[Chronic rectal fistula after rectal amputation. Treatment with transposition of the gracilis muscle].
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Adult↗
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[Treatment of urethro-rectal fistulas. Apropos of 5 cases].
Urethro-rectal fistulas, consisting of prostato-rectal fistulas and fistulas communicating between the bulbo-membranous urethra and the rectum, are rare, easily diagnosed diseases, which essentially raise a problem of choice of surgical technique. Although the predominant aetiology is currently iatrogenic, many other less frequent aetiologies can also be responsible. Treatment is usually surgical with a large number of possible incisions. In the light of 5 cases, the authors review the various surgical techniques allowing cure of these fistulas, and indicate the advantages and disadvantages or each one.
Adult↗
Transposition of the rectus abdominis muscle for complicated pouch and rectal fistulas.
PURPOSE: Operative repair for complicated pouch and rectal fistulas is often difficult. We present our experience with ten consecutive patients operated on for complicated pouch and rectal fistulas by transposition of the rectus abdominis muscle. METHODS: Ten patients with high and complex pouch and rectal fistulas were treated with the interposition of a vascularized rectus abdominis muscle flap. All patients received standard bowel preparation and antibiotics. All were diverted by a temporary ileostomy. RESULTS: Causes of fistulas included Crohn's disease (n = 3), previous rectal surgery (n = 5), anal atresia (n = 1), and sphincter repair (n = 1). Three patients had a third recurrence. The procedure was performed in combination with a plastic surgeon. All fistulas healed. No special postoperative care was required. There were no cosmetic or functional complaints caused by transposition of the rectus abdominis muscle. CONCLUSIONS: Transposition of the rectus abdominis muscle is a suitable technique in treatment of fistulas between the rectum or ileal pouch and the vagina or urinary system, with no obvious side effects and excellent clinical outcome.
Adult↗
HIV-positive African children with rectal fistulae.
BACKGROUND/PURPOSE: Human immunodeficiency virus (HIV) disease is an increasingly common infection in children in sub-Sahara Africa. Rectal fistulation is one such condition with which these patients present to the paediatric surgeon. This appeared to be an exclusively female condition until 2 male patients were treated recently. METHODS: A 6-year (1996 through 2001) retrospective study found 39 children presenting with HIV-related rectal fistulae. Thirty-seven girls were seen with rectovaginal fistulae (RVF), and there is supportive documentation showing an increase in this condition throughout Southern Africa. Until now, boys have not been described with this condition. The author presents 2 boys who complete this spectrum of HIV-related acquired rectal fistulae. RESULTS: All patients were found to have rectal fistula at the dentate line. In girls it varied in size from pin-point to 5 mm diameter, tracking anteriorly into the vagina. When closure of the fistula was attempted, it broke down. The 2 boys had a large fistula, which tracked to the prostatic urethra on the right of the verumontanum. The first patient underwent a successful repair. The second patient had a "Y"-shaped fistula based at the dentate line, with the second limb passing into the bladder. The parents refused further treatment and took the child home. CONCLUSIONS: HIV disease affects increasing numbers of children. A spectrum of rectal fistulae now has been seen in both girls and boys. These acquired rectal fistulae arise at the dentate line in both genders. Girls with these fistulae are seen more commonly, presenting with RVF. The closure of a fistula has only been successful in one boy.
Child↗
[Treatment of prostato-rectal fistulae. Apropos of 5 cases].
The authors report 5 cases of prostato-rectal fistulae. Two men were treated by a posterior approach and two by an abdominal approach because of associated lesions. They review all of the techniques of approaching the prostato-rectal fistulas. The transsphincteric approach provides excellent exposure and reliable closure of prostato-rectal fistulas: the concern for possible anal incontinence is unfounded. Additional security can be obtained by performing a colostomy beforehand.
Adolescent↗
[Clinical course and treatment of traumatic rectal fistula].
From experience in treatment of 104 patients with rectal fistulas of traumatic origin the authors distinguished the specific features of the clinical manifestations of the disease which must be taken into consideration in choosing the therapeutic tactics. In contrast to the management of common chronic paraproctitis, the treatment of traumatic rectal fistulas differs in principle, particularly when the internal opening of the fistula is in the wall of the rectal ampulla++. The authors determined the indications for various methods of treatment and techniques of operative interventions, including multistage surgical treatment with the creation of temporary colostomy.
Adolescent↗
A case report: vesico-rectal fistula with ano-urethral atresia.
Vesico-rectal fistula is a rare congenital abnormality causing severe early second trimester oligohydramnios. Prenatal diagnosis of such a case is reported here. Ultrasound diagnosis could be aided by transabdominal amnio-infusion and, if necessary, fetal intraperitoneal saline installation. In a karyotypically normal fetus with normal somatic growth, demonstration of normal fetal kidneys together with a functioning urinary bladder, in presence of severe oligohydramnios, is very suggestive of the diagnosis. Since pulmonary hypoplasia is the major cause of neonatal mortality in these cases, restoration of normal amniotic fluid volume by serial amnio-infusion was attempted. Although amnio-infusion is an important diagnostic aid in the evaluation of severe midtrimester oligohydramnios, the role of multiple therapeutic amnio-infusion in improving lung growth remains to be evaluated.
Abnormalities, Multiple↗
[The York Manson approach in the treatment of prostato-rectal fistulae].
The York Mason approach appears to be one of the most suitable techniques for the treatment of prostato-rectal fistulas, as it provides a maximum chance of success with no morbidity, as no cases of anal incontinence have been reported to date. The authors report a case of prostato-rectal fistula secondary to transurethral resection of the prostate for benign prostatic hyperplasia treated by the YORK MASON posterior trans-anosphincteric approach.
