WorldWideScience

Sample records for anal fistulae induced

  1. Anal Abscess/Fistula

    Science.gov (United States)

    ... to determine if antibiotics are indicated. TREATMENT OF ANAL FISTULA Currently, there is no medical treatment available for ... surgery is almost always necessary to cure an anal fistula. If the fistula is straightforward (involving minimal sphincter ...

  2. Anal abscess and fistula.

    Science.gov (United States)

    Sneider, Erica B; Maykel, Justin A

    2013-12-01

    Benign anorectal diseases, such as anal abscesses and fistula, are commonly seen by primary care physicians, gastroenterologists, emergency physicians, general surgeons, and colorectal surgeons. It is important to have a thorough understanding of the complexity of these 2 disease processes so as to provide appropriate and timely treatment. We review the pathophysiology, presentation, diagnosis, and treatment options for both anal abscesses and fistulas.

  3. [Cryptoglandular anal fistulas].

    Science.gov (United States)

    de Parades, Vincent; Zeitoun, Jean-David; Bauer, Pierre; Atienza, Patrick

    2008-10-31

    Cryptoglandular anal fistulae are the most frequently occurring form of perianal sepsis. Characteristically they have an endoanal primary opening, a fistula track and an abscess and/or an external purulent opening. Antibiotic therapy is not of use in initial management except in special cases. Treatment of an abscess, if present, is required urgently and when possible, consists of its incision under local anaesthesia. Treating the fistula track occurs afterwards and aims to dry up the purulent discharge and avoid recurrence of the abscess by means of surgical fistulotomy. These techniques are very effective in terms of eradication of the problem but there is sometimes a risk of anal incontinence. This explains the increasing interest in sphincter preserving techniques using the advancement of a covering flap of rectal mucosa and the injection of fibrin glue.

  4. Cryptoglandular anal fistula.

    Science.gov (United States)

    de Parades, V; Zeitoun, J-D; Atienza, P

    2010-08-01

    Fistula arising from the glands of the anal crypts is the most common form of anoperineal sepsis. It is characterized by a primary internal orifice in the anal canal, a fistulous tract, and an abscess and/or secondary perineal orifice with purulent discharge. Antibiotics are not curative. The treatment of an abscess is urgent and consists, whenever possible, of incision and drainage under local anesthesia. Definitive treatment of the fistulous tract can await a second stage. The primary aim is to control infection without sacrificing anal continence. Fistulotomy is the basis for all treatments but the specific technique depends on the height of the fistula in relation to the sphincteric mechanism. Overall results of fistulotomy are excellent but there is some risk of anal incontinence. This explains the growing interest in sphincter sparing techniques such as the mucosal advancement flap, the injection of fibrin glue, and the plug procedure. However, results of these procedures are not yet good enough and leave much room for improvement.

  5. [Perianal fistula and anal fissure].

    Science.gov (United States)

    Heitland, W

    2012-12-01

    CRYPTOGLANDULAR ANAL FISTULA: Perianal abscesses are caused by cryptoglandular infections. Not every abscess will end in a fistula. The formation of a fistula is determined by the anatomy of the anal sphincter and perianal fistulas will not heal on their own. The therapy of a fistula is oriented between a more aggressive approach (operation) and a conservative treatment with fibrin glue or a plug. Definitive healing and the development of incontinence are the most important key points. ANAL FISSURES: Acute anal fissures should be treated conservatively by topical ointments, consisting of nitrates, calcium channel blockers and if all else fails by botulinum toxin. Treatment of chronic fissures will start conservatively but operative options are necessary in many cases. Operation of first choice is fissurectomy, including excision of fibrotic margins, curettage of the base and excision of the sentinel pile and anal polyps. Lateral internal sphincterotomy is associated with a certain degree of incontinence and needs critical long-term observation.

  6. Modern management of anal fistula.

    Science.gov (United States)

    Limura, Elsa; Giordano, Pasquale

    2015-01-07

    Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of continence. For the simple and most distal fistulae, conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore, well accepted in clinical practise. However, for the more complex fistulae where a significant proportion of the anal sphincter is involved, great concern remains about damaging the sphincter and subsequent poor functional outcome, which is quite inevitable following conventional surgical treatment. For this reason, over the last two decades, many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function. Among them, the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula. Another technique, the anal fistula plug, derived from porcine small intestinal submucosa, is safe but modestly effective in long-term follow-up, with success rates varying from 24%-88%. The failure rate may be due to its extrusion from the fistula tract. To obviate that, a new designed plug (GORE BioA®) was introduced, but long term data regarding its efficacy are scant. Fibrin glue showed poor and variable healing rate (14%-74%). FiLaC and video-assisted anal fistula treatment procedures, respectively using laser and electrode energy, are expensive and yet to be thoroughly assessed in clinical practise. Recently, a therapy using autologous adipose-derived stem cells has been described. Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae, and studies remain in progress. The aim of this present article is to review the pertinent literature, describing the advantages and limitations of

  7. New Techniques for Treating an Anal Fistula

    OpenAIRE

    Song, Kee Ho

    2012-01-01

    Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is exp...

  8. [Surgical treatment of anal fistula].

    Science.gov (United States)

    Zeng, Xiandong; Zhang, Yong

    2014-12-01

    Anal fistula is a common disease. It is also quite difficult to be solved without recurrence or damage to the anal sphincter. Several techniques have been described for the management of anal fistula, but there is no final conclusion of their application in the treatment. This article summarizes the history of anal fistula management, the current techniques available, and describes new technologies. Internet online searches were performed from the CNKI and Wanfang databases to identify articles about anal fistula management including seton, fistulotomy, fistulectomy, LIFT operation, biomaterial treatment and new technology application. Every fistula surgery technique has its own place, so it is reasonable to give comprehensive individualized treatment to different patients, which may lead to reduced recurrence and avoidance of damage to the anal sphincter. New technologies provide promising alternatives to traditional methods of management. Surgeons still need to focus on the invention and improvement of the minimally invasive techniques. Besides, a new therapeutic idea is worth to explore that the focus of surgical treatment should be transferred to prevention of the formation of anal fistula after perianal abscess.

  9. Anal fistula. Past and present.

    Science.gov (United States)

    Zubaidi, Ahmad M

    2014-09-01

    Anal fistula is a common benign condition that typically describes a miscommunication between the anorectum and the perianal skin, which may present de novo, or develop after acute anorectal abscess. Athough anal fistulae are benign, the condition can still negatively influence a patient's quality of life by causing minor pain, social hygienic embarrassment, and in severe cases, frank sepsis. Despite its long history and prevalence, anal fistula management remains one of the most challenging and controversial topics in colorectal surgery today. The end goals of treatment include draining the local infection, eradicating the fistulous tract, and minimizing recurrence and incontinence rates. The goal of this review is to ensure surgeons and physicians are aware of the different imaging and treatment choices available, and to report expected outcomes of the various surgical modalities so they may select the most suitable treatment. 

  10. Experimental model of anal fistula in rats

    OpenAIRE

    Arakaki, Mariana Sousa; Santos,Carlos Henrique Marques dos; Falcão, Gustavo Ribeiro; Cassino,Pedro Carvalho; Nakamura, Ricardo Kenithi; Gomes,Nathália Favero; Santos,Ricardo Gasparin Coutinho dos

    2013-01-01

    INTRODUCTION: the management of anal fistula remains debatable. The lack of a standard treatment free of complications stimulates the development of new options. OBJECTIVE: to develop an experimental model of anal fistula in rats. METHODS: to surgically create an anal fistula in 10 rats with Seton introduced through the anal sphincter musculature. The animals were euthanized for histological fistula tract assessment. RESULTS: all ten specimens histologically assessed had a lumen and surroundi...

  11. Treatment of non-IBD anal fistula

    DEFF Research Database (Denmark)

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter;

    2015-01-01

    The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should be ...

  12. Treatment of non-IBD anal fistula

    DEFF Research Database (Denmark)

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter;

    2015-01-01

    The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should...... be supplemented with an endoluminal ultrasound scan and/or an MRI scan. St. Mark's fistula chart should be used for the description. Simple fistulas are amenable to fistulotomy, whereas treatment of complex fistulas requires special expertise and management of all available treatment modalities to tailor...

  13. [The anal fistula disease and abscess].

    Science.gov (United States)

    Strittmatter, Bernhard

    2004-01-01

    There are two forms of anal fistulas arising from its pathogenesis: the acute stage is the abscess, whereas the chronic stage is the fistula in ano. The classification of the fistula in ano is named after Parks. Pathogenesis and classification are explained. For complete cure, every abscess needs precise examination to be able to show the course and shape of the fistula. The surgical procedure depends on the fistula tract. Most fistulas can be operated by means of a fistulotomy or fistulectomy. Recovery depends on locating the total fistula tract.

  14. New techniques for treating an anal fistula.

    Science.gov (United States)

    Song, Kee Ho

    2012-02-01

    Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing. Another addition to the sphincter-preserving options is the ligation of intersphincteric fistula tract procedure. This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane. Recently, cell therapy for an anal fistula has been described. Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential. These properties are useful for the regeneration or the repair of damaged tissues. This article discusses the rationales for, the estimated efficacies of, and the limitations of new sphincter-preserving techniques for the treatment of anal fistulae.

  15. VAAFT - Videoassisted anal fistula treatment: a new approach for anal fistula

    OpenAIRE

    Mendes,Carlos Ramon Silveira; FERREIRA, Luciano Santana de Miranda; Sapucaia,Ricardo Aguiar; LIMA, Meyline Andrade; Araujo, Sergio Eduardo Alonso

    2014-01-01

    INTRODUCTION: Anal fistula is an epithelised path between the rectum or anal canal and the perianal region. The use of laparoscopic surgery with a minimally invasive procedure has led to the development of video-assisted surgical treatment of anal fistula.OBJECTIVE: To describe the surgical technique VAAFT as a new approach to fistula.CONCLUSION: This is a safe and reproducible procedure. It enables the study of the entire fistula, obtaining the identification of accessory paths, cavitations ...

  16. Anal fistula: intraoperative difficulties and unexpected findings.

    Science.gov (United States)

    Abou-Zeid, Ahmed A

    2011-07-28

    Anal fistula surgery is a commonly performed procedure. The diverse anatomy of anal fistulae and their proximity to anal sphincters make accurate preoperative diagnosis essential to avoid recurrence and fecal incontinence. Despite the fact that proper preoperative diagnosis can be reached in the majority of patients by simple clinical examination, endoanal ultrasound or magnetic resonance imaging, on many occasions, unexpected findings can be encountered during surgery that can make the operation difficult and correct decision-making crucial. In this article we discuss the difficulties and unexpected findings that can be encountered during anal fistula surgery and how to overcome them.

  17. Anal fistula: Intraoperative difficulties and unexpected findings

    Institute of Scientific and Technical Information of China (English)

    Ahmed A Abou-Zeid

    2011-01-01

    Anal fistula surgery is a commonly performed procedure. The diverse anatomy of anal fistulae and their proximity to anal sphincters make accurate preoperative diagnosis essential to avoid recurrence and fecal incontinence. De-spite the fact that proper preoperative diagnosis can be reached in the majority of patients by simple clinical ex-amination, endoanal ultrasound or magnetic resonance imaging, on many occasions, unexpected findings can be encountered during surgery that can make the oper-ation difficult and correct decision-making crucial. In this article we discuss the difficulties and unexpected find-ings that can be encountered during anal fistula sur-gery and how to overcome them.

  18. Treatment of non-IBD anal fistula.

    Science.gov (United States)

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter; Buntzen, Steen; Thorlacius-Ussing, Ole; Andersen, Jens; Krupa, Marek; Qvist, Niels

    2015-05-01

    The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should be supplemented with an endoluminal ultrasound scan and/or an MRI scan. St. Mark's fistula chart should be used for the description. Simple fistulas are amenable to fistulotomy, whereas treatment of complex fistulas requires special expertise and management of all available treatment modalities to tailor the right operation to the individual patient. The given levels of evidence and grades of recommendations are according to the Oxford Centre for Evidence-based Medicine (www.cemb.net).

  19. Anal fistulas : New perspectives on treatment and pathogenesis

    NARCIS (Netherlands)

    R.S. van Onkelen (Robbert)

    2015-01-01

    markdownabstractAbstract The objective of modern anal fistula treatment is healing of the fistula without diminished fecal continence. Sphincter saving techniques have been developed for anal fistulas, for which fistulotomy is not suitable. Treatment of these anal fistulas remains challenging and

  20. Introducing the operation method for curing anal fistula by laser

    Science.gov (United States)

    Ji, Bingzhi

    1993-03-01

    The key to the treatment of anal fistula lies in scavenging the infected anal gland thoroughly, which is the source of anal fistula infection. The fistula tract at the internal orifice of the anal fistula is cut 1 cm using laser with the infectious source completely degenerated and the wound gassified and scanned. The residual distal fistula softens and disappears upon the action of organic fibrinolysin.

  1. [Pay attention to the imaging diagnosis of complex anal fistula].

    Science.gov (United States)

    Zhou, Zhiyang

    2015-12-01

    The diagnosis and treatment of complex anal fistula has been a significant challenge. Unwise incision and excessive exploration will lead to the secondary branch, sinus and perforation. A simple fistula may become a surgical problem and result in disastrous consequences. Preoperative accurate diagnosis of anal fistula, including in the internal opening, primary track and location of the fistula, extensions and abscess, is important for anal fistula treatment. In the diagnosis of anal fistula, imaging examination, especially MRI plays a crucial role. Localization and demarcation of anal fistula and the relationship with sphincter are important. MRI has been an indispensable confirmatory imaging examination.

  2. Treating anal fistula with the anal fistula plug: case series report of 12 patients

    OpenAIRE

    Saba, Reza Bagherzadeh; Tizmaghz, Adnan; Ajeka, Somar; Karami, Mehdi

    2016-01-01

    Introduction Recurrent and complex high fistulas remain a surgical challenge. This paper reports our experience with the anal fistula plug in patients with complex fistulas. Methods Data were collected prospectively and analyzed from consecutive patients undergoing insertion of a fistula plug from January 2011 through April 2014 at Hazrat-e-Rasoul Hospital in Tehran. We ensured that sepsis had been eradicated in all patients prior to placement of the plug. During surgery, a conical shaped col...

  3. Treatment of anal fistula and abscess.

    Science.gov (United States)

    Pigot, F

    2015-04-01

    The glands of Hermann and Desfosses, located in the thickness of the anal canal, drain into the canal at the dentate line. Infection of these anal glands is responsible for the formation of abscesses and/or fistulas. When this presents as an abscess, emergency drainage of the infected cavity is required. At the stage of fistula, treatment has two sometimes conflicting objectives: effective drainage and preservation of continence. These two opposing constraints explain the existence of two therapeutic concepts. On one hand the laying-open of the fistulous tract (fistulotomy) in one or several operative sessions remains the treatment of choice because of its high cure rates. On the other hand surgical closure with tract ligation or obturation with biological components preserves sphincter function but suffers from a higher failure rate.

  4. Video Assisted Anal Fistula Treatment in a Child with Perianal Fistula

    OpenAIRE

    Naeem Liaqat; Asif Iqbal; Sajid Hameed Dar; Faheem Liaqat

    2016-01-01

    Perianal fistula formation is a rare complication in children after rectal biopsy. Perianal fistula may become difficult to treat; therefore a lot of surgical options are present. One of these options is video assisted anal fistula treatment (VAAFT). We present a 6-year-old female who developed perianal fistula following rectal biopsy for which VAAFT was done successfully.

  5. Video Assisted Anal Fistula Treatment in a Child with Perianal Fistula

    Directory of Open Access Journals (Sweden)

    Naeem Liaqat

    2016-01-01

    Full Text Available Perianal fistula formation is a rare complication in children after rectal biopsy. Perianal fistula may become difficult to treat; therefore a lot of surgical options are present. One of these options is video assisted anal fistula treatment (VAAFT. We present a 6-year-old female who developed perianal fistula following rectal biopsy for which VAAFT was done successfully.

  6. Update on anal fistulae: Surgical perspectives for the gastroenterologist

    OpenAIRE

    Helena Tabry; Farrands, Paul A

    2011-01-01

    Anal fistulae are common and debilitating; they are characterized by severe pain and discharge. They arise following infection near the anal canal, or as a primary event from an abscess in the abdomen, fistulating into the vagina or perianal skin. The term ‘cryptoglandular’ is given to abscesses arising from the anal glands.For many years, the treatment of choice was to lay open the fistula; however, this risks causing incontinence with potentially devastating consequences. Alternative surgic...

