaginal or anovulvar fistulae underwent, transperineal and endoanal ultrasound, on the same day. Transperineal ultrasound was performed using regular convex and high-resolution linear probes. Endoanal ultrasound was performed using an ultrasound system with a 7 MHz rotating endoanal probe. Fistulae were classified according to Parks' classification in intrasphincteric, transsphincteric, suprasphincteric, and extrasphincteric. Rectovaginal or anovulvar fistulae were described separately. Presence of abscesses was also reported. RESULTS Fifty-two fistulae (3 intra-sphincteric, 28 transsphincteric, 8 suprasphincteric, 2 extrasphincteric, 9 rectovaginal, and 2 anovulvar) were detected by transperineal ultrasound. Endoanal ultrasound confirmed the correct classification of 45 fistulae (predictive positive value: 86.5%). Of the 53 fistulae detected by endoanal ultrasound, 45 were correctly classified by transperineal ultrasound (sensitivity 84.9%). Transperineal ultrasound showed 10 perianal abscesses: 2 horseshoe, 4 deep, and 4 superficial. Endoanal ultrasound confirmed all horseshoe, 3 deep, and 2 superficial abscesses and did not find further abscesses. CONCLUSIONS Transperineal ultrasound is a simple, painless, real-time method to detect and classify perianal and rectovaginal fistulae and/or abscesses in Crohn's disease.
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Affiliation(s)
- Giovanni Maconi
- Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, University of Milan, Italy
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Abstract
The congenital H-type fistula between the anorectum and the urogenital tract without anal atresia is an extremely rare entity in the spectrum of anorectal anomalies. We report about two young girls, who had a congenital fistula between the left labium/vulva and the anus (=H-type fistula). After the management of the local infection and the abscess, the two patients underwent an anterior sagittal anorectovaginoplasty (ASARVP). Up to now there was no relapse of the fistula or the abscess in both cases. Thus ASARVP can be used as a simple method for congenital H-type fistulas with excellent functional and anatomical results.
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Affiliation(s)
- T Meyer
- Abteilung für Kinderchirurgie, Chirurgische Universitätsklinik und Poliklinik, Zentrum Operative Medizin, Bayerische Julius-Maximilians-Universität, Würzburg.
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Leonhardt H, Liedman B, Wingren U, Lönn L. [Endovascular treatment in massive uncontrolled intestinal hemorrhage. Stabilization with aortic balloon allows time for angiographic survey]. Lakartidningen 2005; 102:1326-7, 1329-30. [PMID: 15921109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Henrik Leonhardt
- Röntgenavdelningen, Sahlgrenska Universitetssjukhuset, Göteborg.
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10
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Abstract
BACKGROUND AND PURPOSE Urinary-tract fistulas present unique clinical challenges that often necessitate open surgical excision with interposition of healthy tissue. Advances in retrograde instrumentation have enabled endourologists to employ more minimally invasive approaches to urologic disease, including fistulas. We reviewed our experience with endoscopic injection of fibrin glue for the treatment of urinary-tract pathology. PATIENTS AND METHODS We performed a retrospective review of the eight patients at our institution who have undergone retrograde endoscopic injection of fibrin glue for the treatment of urinary-tract pathology. The data collected included age, presentation, treatment technique, method/duration of follow-up, complications, and success, which was defined as subjective and objective resolution of the treated pathology. RESULTS One of these patients was treated for a caliceal diverticulum refractory to percutaneous ablation. The other seven patients were treated for fistulas, including one colovesical fistula, two vesicovaginal fistulas, one ileal conduit-cutaneous fistula, one ureterocutaneous fistula, one urethrocutaneous fistula, and one ureterorectal fistula. All lesions except the urethrocutaneous fistula and the ureterorectal fistula were treated with a single injection of fibrin glue. At a mean follow-up of 11.75 months, this technique was successful in six cases (75%). Two (33%) of the successfully treated patients required two injections. There were no complications. Failures were apparent at initial follow-up. CONCLUSION Retrograde endoscopic injection of fibrin glue offers a novel approach to ablation of caliceal diverticula. Additionally, although open surgical excision of urinary-tract fistulae remains the gold standard treatment, endoscopic injection of fibrin glue offers a safe, minimally invasive approach that may avoid the morbidity of open surgery in such challenging patients.
