difficult fistulae
DESCRIPTION
DIFFICULT FISTULAE. BA Taylor North Cheshire M62 Coloproctology Course. AS (17.10.47). May ’04:L ischio-rectal abscess 27.7.04:Abdominal colic & altered bowel habit: RE; fistula at 3 o’clock 13.12.04:EUA; “high” trans-sphincteric fistula ext. opening 3 o’clock - PowerPoint PPT PresentationTRANSCRIPT
DIFFICULT FISTULAE
BA Taylor
North Cheshire
M62 Coloproctology Course
AS (17.10.47)May ’04: L ischio-rectal abscess27.7.04: Abdominal colic & altered
bowel habit: RE; fistula at 3 o’clock
13.12.04: EUA; “high” trans-sphincteric fistulaext. opening 3 o’clockint. opening 6 o’clock
AS (17.10.47)
AS (17.10.47)13.12.04: EUA
ext. sphincter skeletonized
mucosa/int. sphincter divided
tight (“cutting”) Seton4.1.05: well10.2.05: EUA; minimal residual
division29.3.05: well
KC (4.7.55)30.9.01: R ischio-rectal abscess1.11.01: Discharged (no fistula apparent)7.8.03: Recurrent R ischio-rectal abscess
Drained; horseshoe (5-9 o’clock)
No obvious fistula9.3.04: Healed; discharged
Histology: non-specific
KC (4.7.55)27.9.04: Recurrent R ischio-rectal abscess
EUA; ? int. opening at 6 o’clock2.10.04: Further (posterior) collection9.11.04: Fully healed; offered EUA6.12.04: EUA; high complex supra-levator
fistula. Int. opening at dentate; X2 ext. openings in scar. MR scan
KC (4.7.55)
KC (4.7.55)
KC (4.7.55)
Jan ’05: EUA; external openings cored out
Fistula track curetted
Fibrin glue to track
Overnight stay
March ’05: Healed (so far!)
KH (21.12.84)19.2.03: Abdominal colectomy & ileostomy
Severe CUC20.5.03: Adhesiolysis, proctectomy, double
stapled J pouch-anal anastomosis4.6.03: EUA; tiny pouch-vaginal fistula5.6.03: laparotomy, adhesiolysis, stoma
KH (21.12.84)16.9.03: EUA; no fistulaOct ’03: pouchogram; no fistula11.11.03: EUA (air insufflation/
methylene blue); no fistulaPouchoscopy; normal
Jan ’04: Admission for ileostomy closure
EUA; obvious pouch-vaginal fistula at anastomosis
KH (21.12.84)
KH (21.12.84)
22.3.04: Mucosectomy, direct closure of fistula and pouch advancementHand-sewn, endo-anal re-
anastomosis.June ’04: Pouchogram –veJuly ’04: EUA; ileostomy closureSept ’04: Well
VB (29.8.75)6.10.04: 4th degree obstetric injury
Levators mobilized & overlapped
Perineal muscles closed
Mucosa /skin closed
28.2.05: Excellent bowel function/flatus PV15.3.05: EUA; small ano-vaginal fistula
VB (29.8.75)