  7. VAAFT: Video Assisted Anal Fistula Treatment; Bringing revolution in Fistula treatment

    OpenAIRE

    2015-01-01

    Objective: To share our findings that the new treatment modality Video Assisted Anal Fistula Treatment (VAAFT) is a better alternate to the conventional treatments of Fistula in Ano in our setup with minor changes in the initial method described by Meinero. Methods: Karl Storz Video equipment including Meinero Fistuloscope was used. Key steps are visualization of the fistula tract, correct localization of the internal fistula opening under direct vision and endoscopic treatment of the fistula...

  8. Update on Anal Fistulae: Surgical Perspectives for the Gastroenterologist

    Directory of Open Access Journals (Sweden)

    Helena Tabry

    2011-01-01

    Full Text Available Anal fistulae are common and debilitating; they are characterized by severe pain and discharge. They arise following infection near the anal canal, or as a primary event from an abscess in the abdomen, fistulating into the vagina or perianal skin. The term ‘cryptoglandular’ is given to abscesses arising from the anal glands.

  9. All's Well That Ends Well: Shakespeare's treatment of anal fistula.

    Science.gov (United States)

    Cosman, B C

    1998-07-01

    Textual and contextual evidence suggests that the French king's fistula, a central plot device in Shakespeare's play All's Well That Ends Well, is a fistula-in-ano. Anal fistula was known to the lay public in Shakespeare's time. In addition, Shakespeare may have known of the anal fistula treatise of John Arderne, an ancestor on Shakespeare's mother's side. Shakespeare's use of anal fistula differs from all previous versions of the story, which first appeared in Boccaccio's Decameron and from its possible historical antecedent, the fistula of Charles V of France. This difference makes sense given the conventions of Elizabethan comedy, which included anal humor. It is also understandable when one looks at what wounds in different locations mean in European legend. In this light, it is not surprising that subsequent expurgations treat Boccaccio's and Shakespeare's fistulas differently, censoring only Shakespeare's. This reading has implications for the staging of All's Well That Ends Well, and for our view of the place of anal fistulas in cultural history.

  10. Why do we have so much trouble treating anal fistula?

    Institute of Scientific and Technical Information of China (English)

    Haig Dudukgian; Herand Abcarian

    2011-01-01

    Anal fistula is among the most common illnesses af-fecting man. Medical literature dating back to 400 BC has discussed this problem. Various causative factors have been proposed throughout the centuries, but it appears that the majority of fistulas unrelated to spe-cific causes (e.g. Tuberculosis, Crohn's disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces. The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases. The problem with this single, yet effective, treatment plan is that depending on the thickness of sphincter muscle the fistula trans-gresses, the patient will have varying degrees of fecal incontinence from minor to total. In an attempt to pre-serve continence, various procedures have been pro-posed to deal with the fistulas. These include: (1) sim-ple drainage (Seton); (2) closure of fistula tract using fibrin sealant or anal fistula plug; (3) closure of prima-ry opening using endorectal or dermal flaps, and more recently; and (4) ligation of intersphincteric fistula tract (LIFT). In most complex cases (i.e. Crohn's disease), a proximal fecal diversion offers a measure of symptom-atic relief. The fact remains that an "ideal" procedure for anal fistula remains elusive. The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations. In essence, the price of preservation of continence at all cost is multi-ple and often different operations, prolonged disability and disappointment for the patient and the surgeon. Nevertheless, the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist. Conversely, an expert colorectal surgeon must be familiar with many different opera-tions in order to selectively tailor an operation to the individual patient.

  11. Fistulotomy or seton in anal fistula: a decisional algorithm.

    Science.gov (United States)

    Cariati, Andrea

    2013-09-01

    Fistula in ano is a common proctological disease. Several authors stated that internal and external anal sphincters preservation is in the interest of continence maintenance. The aim of the present study is to report our experience using a decisional algorithm on sphincter saving procedures that achieved us to obtain good results with low rate of complications. From 2008 to 2011, 206 patients underwent surgical treatment for anal fistula; 28 patients underwent perianal abscess drainage plus seton placement of trans-sphincteric or supra-sphincteric fistula (13.6 %), 41 patients underwent fistulotomy for submucosal or low inter-sphincteric or low trans-sphincteric anal fistula (19.9 %) and 137 patients underwent partial fistulectomy or partial fistulotomy (from cutaneous plan to external sphincter muscle plan) and cutting seton placement without internal sphincterotomy for trans-sphincteric anal fistula (66.50 %). Healing rates have been of 100 % and healing times ranged from 1 to 6 months in 97 % of patients treated by setons. Transient fecal soiling was reported by 19 patients affected by trans-sphincteric fistula (11.5 %) for 4-6 months and then disappeared or evolved in a milder form of flatus occasional incontinence. No major incontinence has been reported also after fistulotomy. Fistula recurred in five cases of trans-sphincteric fistula treated by seton placement (one with abscess) (1/28) (3.5 %) and four with trans-sphincteric fistula (4/137) (3 %). Our algorithm permitted us to reduce to 20 % sphincter cutting procedures without reporting postoperative major anal incontinence; it seems to open an interesting way in the treatment of anal fistula.

  12. Why do we have so much trouble treating anal fistula?

    Science.gov (United States)

    Dudukgian, Haig; Abcarian, Herand

    2011-07-28

    Anal fistula is among the most common illnesses affecting man. Medical literature dating back to 400 BC has discussed this problem. Various causative factors have been proposed throughout the centuries, but it appears that the majority of fistulas unrelated to specific causes (e.g. Tuberculosis, Crohn's disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces. The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases. The problem with this single, yet effective, treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses, the patient will have varying degrees of fecal incontinence from minor to total. In an attempt to preserve continence, various procedures have been proposed to deal with the fistulas. These include: (1) simple drainage (Seton); (2) closure of fistula tract using fibrin sealant or anal fistula plug; (3) closure of primary opening using endorectal or dermal flaps, and more recently; and (4) ligation of intersphincteric fistula tract (LIFT). In most complex cases (i.e. Crohn's disease), a proximal fecal diversion offers a measure of symptomatic relief. The fact remains that an "ideal" procedure for anal fistula remains elusive. The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations. In essence, the price of preservation of continence at all cost is multiple and often different operations, prolonged disability and disappointment for the patient and the surgeon. Nevertheless, the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist. Conversely, an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.

  13. Anovestibular fistula with normal anal opening: Is it always congenital?

    Directory of Open Access Journals (Sweden)

    Jain Prashant

    2008-01-01

    Full Text Available Aim: To review 12 cases of anovestibular fistula with normal anal opening. Methods: Retrospective analysis of 12 children with anovestibular fistula and normal anal opening were treated between the years 2000 and 2007. Of these, 11 patients were diagnosed as having acquired anovestibular fistula with normal anal opening and were managed by conservative management. Results: Most of them presented with diarrhea and labial redness. One patient was considered to have fistula of congenital origin and was managed surgically. Eleven patients presented between the ages of 1.5-11 months and were considered as cases of acquired anovestibular fistula and only two of them required surgical management in the form of colostomy and fistula excision. Others were successfully managed by conservative treatment; the fistulous output and labial redness decreased gradually within a period of 5-19 (average 11.5 days. Conclusions: Not all presentations of anovestibular fistula with normal anal opening can be considered as congenital. Presence of inflammation, paramedian fistula, and a favourable response to conservative management/colostomy suggest acquired etiology. Trial of conservative management should be given in the acquired variety.

  14. Treatment of peri-anal fistula in Crohn's disease.

    Science.gov (United States)

    Sica, Giuseppe S; Di Carlo, Sara; Tema, Giorgia; Montagnese, Fabrizio; Del Vecchio Blanco, Giovanna; Fiaschetti, Valeria; Maggi, Giulia; Biancone, Livia

    2014-10-07

    Anal fistulas are a common manifestation of Crohn's disease (CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently employed. However, at the moment, none of these techniques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medical therapy and those causing disabling symptoms. Utmost attention should be paid to correcting the balance between eradication of the fistula and the preservation of fecal continence.

  15. [A case of primary carcinoma associated with anal fistula].

    Science.gov (United States)

    Nushijima, Youichirou; Nakano, Katsutoshi; Sugimoto, Keishi; Nakaguchi, Kazunori; Kan, Kazuomi; Maruyama, Hirohide; Doi, Sadayuki; Okamura, Shu; Murata, Kohei

    2014-11-01

    A 47-year-old man with no history of anal fistula was admitted to our hospital with a complaint of perianal pain. Computed tomography (CT) imaging revealed perianal abscess. Incision and drainage were performed under spinal anesthesia. Ten months after drainage, magnetic resonance imaging revealed anal fistula on the left side of the anus. Subsequently, core-out and seton procedures were performed for ischiorectalis type III anal fistula. Pathological examination of the resected specimen of anal fistula revealed a moderately differentiated adenocarcinoma, leading to the diagnosis of carcinoma associated with anal fistula. No distant metastases or enlarged lymph nodes were observed on positron emission tomography (PET)/CT. We performed abdominoperineal resection with wide resection of ischiorectalis fat tissue. The pathology results were tub2, A, ly0, v0, n0, PM0, DM0, RM0, H0, P0, M0, Stage II. Negative pressure wound therapy was performed for perineum deficiency, after which rapid wound healing was observed. Left inguinal lymph node recurrence was detected 8 months after surgery, for which radiotherapy was administered. Distant metastasis was detected 11 months after surgery. The patient died 21 months after surgery.

  16. Is routine endoanal ultrasound useful in anal fistulas?

    Directory of Open Access Journals (Sweden)

    I. Pascual Migueláñez

    Full Text Available Objective: to evaluate the effectiveness of endoanal ultrasound with hydrogen peroxide enhancement in the assessment of anal fistula (tract and internal opening, and to value the utility of this examination for anal or perianal suppuration when performed by a colorectal surgeon trained in this technique. Patients: endoanal ultrasound was performed in 103 patients with anal or perianal suppuration. Twenty patients were excluded: 9 had the external opening closed, and 11 had cryptoglandular abscesses. All ultrasound scans were performed by the same explorer using a B&K Diagnostic Ultrasound System with a 7 MHz endoprobe. The examination was based on the identification of the three anal planes, then hydrogen peroxide was infused and the procedure was repeated. Results: out of 83 patients included, 11 had a perianal sinus and 72 an anal fistula. In all fistulas the main tract was found: 24 were inter-sphinteric (33.33%, 33 trans-sphincteric (45.83%, 3 supra-sphincteric (4.17%, and 12 extra-sphincteric (16.67%. An internal opening was identified in 69 (95.83%. Conclusions: endoanal ultrasound with hydrogen peroxide enhancement is an effective examination to visualize fistulous tracts and internal openings. We think it is highly useful for anal or perianal suppuration to identify abscesses, to recognize a perianal sinus, to check the sphincteric condition, and to plan subsequent surgery.

  17. Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula: systematic review and meta-analysis.

    Science.gov (United States)

    Hong, K D; Kang, S; Kalaskar, S; Wexner, S D

    2014-08-01

    Sphincter-preserving approaches to treat anal fistula do not jeopardize continence; however, healing rates are suboptimal. In this context, ligation of the intersphincteric fistula tract (LIFT) can be considered promising offering high success rates and a relatively simple procedure. This review aimed to investigate the outcomes of LIFT to treat anal fistula. We conducted a systematic review of the Pubmed, Web of Science, and Cochrane databases, to retrieve all relevant scientific original articles and scientific abstracts (Web of Science) related to the LIFT procedure for anal fistula between January 2007 and March 2013. The search yielded 24 original articles including 1,110 patients; these included one randomized controlled study, three case control studies, and 20 case series. Most studies included patients with trans-sphincteric or complex fistula, not amenable to fistulotomy. During a pooled mean 10.3 months of follow-up, the mean success, incontinence, intraoperative, and postoperative complication rates were 76.4, 0, 0, and 5.5%, respectively. A sensitivity analysis showed that the impact on success in terms of follow-up duration, study size, and combining other procedures was limited. There was no association between pre-LIFT drainage seton and success of LIFT. Ligation of the intersphincteric fistula tract appears to be an effective and safe treatment for trans-sphincteric or complex anal fistula. Combining other procedures and a pre-LIFT drainage seton does not seem to confer any added benefit in terms of success. However, given the lack of prospective randomized trials, interpretation of these data must be cautious. Further trials are mandatory to identify predictive factors for success, and true effectiveness of the LIFT compared to other sphincter-preserving procedures to treat anal fistula.

  18. The Anal Fistula Plug versus the mucosal advancement flap for the treatment of Anorectal Fistula (PLUG trial

    Directory of Open Access Journals (Sweden)

    Janssen Lucas WM

    2008-06-01

    Full Text Available Abstract Background Low transsphincteric fistulas less than 1/3 of the sphincter complex are easy to treat by fistulotomy with a high success rate. High transsphincteric fistulas remain a surgical challenge. Various surgical procedures are available, but recurrence rates of these techniques are disappointingly high. The mucosal flap advancement is considered the gold standard for the treatment of high perianal fistula of cryptoglandular origin by most colorectal surgeons. In the literature a recurrence rate between 0 and 63% is reported for the mucosal flap advancement. Recently Armstrong and colleagues reported on a new biologic anal fistula plug, a bioabsorbable xenograft made of lyophilized porcine intestinal submucosa. Their prospective series of 15 patients with high perianal fistula treated with the anal fistula plug showed promising results. The anal fistula plug trial is designed to compare the anal fistula plug with the mucosal flap advancement in the treatment of high perianal fistula in terms of success rate, continence, postoperative pain, and quality of life. Methods/design The PLUG trial is a randomized controlled multicenter trial. Sixty patients with high perianal fistulas of cryptoglandular origin will be randomized to either the fistula plug or the mucosal advancement flap. Study parameters will be anorectal fistula closure-rate, continence, post-operative pain, and quality of life. Patients will be followed-up at two weeks, four weeks, and 16 weeks. At the final follow-up closure rate is determined by clinical examination by a surgeon blinded for the intervention. Discussion Before broadly implementing the anal fistula plug results of randomized trials using the plug should be awaited. This randomized controlled trial comparing the anal fistula plug and the mucosal advancement flap should provide evidence regarding the effectiveness of the anal fistula plug in the treatment of high perianal fistulas. Trial registration ISRCTN

  19. Usefulness and limitations of CT examinations for deep anal fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Shinichiro; Matsumoto, Akihiko (Yokohama City Univ. (Japan). Faculty of Medicine); Kono, Kazuo (and others)

    1990-05-01

    Preoperative CT examination was performed on 30 cases of deep anal fistula and one case with an anal fistular carcinoma, and its usefulness and the limit of applicability were investigated. The deep anal fistula was recognized as a funicular or tumorous shadow on CT image. The differentiation of tumorous shadow and carcinoma was performed by biopsy under CT observation. While, there were also unidentifiable cases including three out of eight cases (37.5%) in II HC type and one out of 11 cases (9.1%) in II HC and III B types. Particularly, patients with a rectostenosis as the madn lesion could not be identified on CT images. The benefits of CT examination in deep anal fistula were compared with transrectal ultrasonography to establish a procedure for image diagnosis. Transrectal ultrasonography is performed as a routine test and CT examination is added when a lesion waving diameter of more than one cm is observed. Furthermore, active biopsy for patients with suspected carcinoma is planned under CT observation. (author).

  20. Management of anal fistula by ligation of the intersphincteric fistula tract

    DEFF Research Database (Denmark)

    Zirak-Schmidt, Samira; Perdawood, Sharaf

    2014-01-01

    INTRODUCTION: Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-preserving procedure for treatment of anal fistulas described in 2007 by Rojanasakul et al. Several studies have since then assessed the procedure with varied results. This review assesses the relevant literature...... fistula treatment techniques were excluded. Only reports in English were included. Most reports were case studies with no control groups. One report could not be retrieved. RESULTS: A total of 19 original reports were assessed. Details concerning preoperative assessment, antibiotic usage and tract...

  1. [Epithelium and anal glands in rectal pouches and fistula. Histologic studies of swine with congenital anal atresia].