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Affiliation(s)
- Sameer K Sharma
- Department of Urology, Loyola University, 2160 S. First Avenue, Maywood, IL 60153, USA
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Ueno Y, Tanaka S, Shimamoto M, Miyanaka Y, Hiyama T, Ito M, Kitadai Y, Yoshihara M, Sumii M, Chayama K. Infliximab therapy for Crohn's disease in a patient with chronic hepatitis B. Dig Dis Sci 2005; 50:163-6. [PMID: 15712655 DOI: 10.1007/s10620-005-1295-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Yoshitaka Ueno
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
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12
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Abstract
BACKGROUND Management of perianal and rectovaginal fistulae complicating Crohn's disease (CD) is unsatisfactory. Infliximab is effective in the treatment of fistulating CD. However, reopening of fistulae is frequent, suggesting the persistence of deep fistula tracts despite superficial healing. In this study, the clinical and endosonographic behavior of perianal fistulae were evaluated following infliximab infusions, as well as the role of anal endosonography (AE) in predicting their outcome. METHODS Thirty CD patients presenting with perianal and/or rectovaginal fistulae received an infusion of infliximab at a dose of 5 mg/kg at weeks 0 (entry into the study), 2, and 6. Laboratory and clinical assessments were repeated at same intervals and at week 10. AE was performed at entry and at week 10. Thereafter, the perianal region was re-examined every 6 months, and patients were investigated regarding draining of the fistula in the previous months. RESULTS Fifteen patients (53.6%) showed closure of the fistulae at week 10, but only 5 patients had the fistula tracts disappeared at AE. Clinical and AE closure of rectovaginal fistulae was less prevalent than that of perianal fistulae [14.3% versus 63.6% at week 6 (p = 0.035); 28.6% versus 59.1% at week 10 (p = 0.21); 14.3% versus 22.7% at AE (p = 1.00)]. The behavior of fistulae was not affected by their number and AE classification, presence of rectal disease, or setons. Twenty patients with perianal fistulae were followed for a median of 15.5 months. Patients with closed perianal fistulae at week 10 and disappearance of fistulae tract at AE showed a lower relapse rate than those with endosonographic persistence of fistula tract. CONCLUSIONS Infliximab can heal perianal and rectovaginal fistulae in approximately 60% and 30% of patients, respectively. Despite closure, most fistula tracts are still detectable at AE. Persistence of the internal tract is a condition at higher risk of fistula recurrence.
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Affiliation(s)
- Sandro Ardizzone
- Cattedra di Gastroenterologia, Azienda Ospedaliera - Polo Universitario "L. Sacco," Università degli Studi di Milano, Via G.B. Grassi, 74 20157 Milano, Italy
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13
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Abstract
OBJECTIVES Infliximab is an effective therapy for fistulizing Crohn's disease of the perineum. We sought to determine whether the clinical improvement after infliximab is associated with radiological closure of fistula tracts. METHODS Clinical responses and radiological imaging studies by transperineal ultrasound were evaluated in 35 patients with Crohn's disease perianal fistulas after treatment with infliximab 5 mg/kg up to 48 wk. Paired comparison of baseline and follow-up imaging studies at 8 wk and at 56 wk or discontinuation were assessed by an imaging score of perianal fistula severity, based on the Parks criteria. Complete clinical fistula closure and radiological healing were primary outcome measures. RESULTS At 8 wk, after two infusions of infliximab at 0 and 2 wk, clinical fistula closure occurred in 49% of patients. The radiological score at 8 wk was higher for patients with clinical fistula closure than for patients with no clinical improvement (p= 0.023) and two patients showed complete radiological healing. At 56 wk, clinical fistula closure occurred in 46% patients. Clinical fistula scores correlated with radiological scores (R2= 0.52; p < 0.001) but were not associated with fistula complexity, number of fistulas, or number of collections at baseline imaging. The proportion of patients with marked radiological improvement increased from 14% at 8 wk to 43% at 56 wks (p= 0.015) and complete radiological healing occurred in 4 (11%) patients. CONCLUSIONS For perianal fistulizing Crohn's disease, repeat dose infliximab improves clinical and radiological outcomes, although complete radiological healing occurs in a minority of patients.