Fistula↗
Anterior sacral meningocele associated with a rectal fistula. Case report and review of the literature.
The authors report a case of anterior sacral meningocele associated with a rectal fistula in a patient who had presented 20 years earlier with bacterial meningitis. To their knowledge, this is the first case in which a rectal fistula developed due to an anterior sacral meningocele. The clinical presentation, diagnosis, and treatment of this uncommon lesion is discussed.
Adult↗
[Surgical treatment of combined trans-sphincter and extra-sphincter rectal fistula].
The results of surgical treatment of 600 patients with rectal fistula were analyzed. Intrasphincter fistula was observed in 204 patients (34%), transsphinctered fistula--in 72 patients (12%), extrasphincter fistula--in 324 patients (54%). In order to decrease the rate of recurrence of fistula, during performance of plastics of internal hole of the fistula the graft of all the wall of rectum (not only its mucosa) was mobilized up to the level of anal sphincter. Post-operative complications and recurrence of fistula occurred in 4% of patients.
Anal Canal↗
[Prostatic or urethral rectal fistulas].
Reporting 7 new observations of prostatic or urethro-rectal fistulas, the authors insist on their etiological modalities specially of traumatical, inflammatory, post-irradiation, cancerous and congenital origin. The diagnosis methods and surgical techniques are also mentioned.
Aged↗
[Causes and prevention of rectal fistula recurrences].
The study of 412 patients with recidivations of rectal fistulas has shown that most frequent recidivations of extrasphincter fistulas are observed in the presence of ramified suppurative cavities in the pararectal fat. The recidivation may be caused by errors in the preoperative diagnosis and inadequate choice of the operation method, by non-radical operations and insufficient control of the postoperative wound healing.
Adult↗
Seminal vesicle-rectal fistula. Report of a case.
A previously unreported complication of low anterior resection of the rectum, seminal vesicle-rectal fistula, was encountered one month after surgery in an elderly patient with adenocarcinoma of the midrectum. Antibiotic-induced colitis in the immediate postoperative period led to anastomotic leakage with abscess formation and ensuing fistulization to the surgically denuded right seminal vesicle. Pneumaturia, bacteriuria, and right testicular pain were treated by cutaneous vasostomy and antimicrobial therapy. Despite recurrent low-grade urinary sepsis controlled by alternating courses of various antimicrobials, and radiation therapy for local tumor recurrence, the patient remained reasonably healthy until his death two years later due to stroke associated with cerebral metastases.
Adenocarcinoma↗
[Chronic postoperative rectal fistulae. Treatment by transanal colo-anal anastomosis. Apropos of 4 cases].
In a few cases, the postoperative rectal fistulas progress towards chronicity despite correct treatment and left iliac derivation. In 4 cases of such fistulas (3 females and 1 male, mean age 46 years), developed after rectal surgery and persisting for 2 to 16 months in young subjects, in good general condition and with a good long-term prognosis, we performed rectal resection with transanal colo-anal anastomosis according to the Parks technique. This procedure led to healing of the course of the fistulas, then closure of the derivation anus in the 4 patients. The functional results proved to be satisfactory, following short-term rehabilitation with biofeedback. After discussing the other surgical possibilities, the authors estimate that such a radical cure must be decided upon without delay, in case of chronic rectal fistula.
Adult↗
[Plastic operations in rectal fistulae].
Experiments were conducted on 48 dogs to study the terms and degree of resolution of various plastic materials--areas of fascia lata of the animal's thigh, as well as explants (medical glue compositions, biological absorbable lavsan-armored Soviet medical films) in the pararectal tissues and in artificial formation of rectal fistulas. It is shown that auto- and explantation may be performed in the treatment of rectal fistulas in patients. The suggested method was applied in the clinic in 136 operations for complex trans- and extrasphincteric pararectal fistulas. The results were followed-up for 12 months to 5 years and proved to be good in 126 patients.
Animals↗
[Changes in blood serum proteins and blood electrolytes in patients with rectal fistulas and hemorrhoids].
Changes in blood serum and electrolytes were studied in 113 patients with rectal fistulas and hemorrhoid. The data obtained provided the opportunity for estimating objectively the intensity of inflammatory and destructive processes in pararectal cellular tissue.
Adult↗
Urethroperineal-rectal fistula in Crohn's disease.
A 19-year-old white male with Crohn's disease, who complained of passing urine per rectum and having retrograde ejaculations, was noted to have a urethroperineal-rectal fistula. The fistulous communication remained patent despite pharmacologic therapy, a diversion ileostomy, and a total proctocolectomy. A fistulectomy and definitive urethral repair finally resulted in resolution of the problem.
Adult↗
Flap advancement and core fistulectomy for complex rectal fistula.
BACKGROUND: The treatment of low fistula in ano is well accepted but controversy surrounds the management of high trans-sphincteric fistulas and more complex fistulas. This study assesses the clinical results of advancement flap techniques in association with core fistulectomy for complex fistula in ano. METHODS: A retrospective analysis of the use of advancement flap techniques together with core fistulectomy in 25 patients (26 fistulas) was performed. Clinical outcome was assessed in terms of fistula healing, continence, failure and technical problems. RESULTS: Successful healing of 20 of the 26 complex fistulas was achieved using this technique with no disturbance of continence and minimal (technical) complications. CONCLUSION: Flap advancement and core fistulectomy is a safe, effective procedure for complex rectal fistulas with good functional results and minimal or no disturbance of continence, and should be considered for the treatment of complex perianal fistulas.
Adult↗