    Science.gov (United States)

    Lambrecht, W; Kluth, D; Lierse, W

    1989-02-01

    The epithelial coating of the rectal pouch and fistula was studied morphologically in 33 newborn piglets with high and low forms of anal atresia and was found to be similar to the epithelial coating of the anal canal in normal piglets: the typical epithelium of the rectum changed its character into transitional epithelium at the region of the internal sphincter which surrounded the fistulae in all animals. In the caudal part of the fistula the transitional epithelium was followed by squamous epithelium. Only in male piglets with deformities and recto-urethral fistulae no squamous epithelium was found. In these cases transitional epithelium covered all parts of the fistula and the region of the internal sphincter. Anal glands were found in all animals, with or without anorectal malformations. They always invaded the internal sphincter. According to our morphological studies the fistula in anorectal malformations represents an ectopic anal canal.

  2. Video-assisted anal fistula treatment: technical considerations and preliminary results of the first brazilian experience

    OpenAIRE

    Mendes,Carlos Ramon Silveira; FERREIRA, Luciano Santana de Miranda; Sapucaia,Ricardo Aguiar; LIMA, Meyline Andrade; Araujo, Sergio Eduardo Alonso

    2014-01-01

    Backgroung : Anorectal fistula represents an epithelized communication path of infectious origin between the rectum or anal canal and the perianal region. The association of endoscopic surgery with the minimally invasive approach led to the development of the video-assisted anal fistula treatment. Aim : To describe the technique and initial experience with the technique video-assisted for anal fistula treatment. Technique : A Karl Storz video equipment was used. Main steps included the ...

  3. A New Method to Treat High Anal Fistula - Bidirectional Isobaric Drainage

    DEFF Research Database (Denmark)

    Zheng, Linghua; Wang, Yanmei; Zhao, Jingbo

    2016-01-01

    Background and aim: Traditionally, the principle of the treatment for anal fistula is "open fistula, fistulotomy ". Fistulotomy is the standard treatment for simple and low fistulas. However for the high fistula, the anorectal ring will be disconnected by fistulotomy. A better treatment should...... postoperative pain and protect anal function. In the patients of Experimental group, the appearance was kept well and had good anal closure (Figure 1 A-D). However, in the patients of Control group, the appearance was changed and the anal closure was not well (Figure 1 E-H). Conclusions and perspectives...

  4. Radiofrequency fistulotomy: a better alternative for treating low anal fistula

    Directory of Open Access Journals (Sweden)

    Pravin Jaiprakash Gupta

    Full Text Available CONTEXT: Wide varieties of approaches are employed in dealing with low anal fistula. However, the simple method of laying open the fistula tract (fistulotomy is still considered to be the favored one. MATERIALS AND METHODS: A modified approach to the procedure of fistulotomy is discussed. This study describes the procedure, which used a technique of radiofrequency surgery, and its outcome in 232 patients with low anal fistula. The patients were followed for a period of 15 months. RESULTS: The patients were discharged on the same day as the procedure. The mean period off work was four days. The average healing time recorded was 67 days. Four wound complications in the form of premature closure of the external wound were noted, which required trimming of the edges. Two of these wounds remained unhealed. The recurrence rate was 1.7%. CONCLUSION: In this era when the emphasis is on criteria like the minimization of hospital stay, reduction of postoperative pain, early resumption of work and low and comparable recurrence rates, there is a future for the procedure of radiofrequency fistulotomy.

  5. Poor Outcomes of Complicated Pouch-Related Fistulas after Ileal Pouch-Anal Anastomosis Surgery

    DEFF Research Database (Denmark)

    Kjaer, M D; Kjeldsen, J; Qvist, N

    2016-01-01

    BACKGROUND AND AIMS: Development of a pouch-related fistula tract is an uncommon but highly morbid complication to restorative proctocolectomy with ileal pouch-anal anastomosis. Pouch failure with permanent ileostomy is reported in 21%-30% of patients, yet the factors contributing to pouch excision...... with diagnosed pouch-related fistulas were registered with information related to fistula classification, treatments, and outcome. RESULTS AND CONCLUSION: The final analysis included 48 (10.7%) of the 447 total ileal pouch-anal anastomosis patients with complicated pouch-related fistulas. Pouch-vaginal fistulas......, pouch-perianal fistulas, and other pouch-related fistulas were observed in 19 (63%), 29 (60%), and 10 (21%) patients, respectively, corresponding to an accumulated risk of 8%, 6%, and 2%, respectively. Time from ileal pouch-anal anastomosis surgery to fistula presentation was 24 (0.2-212) months...

  6. Amoebic anal fistula: new insight into an old disease.

    Science.gov (United States)

    Agrawal, Vivek; Garg, Pankaj Kumar; Jain, Bhupendra Kumar; Mishra, Kiran; Mohanty, Debajyoti

    2014-04-01

    A 67-year-old gentleman underwent fistulectomy for low trans-sphincteric anal fistula along with curettage for an associated abscess extending proximally for half a centimeter into the intersphincteric plane. The roof of the cavity became clearly visible after satisfactory culmination of the surgical procedure. Histopathological examination of the fistulous tract and the curetted granulation tissue revealed presence of multiple trophozoites of Entamoeba histolytica exhibiting erythrophagocytosis in the background of mixed inflammatory infiltrate. This case report provides the outlook that yields the novel insight into the possible role of Entamoeba histolytica in the pathogenesis and persistence of the fistulous tract.

  7. A case of metastatic carcinoma of anal fistula caused by implantation from rectal cancer.

    Science.gov (United States)

    Takahashi, Rina; Ichikawa, Ryosuke; Ito, Singo; Mizukoshi, Kosuke; Ishiyama, Shun; Sgimoto, Kiichi; Kojima, Yutaka; Goto, Michitoshi; Tomiki, Yuichi; Yao, Takashi; Sakamoto, Kazuhiro

    2015-12-01

    This case involved an 80-year-old man who was seen for melena. Further testing revealed a tubular adenocarcinoma 50 mm in size in the rectum. In addition, an anal fistula was noted behind the anus along with induration. A biopsy of tissue from the external (secondary) opening of the fistula also revealed adenocarcinoma. Nodules suspected of being metastases were noted in both lung fields. The patient was diagnosed with rectal cancer, a cancer arising from an anal fistula, and a metastatic pulmonary tumor, and neoadjuvant chemotherapy was begun. A laparoscopic abdominoperineal resection was performed 34 days after 6 cycles of mFOLFOX-6 therapy. Based on pathology, the rectal cancer was diagnosed as moderately differentiated adenocarcinoma, and this adenocarcinoma had lymph node metastasis (yp T3N2aM1b). There was no communication between the rectal lesion and the anal fistula, and a moderately differentiated tubular adenocarcinoma resembling the rectal lesion was noted in the anal fistula. Immunohistochemical staining indicated that both the rectal lesion and anal fistula were cytokeratin 7 (CK7) (-) and cytokeratin 20 (CK20) (+), and the patient's condition was diagnosed as implantation of rectal cancer in an anal fistula.In instances where an anal fistula develops in colon cancer, cancer implantation in that fistula must also be taken into account, and further testing should be performed prior to surgery.

  8. Acceptable results using plug for the treatment of complex anal fistulas

    DEFF Research Database (Denmark)

    Kleif, Jakob; Hagen, Kikke; Wille-Jørgensen, Peer

    2011-01-01

    The management of complex fistula-in-ano remains a surgical challenge. Previously published studies on the treatment of fistula-in-ano with the anal fistula plug (AFP) have reported a success rate reaching 35-87%. The aim of this study was to assess the results of the AFP procedure in a group...

  9. [Some critical issues in the diagnosis and treatment of complex anal fistula].

    Science.gov (United States)

    Ren, Donglin; Zhang, Heng

    2015-12-01

    In the past thirty years, colorectal surgeons have made great progress regarding the diagnosis and treatment of complex anal fistula, including the improvement of the accuracy of the preoperative evaluation of complex anal fistula, the improvement and standardization of the diagnosis and treatment of perianal fistulising Crohn's disease, the application of various "sphincter-sparing" procedures. However, complex anal fistula continues to prove a formidable challenge with a high recurrence rate and high incontinence rate. The variety of the surgical treatment also means that there is still no established "golden standard" with respect to that of the complex anal fistula. According to recent relevant literatures and personal experience, some critical issues in the diagnosis and treatment of complex anal fistula, including the approach to the accurate diagnosis, the value and significance of seton technique, the individual algorithm between the minimal invasive and extensive surgical treatments, the value of biopsy, are discussed in this article.

  10. [Choice of surgical procedure and management of postoperative incision for anal fistula].

    Science.gov (United States)

    Chen, Chaowen; Peng, Bo

    2015-12-01

    Anal fistula is a common disease in general surgery. It is difficult to heal without intervention and surgical treatment is the major treatment. Method of surgical treatment and management of postoperative incision are based on features and classifications of anal fistula. Choosing the appropriate approach in accordance with specific conditions of patients can obtain effective healing and proper protection against anal sphincter, along with the improvement of life quality. Comprehensive evaluation on methods of surgical treatment and managements of postoperative incision for anal fistula is presented in this paper.

  11. Overview of anal fistula and systematic review of ligation of the intersphincteric fistula tract (LIFT).

    Science.gov (United States)

    Alasari, S; Kim, N K

    2014-01-01

    Anal fistula management has long been a challenge for surgeons. Presently, no technique exists that is ideal for treating all types of anal fistula, whether simple or complex. A higher incidence of poor sphincter function and recurrence after surgery has encouraged the development of a new sphincter-sparing procedure, ligation of the intersphincteric fistula tract (LIFT), first described by Van der Hagen et al. in 2006. We assessed the safety, feasibility, success rate, and continence of LIFT as a sphincter-saving procedure. A literature search of articles in electronic databases published from January 2006 to August 2012 was performed. Analysis followed Preferred Reporting Items for Systematic Reviews recommendations. All LIFT-related articles published in the English language were included. We excluded case reports, abstracts, letters, non-English language articles, and comments. The procedure was described in detail as reported by Rojanasakul. Thirteen original studies, including 435 patients, were reviewed. The most common fistula procedure type was transsphincteric (92.64 %). The overall median operative time was 39 (±20.16) min. Eight authors performed LIFT as a same-day surgery, whereas the others admitted patients to the hospital, with an overall median stay of 1.25 days (range 1-5 days). Postoperative complications occurred in 1.88 % of patients. All patients remained continent postoperatively. The overall mean length of follow-up was 33.92 (±17.0) weeks. The overall mean healing rate was 81.37 (±16.35) % with an overall mean healing period of 8.15 (±5.96) weeks. Fistula recurrence occurred in 7.58 % of patients. LIFT represents a new, easy-to-learn, and inexpensive sphincter-sparing procedure that provides reasonable results. LIFT is safe and feasible, with favorable short- and long-term outcomes. However, additional prospective randomized studies are required to confirm these findings.

  12. Ligation of Intersphincteric Fistula Tract Is Suitable for Recurrent Anal Fistulas from Follow-Up of 16 Months

    Directory of Open Access Journals (Sweden)

    Yansong Xu

    2017-01-01

    Full Text Available Since 2007, ligation of the intersphincteric fistula tract (LIFT for the management of anal fistula was all introduced with initial success and excitement. It remains controversial which surgical procedure is suitable for transsphincteric fistula, especially to complex anal fistula. This retrospective study was designed to evaluate the results in patients with recurrent anal fistula by LIFT. A retrospective study of 55 complex fistula patients who underwent LIFT procedure in a single medical center was analyzed. Patients and fistula characteristics, complications, and recurrences were reviewed. All 55 patients underwent the procedure with a median follow-up of 16 months. Median operative time was 44 (range 23–88 minutes. Of the 55 patients, 33 (60% healed completely and did not require any further surgical treatment at end of follow-up. Twenty-two (40% recurrences and six complications were observed. Compared with patients who had undergone more than two surgical procedures, LIFT was more suitable for patients who had undergone one to two surgical procedures, and significant difference was observed in number of operations before LIFT (p=0.002. Clinicians can consider the use of LIFT for the treatment of recurrent anal fistulas. A larger number of patients and prospective study are needed to be performed.

  13. Ligation of Intersphincteric Fistula Tract Is Suitable for Recurrent Anal Fistulas from Follow-Up of 16 Months.

    Science.gov (United States)

    Xu, Yansong; Tang, Weizhong

    2017-01-01

    Since 2007, ligation of the intersphincteric fistula tract (LIFT) for the management of anal fistula was all introduced with initial success and excitement. It remains controversial which surgical procedure is suitable for transsphincteric fistula, especially to complex anal fistula. This retrospective study was designed to evaluate the results in patients with recurrent anal fistula by LIFT. A retrospective study of 55 complex fistula patients who underwent LIFT procedure in a single medical center was analyzed. Patients and fistula characteristics, complications, and recurrences were reviewed. All 55 patients underwent the procedure with a median follow-up of 16 months. Median operative time was 44 (range 23-88) minutes. Of the 55 patients, 33 (60%) healed completely and did not require any further surgical treatment at end of follow-up. Twenty-two (40%) recurrences and six complications were observed. Compared with patients who had undergone more than two surgical procedures, LIFT was more suitable for patients who had undergone one to two surgical procedures, and significant difference was observed in number of operations before LIFT (p = 0.002). Clinicians can consider the use of LIFT for the treatment of recurrent anal fistulas. A larger number of patients and prospective study are needed to be performed.

  14. Ligation of Intersphincteric Fistula Tract Is Suitable for Recurrent Anal Fistulas from Follow-Up of 16 Months

    Science.gov (United States)

    2017-01-01

    Since 2007, ligation of the intersphincteric fistula tract (LIFT) for the management of anal fistula was all introduced with initial success and excitement. It remains controversial which surgical procedure is suitable for transsphincteric fistula, especially to complex anal fistula. This retrospective study was designed to evaluate the results in patients with recurrent anal fistula by LIFT. A retrospective study of 55 complex fistula patients who underwent LIFT procedure in a single medical center was analyzed. Patients and fistula characteristics, complications, and recurrences were reviewed. All 55 patients underwent the procedure with a median follow-up of 16 months. Median operative time was 44 (range 23–88) minutes. Of the 55 patients, 33 (60%) healed completely and did not require any further surgical treatment at end of follow-up. Twenty-two (40%) recurrences and six complications were observed. Compared with patients who had undergone more than two surgical procedures, LIFT was more suitable for patients who had undergone one to two surgical procedures, and significant difference was observed in number of operations before LIFT (p = 0.002). Clinicians can consider the use of LIFT for the treatment of recurrent anal fistulas. A larger number of patients and prospective study are needed to be performed.

  15. Acceptable results using plug for the treatment of complex anal fistulas

    DEFF Research Database (Denmark)

    Kleif, Jakob; Hagen, Kikke; Wille-Jørgensen, Peer

    2011-01-01

    The management of complex fistula-in-ano remains a surgical challenge. Previously published studies on the treatment of fistula-in-ano with the anal fistula plug (AFP) have reported a success rate reaching 35-87%. The aim of this study was to assess the results of the AFP procedure in a group...... of Danish patients with complex fistulas, and to analyse if the results were compatible with previous international findings....

  16. Application of YAG laser technique in the treatment of anal fistula

    Science.gov (United States)

    Liu, Jian-xun; Zhang, Xinrong

    1993-03-01

    The method of treating anal fistula with YAG laser technique is described in this essay. One-hundred-twenty patients have been treated successfully with this method and no recurrence was found in our series. Anal fistula is a common disorder in the anus and rectum. The tunnel of fistula zigzags around the external or internal sphincters. If the drainage is poor, and the skin around the external opening grows rapidly, false healing may occur and cause recurrent abscess. In this case, a fistula can not be cured except by operation.

  17. Bacteriological comparison of low anal fistula operated by ordinary methods and laser methods

    Science.gov (United States)

    Yang, Yuanrong; Xiong, Yigai

    1996-09-01

    Since 1989, 42 cases with low anal fistula were operated with laser and ordinary methods respectively. During the operation, secreted or charred tissues were extracted from the surface of the wound for bacteria culture. Experimental group (laser method): no bacteria were found in 24 cases operated by laser method. Control group (ordinary method): bacterial were found in 16 out of 18 cases operated by ordinary methods. The results of two different group showed that they had statistical difference for P anal fistula were operated by the laser, the neurotic carboatomic tissue can block blood vessel and prevent infection from spreading. The high temperature produced by the carboatomic action have enough ability to kill directly the bacteria living in the anal fistula.