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Affiliation(s)
- Imran Rasul
- Department of Medicine, Mount Sinai Hospital and Toronto General Hospital, University of Toronto, Toronto, Canada
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15
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Sánchez Martín R, Molina E, Cerdá J, Estellés C, Casillas MAG, Romero R, Vázquez J. [Treatment of vestibular fistulas in older girls]. Cir Pediatr 2002; 15:140-4. [PMID: 12601970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The vestibular fistula is the anorectal malformation more frequent in females. In this congenital anomaly the anus is located in the vaginal vestibule, having the rectum a common wall with the vagina. With the posterior sagittal approach described by Alberto Peña it changes the treatment of this anorectal malformation, contributing to the possibility of an aesthetic and functional improvement. From 1996 we have operated on 6 girls with ages included between 6 and 22 years (mean of 11 years) that presented a vestibular fistula. Five cases had been operated on in the neonatal period of vestibular fistula carrying out "cut-back", and a case had been operated on for cloaca syndrome. It was carried out in all of them, posterior sagittal approach disecting the rectum, separating it from the vagina and placing it in the sphincter. In a case a colostomy was carried out and in the other five were carried out intestinal cleaning, maintaining absolute diet and postoperative total parenteral nutrition. The evolution has been favorable in all the cases. the functionality of the neo-anus in terms of continence is absolutely normal, presenting an excellent aesthetic aspect. We believe that the posterior sagittal approach is suitable as surgical treatment of the vestibular fistula. The aesthetic improvement and the satisfaction of our patients motivates us to the realization of this technique that also allows us to correct in only one surgical act associated vaginal malformations.
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Affiliation(s)
- R Sánchez Martín
- Servicio de Cirugía Pediátrica, Hospital Infantil Gregorio Marañón, Madrid
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16
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Abstract
OBJECTIVE The exact location of anovaginal and rectovaginal fistulas cannot be determined by physical examination and conventional techniques. The objective of our study was to compare the accuracy of endoluminal sonography and endoluminal MR imaging in revealing the location of anovaginal and rectovaginal fistulas. MATERIALS AND METHODS Nineteen consecutive patients (age range, 28-56 years; median age, 39 years) with clinical indications of an anovaginal or rectovaginal fistula were included in our retrospective study. Endoluminal sonography was performed using a 7.5-MHz transducer. Endoluminal MR imaging was performed at 0.5 T for 10 patients and 1.5 T for nine patients; axial T2-weighted gradient-echo, coronal and sagittal T2-weighted turbo spin-echo (0.5 T), or axial and radial T2-weighted turbo spin-echo and axial T2-weighted fat saturated turbo spin-echo (1.5 T) images were obtained. For a variety of reasons, surgery of the fistula was not attempted in six of these 19 patients. The imaging findings were compared with the findings obtained during surgery in the remaining 13 patients. RESULTS In 12 of the 13 patients, the fistula was found during surgery: seven of the fistulas were anovaginal, and five were rectovaginal. Findings of endoluminal sonography were true-positive in 11 patients, true-negative in one, and false-negative in one. Findings of endoluminal MR imaging were true-positive in 11 patients, false-negative in one, and false-positive in one. Positive predictive value for endoluminal sonography and endoluminal MR imaging were 100% and 92%, respectively. Imaging findings for anal sphincter defects were comparable. CONCLUSION Endoluminal sonography and endoluminal MR imaging have comparable positive predictive values in revealing the location of anovaginal and rectovaginal fistulas.
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Affiliation(s)
- Jaap Stoker
- Department of Radiology, Academic Medical Center, University of Amsterdam, P. O. Box 22700, 1100 DE Amsterdam, The Netherlands
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Sudoł-Szopińska I, Jakubowski W, Szczepkowski M. Contrast-enhanced endosonography for the diagnosis of anal and anovaginal fistulas. J Clin Ultrasound 2002; 30:145-150. [PMID: 11948570 DOI: 10.1002/jcu.10042] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE We assessed whether contrast-enhanced anal endosonography (AES) with hydrogen peroxide improves the identification of anal fistulas and their internal openings compared with non-contrast AES. METHODS The study group comprised 12 patients who had various types of anal fistulas with visible external openings. AES was performed before and about 15 seconds after injection of 1 ml of 3% hydrogen peroxide into the fistula tract through the external opening. RESULTS Both contrast and non-contrast AES revealed 7 transsphincteric, 2 intersphincteric, 1 suprasphincteric, and 2 anovaginal fistulas. Simple tracts were found in 8 cases and complex tracts in 4 cases on non-contrast AES. Contrast-enhanced AES revealed 9 simple and 3 complex fistulas. One fistula that appeared complex on the non-contrast study appeared simple after contrast agent administration. Contrast-enhanced AES demonstrated more internal openings than non-contrast AES did. Surgery confirmed 11 of the fistulas; an internal opening could not be located surgically for the other tract. CONCLUSIONS Contrast-enhanced AES appears to be superior to non-contrast AES in the preoperative assessment of anal and anovaginal fistulas and in demonstrating and locating their internal openings.