  18. [Laparoscopic abdominoperineal resection after preoperative chemoradiotherapy for advanced carcinoma associated with anal fistula].

    Science.gov (United States)

    Morikawa, Takashi; Yamashita, Kimihiro; Sumi, Yasuo; Kanemitsu, Kiyonori; Yamamoto, Masashi; Kanaji, Shingo; Imanishi, Tatsuya; Nakamura, Tetsu; Suzuki, Satoshi; Tanaka, Kenichi; Kakeji, Yoshihiro

    2014-11-01

    The patient was a 71-year-old man who was diagnosed with anal fistula 50 years previously. He complained of mucous and bloody stools. He was diagnosed with a carcinoma associated with anal fistula after biopsy. Image examination showed that the tumor was filled with mucinous substances and that it had invaded the levator ani muscle, with left external iliac and left inguinal lymph node metastases. Therefore, preoperative chemoradiotherapy for locally advanced cancer was administered. After chemoradiotherapy, the tumor and metastatic lymph nodes reduced in size. We performed laparoscopic abdominoperineal resection. Histopathologically, the tumor was revealed as a mucinous adenocarcinoma, but no cancer cells were present on the surgical margin. This case suggested that preoperative chemoradiotherapy could be effective for locally advanced carcinoma associated with anal fistula.

  19. Pro-inflammatory cytokines in cryptoglandular anal fistulas

    NARCIS (Netherlands)

    van Onkelen, R. S.; Gosselink, M. P.; van Meurs, M.; Melief, M. J.; Schouten, W. R.; Laman, J. D.

    2016-01-01

    Sphincter-preserving procedures for the treatment of transsphincteric fistulas fail in at least one out of every three patients. It has been suggested that failure is due to ongoing disease in the remaining fistula tract. Cytokines play an important role in inflammation. At present, biologicals targ

  20. Treatment of Anal Fistulas With High Intersphincteric Extension

    NARCIS (Netherlands)

    van Onkelen, Robbert S.; Gosselink, Martijn P.; Schouten, Willem R.

    2013-01-01

    BACKGROUND: Intersphincteric fistulas with a high upward extension, up to or above the level of the puborectal muscle, in the intersphincteric plane are rare. Most of these fistulas have no external opening and they are frequently associated with a high intersphincteric and/or supralevator abscess.

  1. [A case report of metastatic anal fistula cancer treated with neoadjuvant chemotherapy].

    Science.gov (United States)

    Murata, Akihiro; Takatsuka, Satoshi; Shinkawa, Hiroji; Kaizaki, Ryoji; Hori, Takaaki; Ikehara, Teruyuki

    2014-11-01

    A 69-year-old man with perianal pain was diagnosed with an anal fistula and a rectal tumor by magnetic resonance imaging and pulmonary tuberculosis by computed tomography. A colonoscopy confirmed the presence of a circular mass in the rectum 6 cm from the anal verge. Histological examination revealed a moderately differentiated adenocarcinoma. Initially, seton drainage was used to improve the perianal pain. After 2 months of anti-tuberculosis therapy, the patient underwent low anterior resection for the rectal cancer. Six months after surgery, a perianal tumor was detected at the postoperative site of the anal fistula. Biopsy of the tumor revealed adenocarcinoma. Because the histological appearance of the second tumor was identical to the rectal cancer, it was diagnosed as a metastatic anal fistula cancer. The tumor shrunk after 3 courses of neoadjuvant chemotherapy with S-1 plus oxaliplatin (SOX) plus bevacizumab and there was no evidence of distant metastasis. Local resection of the anal fistula cancer was performed. Six months postoperatively, the patient is doing well and shows no sign of recurrence.

  2. Imaging of Anal Fistulas: Comparison of Computed Tomographic Fistulography and Magnetic Resonance Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Liang, Changhu [Shandong Medical Imaging Research Institute, Shandong University, Jinan 250021 (China); Lu, Yongchao [Traditional Chinese Medicine Department, Provincial Hospital Affiliated to Shandong University, Jinan 250021 (China); Zhao, Bin [Shandong Medical Imaging Research Institute, Shandong University, Jinan 250021 (China); Du, Yinglin [Shandong Provincial Center for Disease Control and Prevention, Public Health Institute, Jinan 250014 (China); Wang, Cuiyan [Shandong Medical Imaging Research Institute, Shandong University, Jinan 250021 (China); Jiang, Wanli [Department of Radiology, Taishan Medical University, Taian 271000 (China)

    2014-07-01

    The primary importance of magnetic resonance (MR) imaging in evaluating anal fistulas lies in its ability to demonstrate hidden areas of sepsis and secondary extensions in patients with fistula in ano. MR imaging is relatively expensive, so there are many healthcare systems worldwide where access to MR imaging remains restricted. Until recently, computed tomography (CT) has played a limited role in imaging fistula in ano, largely owing to its poor resolution of soft tissue. In this article, the different imaging features of the CT and MRI are compared to demonstrate the relative accuracy of CT fistulography for the preoperative assessment of fistula in ano. CT fistulography and MR imaging have their own advantages for preoperative evaluation of perianal fistula, and can be applied to complement one another when necessary.

  3. [Application and development of suture-dragging therapy for anal fistula].

    Science.gov (United States)

    Wang, Chen; Yao, Yibo; Dong, Qingjun; Liang, Hongtao; Guo, Xiutian; Cao, Yongqing; Lu, Jingen

    2015-12-01

    Traditional Chinese surgical treatment "suture-dragging" therapy is based on medical thread therapy and tight seton drainage in combination of minimal invasive surgical principle. It can preserve the integrity of anal sphincter musculature involved in fistulous tract or abscess and maintain anal function. This article not only describes in detail about the operation points and mechanisms of "suture-dragging" therapy of anorectal fistula, but also reviews the application and modification of anorectal disease.

  4. Drain fistulography: Radiological sphincter identification in high anal fistulae. Drain-Fistulographie. Radiologische Sphinkteridentifikation bei hohen Analfisteln

    Energy Technology Data Exchange (ETDEWEB)

    Barton, P. (Abt. fuer Roentgendiagnostik, 1. Chirurgische Universitaetsklinik, Vienna (Austria)); Wunderlich, M. (Krankenhaus Hollabrunn (Austria). Chirurgische Abt.); Herbst, F. (1. Chirurgische Universitaetsklinik, Vienna (Austria)); Jantsch, H. (Abt. fuer Roentgendiagnostik, 1. Chirurgische Universitaetsklinik, Vienna (Austria)); Waneck, R. (Abt. fuer Roentgendiagnostik, 1. Chirurgische Universitaetsklinik, Vienna (Austria)); Lechner, G. (Abt. fuer Roentgendiagnostik, 1. Chirurgische Universitaetsklinik, Vienna (Austria))

    1993-07-01

    To warrant permanent surgical cure of high anal fistulae, while avoiding at the same time faecal incontinence due to inadvertent division of the puborectalis muscle, distinction between a trans- and suprasphincteric fistula track is essential. This differentiation is often crucial, since digital-rectal palpation and conventional fistulography tend to be unreliable. Therefore we developed a radiological technique of imaging the anorectal fistulous track, 'drain fistulography'. After silicon drainage of the fistula the contrast-visualization of anal canal, rectum and fistula drain allows to assess the topographic relation between fistula and anal sphincters as well as the sphincteric functional component above the fistula. A transsphincteric fistula track was demonstrated in 7 of 8 patients (5 with recurrent fistulae) by means of 'drain fistulography', permitting complete laying open of each fistula in a second operation. In one patient a supraphincteric fistula track was found and a 'mucosal flap repair' was carried out. After a mean observation time of 53 months all patients are perfectly continent and free of recurrence. The method of 'drain fistulography' is a valuable diagnostic tool to select the appropriate definitive surgical procedure in the treatment of high anal fistulae. (orig.)

  5. Minimally Invasive Anal Fistula Treatment (MAFT)-An Appraisal of Early Results in 416 Patients.

    Science.gov (United States)

    Chowbey, P K; Khullar, R; Sharma, A; Soni, V; Najma, K; Baijal, M

    2015-12-01

    Minimally invasive anal fistula treatment (MAFT) was introduced to minimize early postoperative morbidity, preserve sphincter continence, and reduce recurrence. We report our early experience with MAFT in 416 patients. Preoperative MRI was performed in 150 patients initially and subsequently thereafter. The technique involves fistuloscope-aided localization of internal fistula opening, examination and fulguration of all fistula tracks, and secure stapled closure of internal fistula opening within anal canal/rectum. MAFT was performed as day-care procedure in 391 patients (93.9 %). During surgery, internal fistula opening could not be located in 100 patients (24 %). Seven patients required readmission to hospital. Mean visual analog scale scores for pain on discharge and at 1 week were 3.1 (1-6) and 1.6 (0-3), respectively. Mean duration for return to normal activity was 3.2 days (2-11 days). Fistula recurrence was observed in 35/134 patients (26.1 %) at 1 year follow-up. MAFT may be performed as day-care procedure with benefits of less pain, absence of perianal wounds, faster recovery, and preservation of sphincter continence. However, long-term results from more centers are needed especially for recurrence.

  6. Fibrin glue in the treatment of anal fistula: a systematic review

    Directory of Open Access Journals (Sweden)

    Covarelli Piero

    2009-11-01

    Full Text Available Abstract Background New sphincter-saving approaches have been applied in the treatment of perianal fistula in order to avoid the risk of fecal incontinence. Among them, the fibrin glue technique is popular because of its simplicity and repeatability. The aim of this review is to compare the fibrin glue application to surgery alone, considering the healing and complication rates. Methods We performed a systematic review searching for published randomized and controlled clinical trials without any language restriction by using electronic databases. All these studies were assessed as to whether they compared conventional surgical treatment versus fibrin glue treatment in patients with anal fistulas, in order to establish both the efficacy and safety of each treatment. We used Review Manager 5 to conduct the review. Results The healing rate is higher in those patients who underwent the conventional surgical treatment (P = 0,68, although the treatment with fibrin glue gives no evidence of anal incontinence (P = 0,08. Furthermore two subgroup analyses were performed: fibrin glue in combination with intra-adhesive antibiotics versus fibrin glue alone and anal fistula plug versus fibrin glue. In the first subgroup there were not differences in healing (P = 0,65. Whereas in the second subgroup analysis the healing rate is statistically significant for the patients who underwent the anal fistula plug treatment instead of the fibrin glue treatment (P = 0,02. Conclusion In literature there are only two randomized controlled trials comparing the conventional surgical management versus the fibrin glue treatment in patients with anal fistulas. Although from our statistical analysis we cannot find any statistically significant result, the healing rate remains higher in patients who underwent the conventional surgical treatment (P = 0,68, and the anal incontinence rate is very low in the fibrin glue treatment group (P = 0,08. Anyway the limited collected data do

  7. Management of low transsphincteric anal fistula with serial setons and interval muscle-cutting fistulotomy.

    Science.gov (United States)

    Wang, Chen; Rosen, Lester

    2016-03-01

    This study evaluates low transsphincteric anal fistula managed by serial setons and interval fistulotomy, with attention to healing without recurrence and preservation of continence. Following Institutional Review Board approval, consecutive anal fistula operations performed by a single surgeon from January 1, 2009 to December 31, 2013 were retrospectively reviewed using electronic medical records and telephone interviews for patients lost to follow up. Of the 71 patients, 26 (37%) had low transsphincteric fistula (23 males and 3 females; mean age: 46 years), treated at our institution by seton placement followed by interval surgical muscle cutting and subsequent seton replacement or final fistulotomy. Of the 26 patients, 22 (85%) were initially referred due to previous failed treatment, with a 30.6 month mean duration of fistula prior to referral and a mean of 2.2 (range: 0 -6) prior anorectal surgeries. At a mean follow-up of 11.9 months, none of the 21 patients experienced recurrence or fecal incontinence. Serial seton with interval muscle-cutting sphincterotomy followed by complete fistulotomy is an effective treatment for the management of patients who are either initially seen for low transsphincteric fistula, or referred after failed anorectal surgery for that condition.

  8. Obesity is a negative predictor of success after surgery for complex anal fistula

    Directory of Open Access Journals (Sweden)

    Schwandner O

    2011-05-01

    Full Text Available Abstract Background It was the aim of this study to compare the outcome of surgery for complex anal fistulas in obese and non-obese patients. Methods All patients with complex anorectal fistulas who underwent fistulectomy and/or rectal advancement flap repair were prospectively recorded. Surgery was performed in a standardized technique. Body mass index (BMI [kg/m2] was used as objective measure to indicate morbid obesity. Patients with a BMI greater than 30 were defined as obese, and patients with a BMI below 30 were defined as non-obese. The parameters analyzed related to BMI included success or failure, and reoperation rate due to recurrent abscess. Success was defined as closure of both internal and external openings, absence of drainage without further intervention, and absence of abscess formation. Results Within two years, 220 patients underwent advancement flap repair and met the inclusion criteria. 55% of patients were females, mean age was 39 (range 18-76 years, and the majority of fistulas were located at the posterior site. 69% of patients (152/220 were non-obese (BMI 30. After a median follow-up of 6 months, primary healing rate ("success" for the whole collective was 82% (180/220. Success was significantly different between non-obese and obese patients: In non-obese patients, recurrence rate was significantly lower than in obese patients (14% vs. 28%; p Conclusion Obese patients are at higher risk for failure after surgery for complex anal fistula.

  9. Effect of Shengji Yuhong plaster on the wound healing after anal fistula surgery

    Institute of Scientific and Technical Information of China (English)

    Jin-Zhong Liu; Ma Li

    2016-01-01

    Objective:To observe the effect of Shengji Yuhong plaster on the wound healing after anal fistula surgery.Methods:A total of 120 patients with anal fistula who were admitted in our hospital from January, 2011 to December, 2013 for operation were included in the study and randomized into the observation group and the control group with 50 cases in each group after operation. The patients in the observation group were given external application of Shengji Yuhong plaster, while the patients in the control group were given vaselinum ribbon gauze. The patients in the two groups were given 3-week treatment. The wound area, granulation form, healing rate, healing time, and adverse reactions 1, 2, 3 weeks after operation in the two groups were compared.Results:The wound area 1, 2, 4 weeks after operation in the observation group was significantly less than that in the control group (P<0.05). The granulation form score was significantly lower than that in the control group (P<0.05). The wound repairing rate and the total effective rate were significantly higher than those in the control group (P<0.05), and the average healing time was significantly faster than that in the control group (P<0.05). Conclusions:Shengji Yuhong plaster can significantly shorten the wound healing time in patients after anal fistula surgery and is beneficial for the postoperative rehabilitation.

  10. 浅谈肛瘘的手术治疗%Surgical treatment of anal fistula

    Institute of Scientific and Technical Information of China (English)

    蔡湛

    2013-01-01

    肛瘘是临床较为常见的一种疾病,一般不能自愈,目前其根本的治疗方法仍是手术。近年来我国肛瘘手术都在原有的基础上做了创新和改进,但基本方法没变。可分为括约肌保存手术和括约肌切断手术两大类。每种手术都有利弊,根据临床检查确定肛瘘的类型,选择合适的手术治疗方法,达到减轻患者痛苦,降低术后复发率的目的。%Anal fistula was a clinical common disease, generally cannot self-healing.Operation was still the basic method in the treatment. In recent years our country anal fistula operation in the original basis for innovation and improvement, but did not change the basic method. Can be di-vided into the sphincter preservation operation and sphincter operation two categories. Each opera-tion had advantages and disadvantages, according to the clinical examination to determine the type of operation of anal fistula, chose a suitable treatment method, alleviated the suffering of patients, reduced the postoperative recurrence rate of purpose.

  11. Case of anal fistula with Fournier's gangrene in an obese type 2 diabetes mellitus patient.

    Science.gov (United States)

    Yoshino, Hiroshi; Kawakami, Kyoko; Yoshino, Gen; Sawada, Katsuhiro

    2016-03-01

    A 64-year-old man was admitted to Shin-suma General Hospital, Kobe, Japan, complaining of a 3-day history of scrotal swelling and high fever. He had type 2 diabetes mellitus. On examination, his body temperature had risen to 38.5 °C. Examination of the scrotum showed abnormal enlargement. Laboratory data were as follows: white cell count 35,400/μL and glycated hemoglobin 9.6%. Anal fistula was found in an endorectal ultrasound. Computed tomography scan showed a relatively high density of subcutaneous tissue and elevated air density. Thus, he was diagnosed with Fournier's gangrene. On the fourth hospital day, the patient underwent debridement of gangrenous tissue. Seton surgery was carried out for anal fistula on the 34th hospital day. He responded to the treatment very well. He was discharged on the 33rd postoperative day. Once Fournier's gangrene has been diagnosed, considering the association of anal fistula and perianal abscess is important.

  12. 肛瘘的外科治疗%Surgical treatment of anal fistula

    Institute of Scientific and Technical Information of China (English)

    曾宪东; 张勇

    2014-01-01

    Anal fistula is a common disease. It is also quite difficult to be solved without recurrence or damage to the anal sphincter. Several techniques have been described for the management of anal fistula, but there is no final conclusion of their application in the treatment. This article summarizes the history of anal fistula management, the current techniques available, and describes new technologies. Internet online searches were performed from the CNKI and Wanfang databases to identify articles about anal fistula management including seton, fistulotomy, fistulectomy, LIFT operation, biomaterial treatment and new technology application. Every fistula surgery technique has its own place , so it is reasonable to give comprehensive individualized treatment to different patients, which may lead to reduced recurrence and avoidance of damage to the anal sphincter. New technologies provide promising alternatives to traditional methods of management. Surgeons still need to focus on the invention and improvement of the minimally invasive techniques. Besides, a new therapeutic idea is worth to explore that the focus of surgical treatment should be transferred to prevention of the formation of anal fistula after perianal abscess.%肛瘘是常见的肛周疾病。肛瘘的治疗难点在于降低术后复发率与保护肛周括约肌。目前肛瘘外科治疗方法较多,但在临床应用中各种方法的应用指征与价值仍无定论。本文将综述国内肛瘘外科治疗方法的发展、现状、新技术的临床应用结果。在中国期刊数据库与万方数据裤中检索国内肛瘘外科治疗的相关文献,包括挂线治疗、肛瘘切开术与切除术、LIFT手术以及生物材料治疗和新技术应用的文献。肛瘘外科治疗方法较多但各有千秋,因此施行肛瘘的个体化综合治疗可最大限度的实现低复发率与最大限度的括约肌保护。肛瘘外科治疗新技术的产生实现了对传统治疗的最大

  13. Operative treatment of radiation-induced fistulae

    Energy Technology Data Exchange (ETDEWEB)

    Balslev, I.; Harling, H.

    1987-01-01

    Out of 136 patients with radiation-induced intestinal complications, 45 had fistulae. Twenty-eight patients had rectovaginal fistulae while the remainder had a total of 13 different types of fistulae. Thirty-seven patients were treated operatively and eight were treated conservatively. Thirty-three patients were submitted to operation for rectal fistulae. Of these, 28 were treated by defunctioning colostomy, three were treated by Hartmann's method and resection and primary anastomosis was carried out in two patients. In the course of the period of observation, 35% of the patients developed new radiation damage. The frequency in the basic material without fistulae was 21% (0.05fistulae in 25 patients, eight patients developed new fistulae, Significantly more patients with fistulae died of recurrence as compared with patients with other lesions (p<0.01). Defunctioning colostomy in the treatment of rectal fistula is a reasonable form of treatment in elderly patients and in case of recurrence. Younger patients should be assessed in a special department in view of the possibility of a sphincter-preserving procedure following resection of the rectum and restorative anastomosis. 11 refs.

  14. Anal fistula with foot extension—Treated by kshara sutra (medicated seton) therapy: A rare case report

    Science.gov (United States)

    Ramesh, P. Bhat

    2013-01-01

    INTRODUCTION An ‘anal’ fistula is a track which communicates anal canal or rectum and usually is in continuity with one or more external openings. Distant communication from rectum is rare. It is a challenging disease because of its recurrence especially, with high level and distant communications. Ksharasutra (medicated seton) therapy is being practiced in India with high success rate (recurrence of 3.33%) in the management of complicated anal fistula. PRESENTATION OF CASE A 56 year old man presented with recurrent boils in the left lower limb at different places from thigh to foot. He underwent repeated incision and drainage at different hospitals. Examination revealed sinus with discharge and multiple scars on left lower limb from thigh up to foot. Suspecting anal fistula, MRI was advised which revealed a long cutaneous fistula from rectum to left lower limb. Patient was treated with Ksharasutra therapy. Within 6 months of treatment whole tract was healed completely. DISCUSSION Sushrutha (500BC) was the first to explain the role of surgical excision and use of kshara sutra for the management of anal fistula. Ksharasutra therapy showed least recurrence. Fistula from rectum to foot is of extremely rare variety. Surgical treatment of anal fistula requires hospitalization, regular post-operative care, is associated with a significant risk of recurrence (0.7–26.5%) and a high risk of impaired continence (5–40%). CONCLUSION Rectal fistula communicating till foot may be a very rare presentation in proctology practice. Kshara sutra treatment was useful in treating this condition, with minimal surgical intervention with no recurrence. PMID:23702360

  15. Effect of Suyuping combined with semiconductor laser irradiation on wound healing after anal fistula surgery

    Institute of Scientific and Technical Information of China (English)

    Min Zhao; Chang-Ye Sang; Zhen-Jun Wang; Yan-Chun Xu

    2016-01-01

    Objective:To explore the effect of Suyuping combined with semiconductor laser irradiation on the wound healing after anal fistula surgery.Methods:A total of 180 patients with anal fistula who were admitted in our hospital from October, 2013 to May, 2015 for surgery were included in the study and randomized into the treatment group and the control group with 90 cases in each group. The patients in the control group were given the conventional surgical debridement dressing, a time a day. On this basis, the patients in the treatment group were given Suyuping smearing on the wound sinus tract combined with semiconductor laser irradiation, a time a day for 10 min, continuous irradiation until wound healing. The postoperative wound swelling fading, wound surface secretion amount, and the clinical efficacy in the two groups were recorded.Results:The wound surface swelling degree and wound pain degree at each timing point after operation in the treatment group were significantly lower than those in the control group (P<0.05). The wound surface area at each timing point after operation in the treatment group was significantly lower than that in the control group (P<0.05). The wound surface secretion amount 6, 9, and 12 days after operation in the treatment group was significantly lower than that in the control group (P<0.05). The total effective rate in the treatment group was significantly higher than that in the control group (P<0.05). The average healing time in the treatment group was significantly faster than that in the control group (P<0.05). Conclusions: Suyuping combined with semiconductor laser irradiation in the treatment of patients after anal fistula can effectively improve the local blood and lymphatic circulation of wound surface, promote the growth of granulation tissues, and contribute the wound healing.

  16. Presacral Teratocarcinoma Presenting as Anal Fistula and Rectal Adenocarcinoma: A Unique Case Presentation and Literature Review

    Directory of Open Access Journals (Sweden)

    S.P. Ho

    2012-02-01

    Full Text Available Somatic malignancy arising from presacral or retroperitoneal primary teratoma is extremely rare. We report the case of a 37-year-old male patient with adenocarcinoma of respiratory type arising from primary presacral teratoma, but which first presented as anal fistula and rectal adenocarcinoma. The two tumors show the same morphology and immunophenotype (CK7–CK20+CDx2+. Malignant adenocarcinoma transformations from the normal respiratory epithelium are also found. To the best of our knowledge, this is the second case of respiratory type adenocarcinoma arising from primary presacral mature cystic teratoma.

  17. Is anal endosonography useful in the study of recurrent complex fistula-in-ano? ¿Es útil la ecografía endoanal en el estudio de la fístula anal compleja recidivada?

    Directory of Open Access Journals (Sweden)

    A. M. Fernández-Frías

    2006-08-01

    Full Text Available Introduction: performing anal endosonography in complex fistula-in-ano allows us to design a personalized surgical strategy in each case, thereby improving results. However, there are doubts in the literature as to its utility in recurrent complex fistulas. The aim of this study was to compare the utility of anal ultrasonography in the study of primary versus recurrent complex fistula-in-ano. Patients and method: prospective study of patients diagnosed and treated for complex fistula-in-ano. Physical examination and anal ultrasonography provided data on primary track, internal opening, horseshoe extension and the presence of secondary tracks or cavities in a protocol designed specifically for the study. These assessments were subsequently contrasted with operative findings. Results: we included 35 patients, 19 (54.3% with primary complex anal fistulas and 16 (45.7% with recurrent fistulas. According to the operative findings, fistulas were classified as high transsphincteric in 28 patients (80%, suprasphincteric in 6 (17.1% and extrasphincteric in one patient (2.9%, with no differences between groups. Physical examination correctly classified 28 of the 35 fistulous tracks, in contrast to the 32 (91.4% correctly described on ultrasonography (80%. We did not find any statistically significant differences between the primary and the recurrent fistula groups with regard to sensibility, positive predictive value and accuracy of the anal ultrasonography for any of the parameters studied. Conclusion: the accuracy of anal ultrasonography does not decrease in recurrent complex fistula-in-ano.

  18. Traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess

    Institute of Scientific and Technical Information of China (English)

    Chen Wang; Jin-Gen Lu; Yong-Qing Cao; Yi-Bo Yao; Xiu-Tian Guo; Hao-Qiang Yin

    2012-01-01

    AIM:To evaluate the efficacy and safety of traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess.METHODS:Sixty patients with intersphincteric or transsphincteric anal fistulas with secondary tracks and abscess were randomly divided into study group [suture dragging combined with pad compression (SDPC)] and control group [fistulotomy (FSLT)].In the SDPC group,the internal opening was excised and incisions at external openings were made for drainage.Silk sutures were put through every two incisions and knotted in loose state.The suture dragging process started from the first day after surgery and the pad compression process started when all sutures were removed as wound tissue became fresh and without discharge.In the FSLT group,the internal opening and all tracts were laid open and cleaned by normal saline postoperatively till all wounds healed.The time of healing,postoperative pain score (visual analogue scale),recurrence rate,patient satisfaction,incontinence evaluation and anorectal manometry before and after the treatment were examined.RESULTS:There were no significant differences between the two groups regarding age,gender and fistulae type.The time of healing was significantly shorter (24.33 d in SDPC vs 31.57 d in FSLT,P < 0.01) and the patient satisfaction score at 1 mo postoperative follow-up was significantly higher in the SDPC group (4.07 in SDPC vs 3.37 in FSLT,P < 0.05).The mean maximal postoperative pain scores were 5.83 ± 2.5 in SDPC vs 6.37 ± 2.33 in FSLT and the recurrence rates were 3.33 in SDPC vs 0 in FSLT.None of the patients in the two groups experienced liquid and solid fecal incontinence and lifestyle alteration postoperatively.The Wexner score after treatment of intersphincter fistulae were 0.17 ± 0.41 in SDPC vs 0.40 ± 0.89 in FSLT and transsphincter fistulae were 0.13 ± 0.45 in SDPC vs 0.56 ±1.35 in FSLT.The maximal squeeze pressure and resting pressure declined after treatment in both groups

  19. Magnetic resonance imaging for assessment of anal fistula%MRI 对肛瘘的评价

    Institute of Scientific and Technical Information of China (English)

    谢元忠; 李秀娟; 盛蕾

    2014-01-01

    It is necessary for surgeon to know the relationship between the fistula and the anal sphincter and whether there are any secondary fistulas resulting from the primary fistulas that need to be treated before anal fistula surgery .It is now increasingly recognized that magnetic resonance imaging ( MRI) is very important in anal fistula and is likely to become the main tool to classify the fistula preoperatively .Not only the anal anatomy , fistula type and internal opening , but also the disease which other examines fail to find out such as secondary infections which can cause a recurrence can be displayed well in MRI .This review summarizes the MRI method and imaging anatomy of anal canal and dependency structure , the value of MRI in displaying anal fistula type , fistula course and internal opening location , and the effect of MRI for clinical diagnosis and treatment and prognosis of patients .%肛瘘术前要求外科医师必须清楚瘘管和肛门括约肌之间的关系,有无来源于原发管的继发管需要治疗处理。 MRI在诊断肛瘘中的价值越来越受到临床重视,已成为术前瘘管分类的主要方法。 MRI不仅能精确显示肛管及其肛管周围的解剖,而且能将瘘管分类、明确瘘管的类型、寻找内口位置,同时还能识别其他检查方法未能发现的疾病,如术后是否存在可能会导致复发的继发感染病灶。本文主要综述肛管及相关结构的MRI检查方法、影像解剖表现,以及MRI对肛瘘类型、瘘管形态走行及瘘口的显示价值及其对临床诊治及患者转归的影响。

  20. 高分辨MR成像用于肛瘘分级%High-resolution MRI for anal fistula classification

    Institute of Scientific and Technical Information of China (English)

    郭友; 陈曌; 刘碧华; 黎见明

    2011-01-01

    Objective To observe the clinical value of high-resolution MRI for anal fistula classification.Methods Thirteen patients with surgically proved anal fistulas underwent preoperative high-resolution MR imaging.The imaging protocol included fast field echo (FFE) TlWI at axial planes, turbo spin echo (TSE) T2WI at axial and coronal planes, spectral presaturation inversion recover (SPIR) T2WI at axial planes and contrast-enhancement T1 high resolution isotropic volume excitation (THRIVE).All anal fistulas were classed based-on MRI and compared with operation, including the appearances of internal fistula, extra fistula, fistula canales and perianal abscess.Results In 13 patients, 1 anal fistula was grade Ⅰ , 1 was grade Ⅱ , 1 was grade Ⅲ, 5 were grade Ⅳ and 5 were grade Ⅴ.There were 18 fistula canales, 13 internal fistulas, 11 extra fistulas and 11 perianal abscess in operation.MR displayed 16 fistula canales, 13 internal fistulas, 11 extra fistulas and 11 perianal abscess.The diagnostic accuracy of MRI for fistula was 88.89 % (16/18), the positive rate for internal fistula was 92.86% (13/14).The site, number and perianal abscess of external fistula showed with MRI was the same with operation.Conclusion High-resolution MRI is a very accurate preoperative technique for evaluating the classification of anal fistula.Preoperative MRI can dictate the surgical procedure of choice and is an important determinant of outcome.%目的 探讨高分辨MR成像对肛瘘分级的价值.方法 经手术证实的肛瘘患者13例,全部接受高分辨MR检查,检查序列包括:轴位快速场回波T1WI、冠状位及轴位快速自旋回波T2WI、轴位频谱预饱和翻转恢复T2WI和增强T1高分辨力各向同性容积激励序列.评价MRI检出的瘘管、内口、外口、肛周脓肿及其数量,进行分级,并与手术所见对照.结果 13例肛瘘中,Ⅰ级1例,Ⅱ级1例,Ⅲ级1例,Ⅳ级5例,Ⅴ级5例.手术发现13例肛瘘中共有18个瘘管,11

  1. Fistulas

    Science.gov (United States)

    A fistula is an abnormal connection between two parts inside of the body. Fistulas may develop between different organs, such as between ... two arteries. Some people are born with a fistula. Other common causes of fistulas include Complications from ...

  2. 括约肌外侧切开肛瘘栓填塞--一种改良的肛瘘栓技术%Extrasphincteric Incision and Anal Fistula Plug Repair:a Modified Technique of Anal Fistula Plugging

    Institute of Scientific and Technical Information of China (English)

    于锦利; 鹿雅镜; 段宏岩; 蔡姮婧

    2015-01-01

    2014年10月,对2例括约肌上型肛瘘患者,术前不进行挂线治疗,在括约肌外侧瘘管转折处切断瘘管,将瘘管分为两部分,分别填塞1枚肛瘘栓并缝合固定,通畅引流。2例全部治愈,术后无并发症,肛门功能良好,外口愈合时间12、13 d,肛缘伤口愈合时间50、45 d。随访8个月,无复发。%[Summary] Two cases of suprasphincteric anal fistula were treated in October 2014.Without preoperative seton insertion, the fistula was cut off at the turning point outside the sphincter muscle and filled with 1 piece of anal fistula plug at both end respectively. Adequate drainage was utilized.The 2 cases were all cured, without complications after the operation.The anal function was normal. The healing time of the external opening was 12 and 13 days, while the healing time of the anal margin wound was 50 and 45 days.No recurrence happened during a follow-up for 8 months.

  3. [Perianal mucinous adenocarcinoma. A further reason for histological study of anal fistula or anorectal abscess].