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Imaging Diagnostics Department, II Medical Faculty, Medical Academy, Kondratowicza 8, 03-285 Warsaw, Poland
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Abstract
OBJECTIVE Perianal infection arises in small intersphincteric anal glands predominantly located at the dentate line. Documentation of fluid collections and the relationship of inflammatory tracts to the sphincter mechanism is important for surgical treatment. Transanal sonography for assessment of perianal inflammatory disease is limited because placement of the rigid probe into the anal canal does not allow assessment of disease in the perineal region. The purpose of this study was to validate the use of transperineal sonography in men and both transvaginal and transperineal sonography in women for evaluation of perianal inflammatory disease. SUBJECTS AND METHODS Fifty-four patients, 28 men and 26 women, were imaged with transperineal and a combination of transperineal and transvaginal sonography, respectively. All patients were examined in the supine lithotomy and left lateral position with a transvaginal 8-to 4-MHz probe or a linear 12- to 7-MHz transducer. All fluid collections, sinus tracts, and fistulas were described by their location in relation to the sphincter mechanism and perineum. RESULTS Forty-six of 54 patients had perianal fistulas or sinus tracts: 33 transphincteric, seven intersphincteric, and six extrasphincteric. Fifteen patients had an associated abscess. In the eight remaining patients, there were two anovaginal fistulas, one rectovaginal fistula, one prolapsed internal hemorrhoid, two perianal complex masses, and two vascular perianal or perirectal inflammatory masses. Twenty-six patients underwent surgical procedures involving the anorectal canal or perirectal region, and of these, preoperative sonographic findings were confirmed in 22 (85%) of 26 patients. Three patients refused surgery, and six are awaiting surgery at this writing. Fifteen patients were treated conservatively. CONCLUSION Transperineal and transvaginal sonography are accurate, painless, and cost-effective methods for documenting perianal fluid collections and fistulas or sinus tracts or both.
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Affiliation(s)
- L K Stewart
- Department of Medical Imaging, Toronto General Hospital-University Health Network, 200 Elizabeth St., Toronto, Ontario, Canada M5G 2C4
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Tikhonov A, Kuz'minov A, Poletov N, Minbaev S, Poliakova N. [X-ray study in the examination of patients with perineal fistulas]. Vestn Rentgenol Radiol 2001:43-7. [PMID: 11603329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The paper discusses whether X-ray study of patients with perineal fistulas is required and justified. The main reason is that there is a diversity of diseases which display the same signs as paraproctitis. Of 426 examinees, perineal fistulas were mainly caused by chronic paraproctitis in 85% and by other various diseases showing the similar symptoms in 15%. The basic studies of these patients included fistulography made in 300 patients with external fistulas and proctofistulography performed in 126 patients with incomplete internal fistulas. Comparing the data of X-ray study with those of clinical and morphological ones showed the sensitivity of the former to be 94.5%. Based on the results of their own observations, the authors defined indications for fistulography or proctofistulography. In addition to the analysis of the findings, they present the main points of differential X-ray diagnosis of different diseases manifested by perineal fistulas.