    Science.gov (United States)

    Marti, L; Nussbaumer, P; Breitbach, T; Hollinger, A

    2001-05-01

    A 39-year-old man came to us for surgical treatment of a hidradenitis suppurativa. Upon excision of a perianal abscess, the diagnosis of a rare tumor, a perianal mucinous adenocarcinoma (pT4, pN 1, MO), was made. An abdominoperineal resection was performed, followed by a combination of adjuvant radiation and chemotherapy. A year after the operation, the patient is doing well without any signs of recurrence. This carcinoma probably arises in the anal glands. It often presents as a perirectal abscess and/or an anal fistula. Therefore, the diagnosis is often delayed. At presentation, the tumor is bigger than 5 cm in diameter in 80% of the cases, and the prognosis is poor. It metastasizes mostly to the superficial inguinal or to the retrorectal lymph nodes. There are only case reports and no comparative studies in the literature. In the last 10 years, the carcinoma has mostly been treated by neoadjuvant radiation and chemotherapy, followed by abdominoperineal resection. Since then, the median survival has increased to 3 years. This is the first case report of a combination of a perianal mucinous adenocarcinoma with a hidradenitis suppurativa.

  4. Three-dimensional endoanal ultrasonographic assessment of an anal fistula with and without H_2O_2 enhancement

    Institute of Scientific and Technical Information of China (English)

    Yung Kim; Young Jin Park

    2009-01-01

    AIM: To evaluate the effectiveness of three-dimensional endoanal ultrasound (3D-EAUS) in the assessment of anal fistulae with and without H_2O_2 enhancement. METHODS: Sixty-one patients (37 males, aged 17-74 years) with anal fistulae, which were not simple low types, were evaluated by physical examination and 3D-EAUS with and without enhancement. Fistula classification was determined with each modality and compared to operative findings as the reference standard. RESULTS: The accuracy of 3D-EAUS was significantly higher than that of physical examination in detecting the primary tract (84.4% vs 68.7%, P = 0.037) and secondary extension (81.8% vs 62.1%, P = 0.01) and localizing the internal opening (84.2% vs 59.7%, P = 0.004). A contrast study with H_2O_2 detected several more fistula components including two primary suprasphincteric fistula tracks and one supralevator secondary extension, which were not detected on non-contrast study. However, there was no significant difference in accuracy between 3D-EAUS and H_2O_2- enhanced 3D-EAUS with respect to classification of the primary tract (84.4% vs 89.1%, P = 0.435) or secondary extension (81.8% vs 86.4%, P = 0.435) or localization of the internal opening (84.2% vs 89.5%, P = 0.406). CONCLUSION: 3D-EAUS was highly reliable in the diagnosis of an anal fistula. H_2O_2 enhancement was helpful at times and selective use in difficult cases may be economical and reliable.

  5. Sigmoid exclusion: a new technique in the management of radiation-induced fistula.

    Science.gov (United States)

    Aitken, R J; Elliot, M S

    1985-09-01

    Colovesical and colovaginal fistulas following irradiation for pelvic malignancy represent a formidable surgical problem. Although complex surgical procedures to close the fistulas and restore continence have been described, often a defunctioning colostomy with an associated urinary conduit is the only feasible option. Three patients who have successfully undergone an original procedure (sigmoid exclusion) are presented. Sigmoid exclusion restores continence but avoids a permanent stoma. The involved sigmoid colon was isolated on its mesentery ensuring that the area incorporating the fistulas was not disrupted. The ends of the isolated sigmoid colon were closed and bowel continuity then restored by a colorectal or colo-anal anastomosis. Following closure of a temporary colostomy the patients were continent with no ill effects or sepsis from the excluded colon. This procedure has the dual advantage of restoring continence yet avoiding both an urinary conduit and a permanent colostomy, and represents a useful advance in the surgical management of radiation induced colonic fistulas.

  6. Management of rare, low anal anterior fistula exception to Goodsall′s rule with Kṣārasūtra

    Directory of Open Access Journals (Sweden)

    Pradeep S Shindhe

    2014-01-01

    Full Text Available Anal fistula (bhagandara is a chronic inflammatory condition, a tubular structure opening in the ano-rectal canal at one end and surface of perineum/peri-anal skin on the other end. Typically, fistula has two openings, one internal and other external associated with chronic on/off pus discharge on/off pain, pruritis and sometimes passing of stool from external opening. This affects predominantly male patients due to various etiologies viz., repeated peri-anal infections, Crohn′s disease, HIV infection, etc., Complex and atypical variety is encountered in very few patients, which require special treatment for cure. The condition poses difficulty for a surgeon in treating due to issues like patient hesitation, trouble in preparing kṣārasūtra, natural and routine infection with urine, stool etc., and dearth of surgical experts and technique. We would like to report a complex and atypical, single case of anterior, low anal fistula with tract reaching to median raphe of scrotum, which was managed successfully by limited application of kṣārasūtra.

  7. Epithelial-to-mesenchymal transition in a fistula-associated anal adenocarcinoma in a patient with long-standing Crohn's disease.

    Science.gov (United States)

    Scharl, Michael; Frei, Pascal; Frei, Sandra M; Biedermann, Luc; Weber, Achim; Rogler, Gerhard

    2014-01-01

    Anal adenocarcinomas arising from perianal fistulae represent a rare complication in Crohn's disease (CD) patients. We have previously demonstrated the involvement of an epithelial-to-mesenchymal transition (EMT) in the pathogenesis of CD-associated fistulae. Although EMT has also been implicated in the development of colorectal and anal carcinoma, the molecular link from fistula to carcinoma is unclear. We present a case of a 48-year-old White woman who developed a mucinous anal adenocarcinoma originating from a perianal, CD-associated fistula 24 years after being diagnosed with CD. To characterize the expression of EMT-associated molecules in fistula and carcinoma tissue, immunohistochemical analysis for Snail1, Slug, β-catenin and E-cadherin was performed. A mucinous anal adenocarcinoma developed on a perianal fistula in a patient with long-standing CD. After neoadjuvant radiochemotherapy, the fistula-associated tumour was resected and the patient is presently in remission. Using immunohistochemical analysis, we detected a remarkable staining of the Slug transcription factor in transitional cells lining the fistula tract. This observation is unique to this 'carcinoma'-fistula: we had previously shown Slug expression in cells surrounding the fistula tract but not in transitional cells. Expression of Snail1, β-catenin and E-cadherin in this case was comparable with our previous findings. We describe a rare case of a CD fistula-associated adenocarcinoma within an area of squamous epithelium of the perianal area and an unusual expression pattern of EMT markers in this fistula. This case seems to underline the relevance of our previous findings demonstrating that EMT plays an important role for fistula pathogenesis and likely carcinogenesis in CD patients.

  8. 肛瘘微创手术的治疗进展%The Treatment Progress of Minimally-invasive Surgery for Anal Fistula

    Institute of Scientific and Technical Information of China (English)

    蒋捷

    2013-01-01

    The basic surgical treatment for anal fistula is the anal fistula incision and the anal fistula resection.The anal defect and the anal incontinence are the commonest complications during the treatment of anal fistula.Protecting the function of anus should be put in the first place of the treatment.Nowadays, most surgical treatments damage the function of anus, and along with the emerging of the minimally-invasive surgery, the protection of anal function is getting more and more concerned, so here is to make a review of the minimally-invasive surgery in anal fistula both in China and abroad.%肛瘘最基本的手术是肛瘘切开术和肛瘘切除术,肛瘘治疗过程中最常见的并发症为肛门缺损和肛门失禁.对肛瘘治疗来讲,保护肛门功能应该放在所有治疗目标的第一位.目前肛瘘治疗的术式多存在对肛门功能保护不足的现象,随着微创手术的兴起,目前对肛瘘的治疗越来越倡导肛门功能的保护,由此对国内外以微创手术方法治疗肛瘘的相关文献进行综述.

  9. Treating AIDS with Anal Fistula with TCM Therapy%中医方法治疗AIDS合并肛瘘患者35例体会

    Institute of Scientific and Technical Information of China (English)

    李俊岩; 张燚; 张秋实; 王晶; 李明哲

    2012-01-01

    运用探查切开挂线疗法辅以口服中药汤剂治疗AIDS合并肛瘘,取得较满意临床效果,现选取全身症状及专科查体相似的35例,将治疗体会报道如下.结论:中医药对AIDS合并肛瘘患者疗效显著;AIDS合并肛瘘患者有别于普通肛瘘患者.%Treating AIDS with anal fistula with ligating method combing with oral administration of TCM decoctions has got satisfied effects in clinic. 35 cases with similar general symptoms were introduced. TCM therapy has an obvious effect on AIDS with anal fistula. AIDS with anal fistula is different from common anal fistula.

  10. Anal fistula: results of surgical treatment in a consecutive series of patients

    Directory of Open Access Journals (Sweden)

    Paulo Gonçalves de Oliveira

    2012-03-01

    Full Text Available OBJECTIVES: To evaluate the results of surgical treatment of patients with anal fistulas in a consecutive series of patients. METHODS: A retrospective analytical study of a consecutive series of cases prospectively collected. The sample comprised 210 patients who underwent surgery; demographic data, signs and symptoms, intraoperative classification of the fistulas and healing time were analyzed. RESULTS: The median age was 38 years and 69.0% of the patients were male. The most frequent symptom was perianal orifice with purulent drainage. The fistulas were classified as transsphincteric in 60.9% and the most used operative treatment was the marsupialization of fistulotomy, in 84.2% of cases. Complete healing occurred in all patients between 2 and 16 weeks. One hundred and seventy-eight patients, 84.8% of the patients who underwent surgery, were evaluated at least one year after surgery and recurrence occurred in 6.4% of cases. CONCLUSIONS: There was male prevalence (2.2/1, and most fistulas were transsphincteric. The marsupialization of fistulotomy was the most used operative treatment, and it presented acceptable low rates of morbidity and recurrence of 6.4%.OBJETIVOS: Avaliar os resultados do tratamento cirúrgico de pacientes portadores de fístulas anais em uma série consecutiva de pacientes. MÉTODOS: Estudo analítico, retrospectivo, de uma série consecutiva de casos que foram coletados de forma prospectiva. A casuística englobou 210 pacientes operados, tendo sido analisados os dados demográficos, os sinais e sintomas, a classificação transoperatória das fístulas e o tempo até a cicatrização completa. RESULTADOS: A mediana de idade foi de 38 anos e 69,0% dos pacientes eram homens. O sintoma mais frequente foi a drenagem de secreção purulenta por orifício perianal. As fístulas foram classificadas como transesfincterianas em 60,9%, e o tratamento operatório mais empregado foi a fistulotomia com marsupialização do trajeto

  11. MRI检查对肛瘘诊断价值的研究%MR imaging in detection of anal fistula

    Institute of Scientific and Technical Information of China (English)

    乐剑平; 刘东华; 郭荣州; 黄洋; 文祥明

    2013-01-01

      Objective:To investigate the clinical value of applying MRI to diagnosis of anal fistula.Methods:Twenty-eight patients with anal fistula were undergone preoperative MRI examination between December 2009 and 2012 in our hospital.The MRI presentations were retrospectively ana-lyzed and compared with the operative findings.Results:The operation re-vealed 49 fistulae,32 internal openings and abscess in 5 sites in the total 28 cases required closure of anal fistula.Compared with the operative findings,MRI represented 47 fistulae(95.9%) and 24 internal openings (75%) as well as 5 sites of abscess(100%).Conclusion:MRI can be effective to detection of anal fistula,for it is capable of accurately identif-   ying the internal opening and location for the fistula as well as both sites of the abscess if present.%  目的:探讨 MRI检查应用于肛瘘诊断中的临床价值。方法:选取我院2009年12月~2012年12月间确诊为肛瘘的患者28例,在术前进行MRI 检查,分析 MRI上肛瘘的表现,将影像学检查的结果与手术结果进行对照。结果:28例肛瘘手术显示存在49个瘘管,32个内口,5个脓肿;与手术结果相比:MRI检出存在瘘管47个,符合率为95.9%;准确显示瘘管内口位置24个,符合率为75%;脓腔的检出率为100%。结论:采用MRI 能够准确显示出肛瘘的内口、瘘管位置,以及脓肿的有无、位置,临床符合率高。是一种重要的有价值的肛瘘诊断方法。

  12. MR imaging diagnosis of anal fistula%磁共振成像对肛瘘的诊断

    Institute of Scientific and Technical Information of China (English)

    王新岭; 张善宏; 韩磊; 宋振鹏

    2012-01-01

    Objective To discuss MRI manifestations and diagnostic value of anal fistula. Methods MRI was performed in 21 patients with anal fistula using the phased-array surface coil , the scanning sequences included T2WI-fatsat at the sagittal plane , axial T1WI , T2WI-fatsat,STIR and EPI-DWI and STIR at the coronal plane. The axial and coronal scanning planes were perpendicular and parallel to the long axis of the anal canal, respectively. MRI manifestations of the anal fistulas that was compared with the operation results. Results 17 internal ostia and 23 its branches of anal fistula were showed by MRI. The internal ostia of anal fistula displayed high signal intensity but lower than that of fat on T2WI in 7, high signal intensity on T2WI-fatsat or STIR in 12, similar muscles signal intensity on T1 WI in 17 and high signal intensity on DWI in 15. Fistulas were high signal intensity but lower than that of fat on T2 WI in 11, hyper-intensity on T2 Wl-fatsat or STIR in 17, similar to muscles signal intensity on T1 WI in 23 and high signal intensity on DWI in 19. The fibrous tissues in fistula wall on MRI were showed by MR imaging in 6 , which were lower signal intensity on both T1 WI and T2WI, similar to fat signal intensity on both T2WI-fatsat and STIR. 3 patients with anal fistula (or peri-anal abscess) were accompanied with perianal cellulitis which displayed as streak-like and plaques with low-signal intensity on T1 WI, high signal intensity but lower than that of fat on T2WI, hyper-intensity on both T2WI-fatsat and STIR. The fistulas were high signal intensity on DWI and the perianal cellulitis was low signal intensity on DWI. 17/21 internal openings, 23/25, fistulas and 3/3 perianal abscesses were found by MR imaging and surgery, respectively. Conclusion MRI with the phased-array surface coil can accurately detect the internal ostia, fistula and abscesses of anal fistula,it is a useful diagnostic method for anal fistula.%目的 探讨肛瘘

  13. Clinical Study of External Application of Qiyu Oil(芪榆油) Gauze for Promoting Post-operational Healing in Patients with Anal Fistula

    Institute of Scientific and Technical Information of China (English)

    李绍堂; 曹波; 邓文玲; 李志

    2009-01-01

    Objective:To observe the effects of the external application of Qiyu oil(芪榆油)gauze(QYOG) for promoting post-operational healing in patients with anal fistula and to explore its mechanism of action so as to provide a beneficial scientific basis for its wide use.Methods:Sixty patients with anal fistula scheduled to receive simple low anal fistulectomy were equally assigned,according to the sequence of hospitalization, to the tested group and the control group,and their wounds were classified according to l...

  14. Similar outcomes for anti-tumor necrosis factor-α antibody and immunosuppressant following seton drainage in patients with Crohn's disease-related anal fistula.

    Science.gov (United States)

    Lin, Xutao; Fan, Dejun; Cai, Zerong; Lian, Lei; He, Xiaowen; Zhi, Min; Wu, Xiaojian; He, Xiaosheng; Lan, Ping

    2016-09-01

    Anal fistula is common in patients with Crohn's disease (CD) and leads to significant morbidity. The efficacy of seton drainage combined with anti-tumor necrosis factor-α monoclonal antibody (anti-TNF-α) or immunosuppressant in the treatment of CD-related anal fistula remains unclear. The aim of the present study was to compare the efficacy between seton drainage combined with anti-TNF-α and seton drainage combined with immunosuppressant postoperatively on the treatment of CD-related anal fistula. A total of 65 patients with CD-related anal fistula who had received seton drainage combined with postoperative medication were divided into an antibiotics only group, anti-TNF-α group and immunosuppressant group; all patients were treated with antibiotics. Fistula closure, external orifice exudation rate and recurrence rate were assessed among these patients. The duration of follow-up ranged from 3 to 84 months with an average of 25.3 months. There were 11 (16.9%) cases of recurrence after seton drainage, 9 of which underwent a second seton drainage. In the total study group, 34 (52.3%) cases achieved complete fistula closure, and 10 (15.4%) cases showed external orifice exudation. No significant difference was found among these three groups, regarding fistula closure rate, closure time of fistula and recurrence rate. The external orifice exudation rate was significantly higher in the anti-TNF-α group compared with the antibiotics only group and immunosuppressant group (P=0.004 and P=0.026, respectively). Seton drainage is an effective treatment for CD-related anal fistula. The efficacy is similar whether combined with anti-TNF-α or immunosuppressant.

  15. Rectosigmoid adenocarcinoma revealed by metastatic anal fistula. The visible part of the iceberg: a report of two cases with literature review

    Directory of Open Access Journals (Sweden)

    Benjelloun El

    2012-10-01

    Full Text Available Abstract Colonic adenocarcinoma revealed by metastatic anorectal fistula is rare, with few cases in the literature. Such lesions can be taken for the more common manifestation of a benign perianal abscess or fistula. Once diagnosed, the management of such conditions remains controversial. We herein report two cases with perianal fistula that were subsequently found to have developed perianal adenocarcinoma on biopsy. Further colonic investigation revealed a rectosigmoid adenocarcinoma. Histology and immunohistochemical staining was identical in both primary and metastatic tumors. Preoperative chemoradiation with further rectal low anterior resection and local excision of metastatic anal fistula was performed. There is no recurrence after 3 years of follow-up.

  16. 3D-EAUS and MRI in the Activity of Anal Fistulas in Crohn's Disease.

    Science.gov (United States)

    Alabiso, Maria Eleonora; Iasiello, Francesca; Pellino, Gianluca; Iacomino, Aniello; Roberto, Luca; Pinto, Antonio; Riegler, Gabriele; Selvaggi, Francesco; Reginelli, Alfonso

    2016-01-01

    Aim. This study aspires to assess the role of 3D-Endoanal Ultrasound (3D-EAUS) and Magnetic Resonance Imaging (MRI) in preoperative evaluation of the primary tract and internal opening of perianal fistulas, of secondary extensions and abscess. Methods. During 2014, 51 Crohn's disease patients suspected for perianal fistula were enrolled. All patients underwent physical examination with both the methods and subsequent surgery. Results. In the evaluation of CD perianal fistulas, there are no significant differences between 3D-EAUS and MRI in the identification of abscess and secondary extension. Considering the location, 3D-EAUS was more accurate than MRI in the detection of intersphincteric fistulas (p value = 10(-6)); conversely, MRI was more accurate than 3D-EAUS in the detection of suprasphincteric fistulas (p value = 0.0327) and extrasphincteric fistulas (p  value = 4 ⊕ 10(-6)); there was no significant difference between MRI and 3D-EAUS in the detection of transsphincteric fistulas. Conclusions. Both 3D-EAUS and MRI have a crucial role in the evaluation and detection of CD perianal fistulas. 3D-EAUS was preferable to MRI in the detection of intersphincteric fistulas; conversely, in the evaluation of suprasphincteric and extrasphincteric fistulas the MRI was preferable to 3D-EAUS.

  17. The Clinical Treatment Analysis of 30 Cases of Anal Fistula Surgery%30例手术治疗肛瘘的临床分析

    Institute of Scientific and Technical Information of China (English)

    颜培刚

    2015-01-01

    Objective the surgical treatment effect on anal fistula is to be investigated. Methods Analyze the surgical treatment data selected from 30 patients with anal fistula who are treated in hospital from March 2012 to March 2014. Results All patients with anal fistula are cured and discharged from hospital after surgical treatment;the hospitalization time is from 14 to 40 days and it is 26 days on average;there is no relapse and anal dysfunction. Conclusion Surgical treatment is the only way to cure anal fistula;it is required to cut or excise all fistula branches to cure it.%目的:探讨肛瘘手术治疗方法疗效。方法对2012年3月~2014年3月收治的肛瘘患者30例手术方法资料进行分析。结果肛瘘患者手术治疗均手术成功痊愈出院,住院时间14~40 d,平均26 d,无复发及肛门功能障碍。结论手术是唯一能治愈的手段,手术时应对瘘管的所有分支均要予以切开或切除,根治肛瘘。

  18. Fistula

    Science.gov (United States)

    ... oxygen in the lungs) The navel and gut Inflammatory bowel disease, such as ulcerative colitis or Crohn disease, can lead to fistulas between one loop of intestine and another. Injury can cause fistulas to form ...

  19. 3D-EAUS and MRI in the Activity of Anal Fistulas in Crohn's Disease

    OpenAIRE

    Maria Eleonora Alabiso; Francesca Iasiello; Gianluca Pellino; Aniello Iacomino; Luca Roberto; Antonio Pinto; Gabriele Riegler; Francesco Selvaggi; Alfonso Reginelli

    2015-01-01

    Aim. This study aspires to assess the role of 3D-Endoanal Ultrasound (3D-EAUS) and Magnetic Resonance Imaging (MRI) in preoperative evaluation of the primary tract and internal opening of perianal fistulas, of secondary extensions and abscess. Methods. During 2014, 51 Crohn's disease patients suspected for perianal fistula were enrolled. All patients underwent physical examination with both the methods and subsequent surgery. Results. In the evaluation of CD perianal fistulas, there are no si...

  20. Case of anal fistula with Fournier's gangrene in an obese type 2 diabetes mellitus patient

    OpenAIRE

    YOSHINO, Hiroshi; Kawakami, Kyoko; Yoshino, Gen; Sawada, Katsuhiro

    2015-01-01

    Abstract A 64‐year‐old man was admitted to Shin‐suma General Hospital, Kobe, Japan, complaining of a 3‐day history of scrotal swelling and high fever. He had type 2 diabetes mellitus. On examination, his body temperature had risen to 38.5°C. Examination of the scrotum showed abnormal enlargement. Laboratory data were as follows: white cell count 35,400/μL and glycated hemoglobin 9.6%. Anal fistula was found in an endorectal ultrasound. Computed tomography scan showed a relatively high density...

  1. 重视复杂性肛瘘的影像学诊断%Pay attention to the imaging diagnosis of complex anal fistula

    Institute of Scientific and Technical Information of China (English)

    周智洋

    2015-01-01

    The diagnosis and treatment of complex anal fistula has been a significant challenge. Unwise incision and excessive exploration will lead to the secondary branch , sinus and perforation. A simple fistula may become a surgical problem and result in disastrous consequences. Preoperative accurate diagnosis of anal fistula , including in the internal opening, primary track and location of the fistula, extensions and abscess, is important for anal fistula treatment. In the diagnosis of anal fistula, imaging examination, especially MRI plays a crucial role. Localization and demarcation of anal fistula and the relationship with sphincter are important. MRI has been an indispensable confirmatory imaging examination.%复杂性肛瘘的诊治一直是临床上的严峻挑战. 不明智的切口和过分的探查,将导致继发的分支、窦道和穿孔形成,使一个简单的瘘变成一个外科难题,给患者带来灾难性的后果. 肛瘘术前的精确诊断,包括内口、原发瘘管、分支瘘管和脓肿的识别和定位,是对肛瘘分型和治疗的基本要求. 在肛瘘的诊断中,影像学检查,尤其是MRI扮演着非常重要的角色. 对肛瘘的分型定位、内口显示、瘘管数量和走行及其与括约肌之间关系的判断,MRI已经是不可或缺的确证性影像学检查.

  2. Sphincter-saving surgery for complex anal fistula%复杂性肛瘘保留括约肌手术的治疗进展

    Institute of Scientific and Technical Information of China (English)

    孙薛亮; 林秋; 杨柏霖

    2011-01-01

    目前复杂性肛瘘的治疗普遍存在复发率高、肛门功能保护不足的现状.传统的肛瘘切开术和切割挂线术损伤肛门括约肌,易致肛门失禁,已逐渐被保留括约肌术式,如推移瓣、肛瘘栓、经括约肌问瘘管结扎术等所取代.本文将对复杂性肛瘘保留括约肌手术治疗进展作一综述.%At present, the treatments for complex anal fistula are often associated with high recurrence and insufficient protection of anal function. Fis-tulotomy and cutting seton often lead to damage to the anal sphincters, increasing the risk of incontinence. Recently, they have been replaced gradually by sphincter-saving measures, such as advancement flap, anal fistula plug and ligation of intersphincteric fistula tract. In this article, we will review the recent advances in sphincter-saving surgical treatment of complex anal fistula.

  3. 经肛周三维超声对肛瘘诊断价值的研究%Clinical value of trans-anal three dimensional ultrasound in diagnosis of anal fistula

    Institute of Scientific and Technical Information of China (English)

    余俊丽; 杨川; 王晓学; 郑小迪; 艳玲; 刘广健; 曹飞; 覃斯

    2015-01-01

    目的:探讨经肛周三维超声检查在肛瘘诊断中的应用价值。方法术前对39例肛瘘患者分别行经肛周高频联合经直肠双平面超声和经肛周三维超声检查,以手术结果为金标准,分析并比较2种检查方法对肛瘘的诊断价值。结果经肛周高频联合经直肠双平面二维超声检查均能充分显示39例患者的病灶,进行有效评估;经肛周三维超声因受扫查深度和观察范围不足影响而未能对2例(2/9)高位肛瘘及5例(27.8%)复杂性肛瘘患者进行有效评估。经肛周三维超声检查对内口、瘘管、合并脓肿的探查情况及分型比经肛周高频联合经直肠双平面超声检查的符合率稍低,分别为82.1% vs.87.2%、82.1% vs.92.3%、64.1% vs.76.9%及82.1% vs.92.3%,但比较差异均无统计学意义(P 均>0.05)。2种方法对低位和高位肛瘘以及单纯性和复杂性肛瘘在内口、瘘管、合并脓肿及分型方面的诊断符合率比较差异均无统计学意义(P 均>0.05)。经肛周三维超声检查可以形象地显示肛瘘整体观,可以得到二维图像难以得到的 C 平面。三维表面成像及断层超声成像模式多层面显像可以连续追踪观察瘘管的走行。结论经肛周三维超声检查能直观地评估肛瘘情况,尤其适用于低位及单纯性肛瘘,但因受扫查深度和范围等的影响使其对部分高位和复杂性肛瘘的评估受限。肛周三维超声检查可作为经肛周高频联合经直肠双平面超声的备用检查方式。%Objective To evaluate the clinical value of trans-anal three-dimensional ultrasound in di-agnosis of anal fistula.Methods Thirty nine patients diagnosed with anal fistula received trans-anal high-fre-quency linear probe combined with transrectal biplane ultrasound and trans-anal three-dimensional ultrasound before surgery.Surgical outcomes were considered as gold

  4. Comparison of anal endoscopic and blind exploration looking for the inside mouth in the treatment of anal fistula%肛门镜直视下与盲探寻找内口治疗肛瘘对比

    Institute of Scientific and Technical Information of China (English)

    羿运财

    2015-01-01

    Objective: To investigate the clinical efficacy of anal endoscopic and blind exploration looking for the inside mouth in the treatment of anal fistula. Methods:56 patients with low anal fistula who need operation were randomly divided into the observation group and the control group with 28 cases in each group.In the inner opening of the anal fistula probing,the observation group used the anus mirror,and the control group used blind detection.We compared the operation curative effect and recurrence of the two groups.Results:The difference of the cure rate and recurrence rate between the observation group and the control group had statistical significance(P<0.05).Conclusion:The anus mirror under direct vision looking for the inside mouth in the treatment of anal fistula is better than blind detection looking for the inside mouth in the treatment of anal fistula.%目的:探讨肛门镜直视下寻找内口与盲探寻找内口手术治疗肛瘘的临床疗效。方法:收治低位肛瘘需要手术患者56例,随机分为观察组和对照组,各28例。在肛瘘内口探查上,观察组采用肛门镜,对照组采用盲探,对比两组手术治疗效果及复发情况。结果:观察组痊愈率和复发率与对照组比较差异有统计学意义(P<0.05)。结论:肛门镜直视下寻找内口治疗肛瘘比盲探寻找内口治疗肛瘘效果更好。

  5. Clinical Research on the Treatment of Anal Fistula by the Technique of Closing Internal Opening and Filling Anal Fistula by Biological Patch%生物补片内口封闭瘘道填塞术治疗肛瘘临床观察

    Institute of Scientific and Technical Information of China (English)

    史瑞霞; 王业皇; 吴金萍

    2012-01-01

    Objective:To study the clinical curative effects on the treatment of anal fistula by the technique of closing internal opening and filling anal fistula by biological patch. Methods:The technique of closing internal opening and filling anal fistula by biological patch was used to treat anal fistula. Results: During 13 cases of this group,biological patch and tissue dissolved each other well in the course of disease,part patches were gradually degraded and absorbed and external opening were gradually cured. Al present, 13 cases had been discharged from hospital, among which, 10 cases were cured and in the condition of low - position anal fistula. 1 case achieved excellent effect and was in the condition of low - position and complex anal fistula and 1 case was effective and in the condition of high - position and complex anal fistula. 1 case was ineffective and also in the condition of high - position and complex anal fistula. Conclusion: The technique of closing internal opening and filling anal fistula by biological patch has great superiority in alleviating pain in patients, narrowing areas of wounds,and reducing postoperative defect of anal canal.%目的:探讨生物补片内口封闭瘘道填塞术治疗肛瘘的临床疗效.方法:应用生物补片内口封闭瘘道填塞术治疗肛瘘.结果:本组13例患者均在病程中可见补片与组织相溶良好,部分补片逐渐降解吸收,外口逐渐愈合.经手术出院13例,其中痊愈10例,为低位肛瘘;显效1例,为低位复杂性肛瘘;有效1例,为高位复杂性肛瘘;无效1例,亦为高位复杂性肛瘘.结论:生物补片内口封闭瘘道填塞术在减轻患者疼痛,缩小创面,减少术后肛管缺损等方面具有显著优势.

  6. Value of 3D-SPGR Sequence in Diagnosis of Anal Fistula%3 D-SPGR增强序列在肛瘘诊断中的价值

    Institute of Scientific and Technical Information of China (English)

    邵继满; 陈志坚; 万小玲; 卜军; 肖慧荣

    2015-01-01

    目的:通过钆增强三维损毁梯度回波(3D-SPGR)序列与其他常规 MRI序列比较,评估增强3D-SPGR序列在肛瘘诊断中的临床应用价值。方法对97例肛瘘患者术前均行 MRI平扫及增强扫描,序列包括矢状位 T2加权成像(Sag T2WI)、冠状位T2WI抑脂(Cor T2WI FS)、横断位 T2WI(Ax T2WI)、横断位 T2WI抑脂(Ax T2WI FS)和钆增强三维损毁梯度回波(3D-SPGR)。评估和比较 MRI各序列显示的瘘管、内口、瘘管分支及脓腔。结果97例患者中内口和主瘘管117个,支瘘管143个。1级肛瘘12例,2级肛瘘11例,3级肛瘘11例,4级肛瘘39例,5级肛瘘24例。MRI各序列结果显示,97例患者3D-SPGR显示内口和瘘管、支瘘管的阳性率均明显高于 Sag T2WI、AX T2WI、AX T2WI FS、Cor T2WI及Cor T2WI FS(均P<0.05)。结论钆增强3D-SPGR序列可提高肛瘘诊断的准确率,能够为外科手术方式的选择提供较详尽的影像资料。%Objective To assess the clinical value of gadolinium-enhanced three dimension-spoiled gradient(3D-SPGR)sequence in the diagnosis of anal fistula through comparing with oth-er conventional MRI sequences.Methods Unenhanced and contrast-enhanced MRI were per-formed in 9 7 patients with anal fistula.The MRI sequences included sagittal T2 WI(Sag T2 WI), coronal T2 WI with fat suppression(Cor T2 WI FS),axial T2 WI(Ax T2 WI),axial T2 WI with fat suppression(Ax T2WI FS),and 3D-SPGR.MRI manifestations of fistula,endostoma,fistula branch and vomica were compared with the operation results.Results There were 1 1 7 endosto-mas and main fistulas and 143 fistula branches in the 97 patients.Among these patients,12 had grade 1 anal fistula,1 1 had grade 2 anal fistula,1 1 had grade 3 anal fistula,3 9 had grade 4 anal fis-tula,and 24 had grade 5 anal fistula.Compared with Sag T2WI,AX T2WI,AX T2WI FS,Cor T2WI or Cor T2WI FS,3D-SPGR showed a significant increase in the positive rates of endosto

  7. Anal Canal Adenocarcinoma in a Patient with Longstanding Crohn's Disease Arising From Rectal Mucosa that Migrated From a Previously Treated Rectovaginal Fistula.