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Affiliation(s)
- A Tikhonov
- State Coloproctology Research Center, Ministry of Health of the Russian Federation
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20
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Abstract
Twenty-two patients with 24 fistulae were examined prospectively with real-time sonography. Sonographic findings were compared with those of intravenous urograms and correlated with the findings at examination under anesthesia and at surgery. Various genital abnormalities not revealed by intravenous urography were demonstrated by sonography preoperatively. These included cervical injuries, vesicovaginal fistula showing "flat tire" sign and hourglass deformities, and identification of the site, size, and course of fistulae in seven (29%) of the cases. However, the demonstration of the fistulae by sonography is poor relative to that of examination under anesthesia, in which 21 (87%) of the fistulae were identified. The factors responsible for the difficulty in demonstrating the fistulae on sonography, which included size and multiplicity, are discussed. Sonography is complementary to examination under anesthesia in preoperative evaluation of the patients with obstetric fistulae in general and in those with previous unsuccessful repairs in particular.
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Affiliation(s)
- V A Adetiloye
- Department of Radiology, College of Health Sciences, Obafemi Awolowo University Ile-Ife, Nigeria
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Abstract
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.
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Affiliation(s)
- W Henrich
- University Department of Obstetrics and Gynecology, Charité, Berlin, Germany
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Khanduja KS, Padmanabhan A, Kerner BA, Wise WE, Aguilar PS. Reconstruction of rectovaginal fistula with sphincter disruption by combining rectal mucosal advancement flap and anal sphincteroplasty. Dis Colon Rectum 1999; 42:1432-7. [PMID: 10566531 DOI: 10.1007/bf02235043] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study evaluated the effectiveness of combining advancement flap with sphincteroplasty in patients symptomatic with rectovaginal fistula and anal sphincter disruption. METHODS Twenty patients with rectovaginal fistulas and anal sphincter disruptions after vaginal deliveries underwent combined rectal mucosal advancement flap and anal sphincteroplasty between July 1986 and July 1993. The mean age of the patients was 30 (range, 18-40) years and the mean duration of symptoms was 54.8 weeks (range, 7 weeks to 6 years). In addition to mucosal advancement flap repair, 13 patients underwent two-layer repair of anal sphincters (with reapproximation of the puborectalis in 8 of the patients); 6 patients underwent one-layer overlap repair of anal sphincters (with reapproximation of the puborectalis in 2 of the patients); and 1 patient underwent reapproximation of internal anal sphincter alone because squeeze pressures were adequate, as determined by anal manometry. RESULTS Postoperatively, vaginal discharge of stool and flatus was eliminated entirely in all 20 patients. Perfect anal continence of stool and flatus was restored in 14 patients (70 percent). Incontinence was improved but not eliminated in six patients (4 incontinent to liquid stool and 2 to flatus), and two patients required perineal pads. Subjectively, 19 patients (95 percent) reported the result as excellent or good. There were no complications. CONCLUSION The combination of mucosal advancement flap and anal sphincteroplasty is a safe and highly effective procedure for correcting rectovaginal fistula with sphincter disruption after obstetrical injuries.
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Affiliation(s)
- K S Khanduja
- Division of Colon and Rectal Surgery, Mount Carmel Health System, Columbus, Ohio, USA
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23
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Poen AC, Felt-Bersma RJ, Cuesta MA, Meuwissen GM. Vaginal endosonography of the anal sphincter complex is important in the assessment of faecal incontinence and perianal sepsis. Br J Surg 1998; 85:359-63. [PMID: 9529493 DOI: 10.1046/j.1365-2168.1998.00616.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anal endosonography is an established technique in the evaluation of anorectal disease. However, it is sometimes difficult to visualize the anterior part of the sphincter complex and anal endosonography may be impossible when anal pain or stenosis is present. The aim of this study was to evaluate vaginal endosonography in the diagnosis of faecal incontinence and perianal sepsis. METHODS Anal and vaginal endosonography were performed in 56 women with faecal incontinence (n = 36) or perianal sepsis (n = 20). The technique and pelvic floor anatomy were described, anal sphincter measurements with anal and vaginal endosonography were compared, and the additive value of vaginal over anal endosonography in the diagnosis of faecal incontinence and perianal sepsis was assessed. RESULTS The pelvic floor was clearly imaged with vaginal endosonography. However, after a relatively short learning curve it was still not possible to image the anal sphincters in three of 28 patients. Except for external anal sphincter thickness, which was significantly lower, all anal canal structure measurements were greater with vaginal than with anal endosonography. Concerning the diagnosis of either faecal incontinence or perianal sepsis, vaginal endosonography added important information in comparison with anal endosonography in 14 (25 per cent) of 56 patients. CONCLUSION Vaginal endosonography provides reliable images of the anal sphincters in an undistorted fashion, thereby increasing the diagnostic yield of faecal incontinence and perianal sepsis in 25 per cent of patients. Therefore, endosonographists should become acquainted with this technique.
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Affiliation(s)
- A C Poen
- Department of Surgery, University Hospital 'Vrije Universiteit', Amsterdam, the Netherlands
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24
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Affiliation(s)
- A R Jeyarajah
- Department of Gynaecological Oncology, St. Bartholomew's Hospital, London, United Kingdom
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25
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Abstract
Recto-vaginal fistula is well known to occur in association with imperforate anus. We describe the case of an isolated "H-type" recto-vaginal fistula with no other anorectal abnormalities. The patient presented at 2 months of age with a vulval abscess and passing faeces per vaginum. Unilateral renal agenesis was also seen in this patient. We are unaware of any previous reports in the English-language literature of this isolated abnormality.
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Affiliation(s)
- D W White
- Department of Radiology, Alder Hey, Royal Liverpool Children's Trust, Eaton Road, Liverpool L12 2AP, UK
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26
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Abstract
PURPOSE To evaluate a device designed for occlusion of rectovaginal fistula in patients with acquired rectovaginal fistula. MATERIALS AND METHODS The device consisted of a disk portion, an anchoring portion, and a shaft that connected each portion. The device was framed with a nitinol wire. The disk portion was framed in a four-leaf clover configuration, and the anchoring portion had two ellipsoid arms. The disk and anchoring portions were mounted with a nylon patch and coated with silicone. The device was designed for transrectal insertion and was placed in seven women with rectovaginal fistula caused by pelvic irradiation or pelvic surgery. RESULTS All devices were placed successfully, and all fistulas were completely occluded after placement of the device. No procedural complications were encountered. The follow-up period was 1-26 months. One patient died of distant metastasis 5 months after placement of the device. None of the patients reported leakage from the rectovaginal fistula during the follow-up period. CONCLUSION The occlusion device may be promising and beneficial for use in occlusion of rectovaginal fistula that results from pelvic irradiation or pelvic surgery.
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Affiliation(s)
- B H Lee
- Department of Radiology, Korea Cancer Center Hospital, Nowon-gu, Seoul
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27
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Abstract
PURPOSE To evaluate transvaginal ultrasonography (US) as an alternative to transanal US for determining the anatomic cause of fetal incontinence in women. MATERIALS AND METHODS Transvaginal US of the anal canal was performed in 28 women (aged 27-74 years) with fecal incontinence. A side-fire endorectal probe was inserted into the vagina and directed toward the posterior vaginal wall. RESULTS The internal anal sphincter (IAS) and external anal sphincter muscles were imaged as independent bands in all 28 patients. The calculated mean thickness of the IAS in patients aged younger than 55 years was not significantly different from that in patients aged older than 55 years (P=.31). Posttraumatic anterior muscle disruptions were detected in 16 women; three also had rectovaginal fistulas. A rectal fistula with abscess was detected in one of 12 patients with intact muscles. All muscle disruptions, fistulas, and abscesses were surgically confirmed. CONCLUSION Transvaginal US enables determination of the anatomic cause of fecal incontinence, allowing the surgeon to select patients who would benefit form surgical repair.
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Affiliation(s)
- A A Alexander
- Division of Diagnostic Ultrasound, Department of Radiology, Thomas Jefferson University Hospital, Jefferson Medical College, Philadelphia, PA 19107, USA
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28
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Jung G, Krahe T, Brochhagen HG, Krüger K, Lackner K. [Value of computed tomography in the diagnosis of fistulas]. ROFO-FORTSCHR RONTG 1995; 163:480-3. [PMID: 8547617 DOI: 10.1055/s-2007-1016033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose of the study was to determine the value of computed tomography (CT) in demonstrating fistulae in comparison with conventional radiographic methods. METHODS In a prospective study 25 patients were evaluated by conventional radiographic methods and CT. RESULTS The identification of the fistulous tract was possible with CT in 27 of 29 cases, whereas 2 fistulae could only be detected by indirect signs. Furthermore, CT showed a larger extent of the fistulous tract in 5 patients and revealed complications such as inflammatory mass, abscess or osteomyelitis in 11 cases. CONCLUSION CT seems to be superior in demonstrating the extent of a fistulous tract and provides valuable information on the surrounding structures.
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Affiliation(s)
- G Jung
- Institut und Poliklinik für Radiologische Diagnostik, Universität zu Köln
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29
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Guzman ER, Ranzini A, Day-Salvatore D, Weinberger B, Spigland N, Vintzileos A. The prenatal ultrasonographic visualization of imperforate anus in monoamniotic twins. J Ultrasound Med 1995; 14:547-551. [PMID: 7563305 DOI: 10.7863/jum.1995.14.7.547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- E R Guzman
- Division of Maternal-Fetal Medicine, UMDNJ-Robert Wood Johnson Medical School, St. Peter's Medical Center, New Brunswick, New Jersey 08903-0591, USA
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30
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Pompili GG, Damiani G, Mariani P, Matacena G, Ardizzone S, Bianchi Porro G, Cornalba G. [Computerized tomography in the diagnosis of Crohn disease]. Radiol Med 1994; 88:44-8. [PMID: 8066254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Fifty patients affected with Crohn's disease were examined with CT in a 12-month period; 39 of them underwent an intestinal enema and 24 a colon enema. Our goal was to assess the comparative contribution of CT and conventional radiology to the diagnosis of this disease. CT proved to be the method of choice to diagnose wall diseases with colon or small bowel wall thickening, which is usually homogeneous as demonstrated in 94% of the patients, intraabdominal abscesses in 3 patients (6%), perianal (4%), enterocutaneous (2%) and enteromuscle (2%) fistulas. CT was comparable to barium studies for rectovaginal (2%) and enterocolic (4%) fistulas. Conventional radiology was better than CT to assess mucosal diseases and ileum-ileal fistulas which were demonstrated with small bowel enema in 4 patients and in one patient only with CT. Therefore, we believe CT to be a complementary method to barium studies and a necessary tool for the correct staging of this disease, especially relative to the diagnosis of extramural lesions.
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Affiliation(s)
- G G Pompili
- Reparto di Radiologia, Ospedale Luigi Sacco, Milano
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31
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Abstract
Currarino et al. in 1981 described an association between an anterior sacral defect, congenital anorectal stenosis or another type of low anorectal malformation and a presacral mass. We are only aware of one previous report in the English literature of the association of a rectovaginal fistula with this triad and to our knowledge the association has not been described in the radiological literature.
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Affiliation(s)
- I M Lang
- Department of Radiology, Booth Hall Children's Hospital, Manchester
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32
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Loran OB, Briskin BS, Zaĭtsev AV, Bunin VA. [The surgical treatment of patients with complex intestinal-urogenital fistulae]. Urol Nefrol (Mosk) 1994:41-45. [PMID: 8203073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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33
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Fadiran OA, Dare FO, Jeje EA, Nwosu SO, Oyero TO. Amoebic recto-vaginal fistula--a case report and review of literature. Cent Afr J Med 1993; 39:172-5. [PMID: 8020083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A case of amoebic recto-vaginal fistula is presented, with a review of literature on this rare complication of intestinal amoebiasis. A temporary defunctioning sigmoid colostomy was necessary. This in combination with oral metronidazole and tetracycline resulted in spontaneous closure of the fistulous tract. Non-traumatic recto-vaginal fistula poses a major diagnostic problem especially in the tropics where many granulomatous infections are endemic and could mimic carcinoma.
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Affiliation(s)
- O A Fadiran
- Department of Surgery, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
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34
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Langenscheidt P, Mast GJ, Becht E, Ziegler M. [Complexity-oriented surgical strategies in vesicovaginal fistulas]. Urologe A 1991; 30:94-8. [PMID: 2058074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Since 1975 a total of 55 patients with vesicovaginal fistulas have undergone surgery at the Clinic of Urology, University of Saarland, Homburg/Saar. A majority (55%) of the cases were complicated. In 9 cases supravesical urinary diversion was necessary. Successful closure of the fistula was achieved in 45 patients (81.8%); only in one case is the fistula still present. In 5 patients with uncomplicated fistulas successful closure was accomplished by a vaginal approach. In the presence of complications, e.g., previous radiotherapy or accompanying lesions of the ureter or rectum, a transvesical/transabdominal approach was preferred; surgery was successful in 93.3% of such cases.
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Affiliation(s)
- P Langenscheidt
- Urologische Klinik und Poliklinik, Universität des Saarlandes, Homburg/Saar
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35
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Abstract
Computed tomography of 25 cases of enterovaginal (19 cases) or vesicovaginal fistula (6 cases) were reviewed. Underlying causes of fistulization included gynecological malignancy and radiation therapy (14 of 25), inflammatory diseases of bowel (8 of 25), and miscellaneous conditions (3 of 25). A CT finding of contrast within the vagina provided definitive confirmation of the suspected diagnosis of vaginal fistula in 60% of patients (15 of 25), a detection rate superior to conventional examinations in our series. Other CT findings suggestive of vaginal fistulas included detection of air (20 of 25) and/or fluid (5 of 25) within the vagina. Computed tomographic findings associated with vaginal fistulas such as radiation changes, contiguous pelvic mass, or adherent thickened bowel gave clues to the underlying etiology of the fistula and provided important information regarding the extent of disease prior to attempted surgical repair.
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Affiliation(s)
- J E Kuhlman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD
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36
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37
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38
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Paul DJ, Lloyd TV. Hindgut duplication with rectovaginal fistula. Obstet Gynecol 1979; 54:390-2. [PMID: 471389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Complete colon duplication is an extremely rare congenital anomaly that occasionally presents diagnostic problems. This report presents a 23-year-old black woman with complete duplication of the colon and distal ileum, with termination of 1 colon into the vagina.
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39
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Palmer JA, Bush RS. Radiation injuries to the bowel associated with the treatment of carcinoma of the cervix. Surgery 1976; 80:458-64. [PMID: 968730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Advances in radiation techniques and increased dosage have improved the cure rate of patients with cancer of the cervix to 65 percent. Associated with this increased dosage (betatron, 5,250 r and intracavitary 137-cesium, 4,000 r at point A) has been a serious complication incidence of 10 percent. Major intestinal complications usually become manifest within an 8 to 24 month period following radiation. Few are associated with tumor and the majority are amenable to surgical correction. Rectosigmoid stenosis is a common and frequently unrecognized complication. The 8 to 12 cm. segment of rectosigmoid, with its rigid wall and narrowed lumen, can be recognized on barium examination. The symptoms are those on incomplete obstruction and deterioration, frequently confused with tumor progression. Thirty-one patients have been treated by resection and low anterior anastomosis with relief of symptoms. Rectosigmoid stenosis progressing to necrosis, perforation, or fistula (an additional 29 patients) is treated best by the Hartmann operation as a first stage. This procedure has been less complicated than either colostomy alone or resection and anastomosis. Fifteen patients with low level rectovaginal fistula or stenosis were treated by defunctioning sigmoid colostomy. A loop transverse colostomy was unsatisfactory. Ileorectovaginal fistulas occurred in an additional six patients. Preoperative investigation should establish the presence or absence of an ileal component in all fistulas. Radiation ileitis is rare as an isolated finding but frequently is associated with severe rectosigmoid damage. Surgical treatment is seldom necessary but, if indicated (ten patients), resection appears to be preferable to bypass.
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40
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Bagby RJ, Clements JL, Patrick JW, Rogers JV, Weens HS. Genitourinary complications of granulomatous bowel disease. Am J Roentgenol Radium Ther Nucl Med 1973; 117:297-306. [PMID: 4685859 DOI: 10.2214/ajr.117.2.297] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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41
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Hörmann D. [Radiography of anorectal anomalies]. Zentralbl Chir 1972; 97:1783-90. [PMID: 4676975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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42
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43
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44
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Ricci G, Guglielmi M, Pedrazzoli S, Ottolenghi A. [Congenital rectovulvar fistula without anal atresia]. Acta Chir Ital 1970; 26:395-408. [PMID: 5518865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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45
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Amici F, Leocani B. [Pneumoseptostratigraphy of the pelvic region. Technics and cases]. Riv Ostet Ginecol 1968; 23:139-54. [PMID: 5736531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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46
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47
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48
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Tancer ML, Zahiruddin S. Diagnosis of sigmoidovaginal fistula by vaginogram. Report of 2 cases. Obstet Gynecol 1966; 28:815-9. [PMID: 5923354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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