    Science.gov (United States)

    Maejima, Taku; Kono, Toru; Orii, Fumika; Maemoto, Atsuo; Furukawa, Shigeru; Liming, Wang; Kasai, Shoji; Fukahori, Susumu; Mukai, Nobutaka; Yoshikawa, Daitaro; Karasaki, Hidenori; Saito, Hiroya; Nagashima, Kazuo

    2016-07-04

    BACKGROUND This study reports the pathogenesis of anal canal adenocarcinoma in a patient with longstanding Crohn's disease (CD). CASE REPORT A 50-year-old woman with a 33-year history of CD presented with perianal pain of several months' duration. She had been treated surgically for a rectovaginal fistula 26 years earlier and had been treated with infliximab (IFX) for the previous 4 years. A biopsy under anesthesia revealed an anal canal adenocarcinoma, which was removed by abdominoperineal resection. Pathological examination showed that a large part of the tumor consisted of mucinous adenocarcinoma at the same location as the rectovaginal fistula had been removed 26 years earlier. There was no evidence of recurrent rectovaginal fistula, but thick fibers surrounded the tumor, likely representing part of the previous rectovaginal fistula. Immunohistochemical analysis using antibodies against cytokeratins (CK20 and CK7) revealed that the adenocarcinoma arose from the rectal mucosa, not the anal glands. CONCLUSIONS Mucinous adenocarcinoma can arise in patients with CD, even in the absence of longstanding perianal disease, and may be associated with adenomatous transformation of the epithelial lining in a former fistula tract.

  8. Clinical observation analysis of treatment 334 patients' anal sinusitis by incision and drainage anal fistula%肛窦切开引流术治疗肛窦炎334例临床分析

    Institute of Scientific and Technical Information of China (English)

    徐征; 赵义群; 李文峰

    2012-01-01

    目的 探索肛窦炎的有效治疗方法及疗效.方法 回顾性总结我科2005~2008年634例肛窦炎治疗经过,治疗组334例,采用肛窦切开引流术;对照组300例采用保守治疗.结果 治疗后,治疗组总有效率100%;对照组总有效率80.3%.治疗组复发率明显少于对照组.结论 肛窦切开引流术可治疗肛窦炎,并有效避免了脓肿或肛瘘的发生.%Objective In order to probe into the effective therapy and curative effect. Methods Reviewed summary our hospital 634 patients, 334 anal sinusitis patients by using anal fistula curative effect and other 300 patients take conservation treatment. Results After treatment, patients in the treatment group have a 100% effective rate; an other group has a 80. 3% . Treatment group's recurrence rate is absolutely less than normal group. Conclusion Incision and drainage anal fistula can cure anal sinusitis and avoid abscess and anal fistula effective.

  9. Comparative study of internal anal competent seton combined with external anal fistula resection and suture or exclusion for the treatment of high anal fistula%肛管内主管挂线联合肛门外瘘管切除缝合或旷置治疗高位肛瘘疗效的对比研究

    Institute of Scientific and Technical Information of China (English)

    任炜

    2016-01-01

    Objective To compare the effects of internal anal competent seton combined with external anal fistula resection and suture or exclusion on high anal fistula. Methods The curative effect of 65 cases underwent internal anal competent seton combined with external anal fistula resection and su-ture and 62 cases underwent internal anal competent seton combined with external anal fistula exclusion were comparative analyzed. Results The total efficiency of suture group was 90. 77% ,which was signif-icantly higher than that of the exclusion group(70. 97% ),the difference was significant(P ﹤ 0. 05). The suture wound healing time and Wexner score of suture group were significantly lower than those of exclu-sion group(P ﹤ 0. 05). The recurrence rate of suture group(1. 54% )was significantly lower than that of the exclusion group(9. 68% ),the difference was significant(P ﹤ 0. 05). Conclusions Internal anal competent seton combined with external anal fistula resection and suture in the treatment of high anal fis-tula significant can accelerate the healing of incision and improve the recovery of anal function.%目的:比较肛管内主管挂线联合肛门外瘘管切除缝合或旷置治疗高位肛瘘的疗效。方法对65例行肛管内主管挂线联合肛门外瘘管切除缝合术与62例行肛管内主管挂线联合肛门外瘘管旷置术的疗效进行对比分析。结果缝合组的总有效率为90.77%,显著高于旷置组(70.97%),差异有统计学意义(P ﹤0.05);缝合组缝合处愈合时间和 Wexner 评分显著低于旷置组,差异有统计学意义(P ﹤0.05);缝合组复发率(1.54%)显著低于旷置组(9.68%),差异有统计学意义(P ﹤0.05)。结论肛管内主管挂线联合肛门外瘘管切除缝合术治疗高位肛瘘疗效显著,可加快切开愈合,提高肛门功能恢复。

  10. Redo Ileal pouch-anal anastomosis combined with anti-TNF-α maintenance therapy for Crohn's disease with pelvic fistula: report of two cases.

    Science.gov (United States)

    Araki, Toshimitsu; Okita, Yoshiki; Fujikawa, Hiroyuki; Ohi, Masaki; Tanaka, Koji; Inoue, Yasuhiro; Uchida, Keiichi; Mohri, Yasuhiko; Kusunoki, Masato

    2014-10-01

    Pouch failure has been reported to occur after ileal pouch-anal anastomosis for Crohn's disease. We report two cases of patients with Crohn's disease, who underwent redo ileal pouch-anal anastomosis (redo-IPAA) combined with anti-TNF-α maintenance therapy, with good functional results. The first patient, a man with presumed ulcerative colitis, suffered pelvic fistula recurrence and anastomotic dehiscence. He underwent redo-IPAA, at which time longitudinal ulcers were found. Infliximab was started 4 days postoperatively and continued. The second patient, a woman treated for ulcerative colitis, underwent laparoscopic IPAA 8 years later. After the development of a pelvic fistula, twisted mesentery of the ileal pouch was found intraoperatively and Crohn's disease was diagnosed. Adalimumab therapy resulted in fistula closure. Redo-IPAA was performed to normalize the twisted mesentery of the ileal pouch. No complications have been observed in either patient, both of whom have experienced good functional results after closure of the covering stomas.

  11. 肛瘘的诊断及中医治疗研究%Study on the Diagnosis and Treatment of Anal Fistula of TCM

    Institute of Scientific and Technical Information of China (English)

    田力; 安超

    2016-01-01

    中医学对肛瘘的认识可追溯到春秋战国时期,古文献中记载了中医学对肛瘘的众多认识及治疗方法,沿用至今.中医在治疗肛瘘方面有其独有的特色,尤其是中医外治法,成为治疗肛瘘的主要手段,临床治疗效果显著,得到了广泛认可.但肛痿自身有着复杂的特性,致使其复发率较高,严重影响患者的生活质量,这就使得肛瘘的术前检查显得尤为重要.随着现代医学的发展与进步,肛瘘的术前检查方法也越来越多元化,由传统的检查方法逐步发展到更为科学的检查方法,尤其是现代影像医学的发展,对肛瘘的术前诊断也更为直观、科学,给手术方案的制定提供了有力的参考依据,使中医治疗肛瘘手术方案的制定更加合理化,有效地提高了肛瘘手术的成功率,降低了肛瘘术后的复发率,减轻了患者痛苦.%TCM understanding of anal fistula can be traced back to the spring and Autumn period,the ancient literature records of anal fistula many understanding and treatment methods of traditional Chinese medicine,still in use.Traditional Chinese medicine has its unique characteristics in the treatment of anal fistula,especially TCM,become the main means of the treatment of anal fistula,clinical effect is remarkable,get widely recognized.But its anal fistula has a complex characteristics,resulting in a higher rate of recurrence,seriously affecting the quality of life of patients,the anal fistula preoperative examination is particularly important.With the development of modern medicine and progress,inspection method of perianal fistula are more diverse,from the traditional check method the gradual development of a more scientific inspection method,especially the development of modern medical imaging,the diagnosis of perianal fistula is more intuitive,scientific,provides a powerful reference for surgical planning,The formulation of traditional Chinese medicine in the treatment of anal fistula

  12. 采用间断暴露瘘道切开挂线治疗高位单纯性肛瘘报告%Interrupted Exposing Fistula Tract and Seton Division for Simple High Anal Fistula: 30 Cases Report

    Institute of Scientific and Technical Information of China (English)

    王俊江; 刘希家; 王荣

    2012-01-01

    目的:观察间断暴露瘘道切开挂线术治疗高位单纯性肛瘘的临床疗效.方法:选择30例高位单纯性肛瘘患者,采用间断暴露瘘道,切开挂线治疗.结果:30例患者全部一次性治愈,平均住院时间25~30天.结论:间断暴露瘘道,切开挂线治疗高位单纯性肛瘘疗效确切,疗程短、安全,无后遗症.%Objective: To assess the clinical effects of interrupted exposing fistula tract and seton division for simple high anal fistula. Methods: 30 cases of simple high anal fistula were selected and treated with interrupted exposing fistula tract and seton division. Results: All patients achieved primary cure, the mean hospital stays was 25~30 days. Conclusion: The interrupted exposing fistula tract and seton division had definitely curative effect and short course, which was a safe and few complicating method.

  13. LIFT术在肛瘘治疗中的应用%Clinical Application of LIFT Procedure in Treatment of Anal Fistula

    Institute of Scientific and Technical Information of China (English)

    陈敏; 张涛; 龚旭晨

    2012-01-01

    目的 探讨结扎括约肌间瘘管术(LIFT)对肛瘘的临床疗效.方法 对50例肛瘘管患者行LIFT术,并结合术中所见以及术后随访对LIFT术的疗效进行评价.结果 经LIFT术治疗的肛瘘患者,随访3~6个月,仅3例出现复发,术后未发生肛门失禁.结论 LIFT术操作简便,疗效显著,不损伤括约肌功能,是治疗肛瘘的有效方法.%Objective To investigate the clinical effect of LIFT procedure in treatment of anal fistula. Methods LIFT procedure was done to 50 patients with anal fistula. The finding in operation and follow-up was used to estimate the effect of LIFT procedure. Results Only 3 of the 50 patients have been found recrudescence after follow-up of 3 to 6 months. There were no anal incontinence in all the patients after the operation. Conclusion LIFT procedure as a simplified technique has notable curative effect,which does no harm to the sphincter muscle,thas is an effective treatment for anal fistula.

  14. Utility of transperineal and anal ultrasonography in the diagnostics of hidradenitis suppurativa and its differentiation from a rectal fistula 

    Directory of Open Access Journals (Sweden)

    Małgorzata Kołodziejczak

    2012-11-01

    Full Text Available Introduction:The pathogenesis of hidradenitis suppurativa (HS is not fully understood. There exist several theories, in which mechanical factors, genetic factors, as well as immunological dysfunction of lymphocytes are suspected. Clinically, this entity is frequently mistaken for anal fistula with consequently wrong treatment.We aim to determine the utility of transperineal ultrasound (TPUS and anal ultrasound (AUS in the diagnosis of HS and its differentiation from an anal fistula.Material/Methods:Retrospective analysis was performed on 51 patients (5 females, 46 males aged 20–71 years (mean age 47.5, who were operated on in the years 2006–2011 for HS in the area of the anus and perineum, and pre-operatively had been imaged with TPUS and AUS. Sixty-seven operations were analyzed, as 11 patients were operated on more than once due to HS recurrence.Results:In 66 out of 67 cases (98.5� the pre-operative TPUS and AUS were in accordance with the intraoperative findings. Only in 1 patient was a pilonidal cyst diagnosed intraoperatively. In all 67 patients, the TPUS showed typical fluid-solid changes localized in the subcutaneous adipose tissue. In 6 out of 67 cases of HS (8.9�20AUS showed an anal fistula coexisting with the HS. In 2 cases (2.9�20a skin malignancy coexisting with HS was found.Discussion:TPUS is an accessible imaging method, which confirms the typical localization of changes of HS, and together with AUS it allows for the proper differentiation of HS from an anal fistula or an abscess.

  15. Late-onset fistula presenting as buttock abscess in two patients with ileo-anal J-pouches for ulcerative colitis.

    Science.gov (United States)

    Banerjee, S; Farquharson, M; Cecil, T D; Gold, D; Moran, B J

    2004-03-01

    Two cases are described of patients who presented with a buttock abscess 3 and 5 years after restorative proctocolectomy for ulcerative colitis. In both the abscess was secondary to a fistula, which was shown on further investigation to be a track traversing the greater sciatic notch. Both patients had had an ileo-anal J-pouch after a proctectomy which had included a mesorectal excision. The possibility that these unusual fistulae might be more common following removal of the mesorectum rather than a close rectal dissection is explored.

  16. 肛瘘术后复发危险因素分析%Risk factors for recurrence after anal fistula surgery

    Institute of Scientific and Technical Information of China (English)

    张玉茹; 李非; 刘连成

    2013-01-01

    目的 探讨肛瘘术后复发的危险因素.方法 2010年7月至2010年12月收治腺源性肛瘘手术患者963例,随访到906例,对随访的患者资料进行复发危险因素分析.结果 随访12 ~18个月,复发51例,总复发率5.6%.单因素分析显示复发与肛瘘分型、肛瘘位置、存在脓液、内口位置有关.多因素分析显示复发与肛瘘分型、肛瘘高低、存在脓液有关.结论 高位复杂肛瘘、肛瘘伴有脓液术后复发率较高,识别手术复发相关的危险因素对于减少复发有重要意义.%Objective To assess risk factors for anal fistula recurrence.Methods The records of 963 patients who underwent surgery for anal fistula between July 2010 and December 2010 in Beijing Rectum Hospital were retrospectively reviewed and 906 of them were followed up.Risk factors associated with recurrence were analyzed by using univariate and multivariate regression methods.Results Based on the observation for 12 to 18 months,51 patients(5.6%)had recurrence.Risk factors associated with recurrence in univariate analysis included fistula type,fistula location,associated liquor puris and location of internal fistulous opening.Risk factors associated with recurrence in multivariate analysis included fistula type,high anal fistula and associated liquor puris.Conclusion High complex anal fistula and fistula with liquor puris had a higher recurrence rate.Identification of the risk factors associated with recurrence is important for reducing recurrence.

  17. Value of high-field MRI in diagnosis of anal fistula%高场磁共振在肛瘘诊治中的应用价值

    Institute of Scientific and Technical Information of China (English)

    谢乐华; 曹波; 肖湘生

    2014-01-01

    Objective To study the clinical application of high-field of MRI to the diagnosis of anal fistu_las. Methods 35 cases with anal fistulas were accepted MR scanning of pelvic without contrast, Scanning se_quences including TlWl、T2WI and T2WI fatsat in the transverse plane,T2WI fatsat in the sagittal plane and the coronal plane. The imaging of the anal fistulas was analyzed. Evaluate the relationship between internal and external sphincter fistula. The types and the display of the internal and external openings were assessed and the diagnosis with the operation results was compared. Results 33 cases of anal fistulas surgery MR ima_ging results are consistent with the operation results. Fistula showed low signal in T1WI and high signal in T2WI or T2WI fatsat, Abscess showed high signal on DWI;MRI with orificium and fistula coincidence rate with surgery were 94. 9% and 92. 5% respectively. Conclusion High-field MRI can locate the internal o_pening of anal fistula, form of anal fistula, and the relation of anal fistula with sphincter, which has impor_tant clinical practical and promotional value.%目的:探讨高场磁共振成像( MRI)在肛瘘诊断中的临床应用。方法35例肛瘘患者行盆腔MR平扫检查,扫描序列包括轴位T1WI、T2WI及T2WI脂肪抑制序列,矢状面及冠状面T2WI抑脂序列。分析肛瘘的MRI表现,评价瘘管与内外括约肌的关系,比较内、外口的显示率,并将诊断结果与手术进行对照。结果33例肛瘘MR检查结果与手术结果一致;T2 WI及T2 WI脂肪抑制序列图像上,瘘管及肛周脓肿表现为高信号,于T1 WI表现为条状略低信号,以抑脂像病灶显示最佳;脓肿在DWI上呈高信号。瘘口及瘘管MRI与手术符合率分别为94.9%及92.5%。结论应用高场MRI能准确定位肛瘘的内口、瘘管的走向及其与肛管直肠括约肌之间的关系,具有重要的临床实用和推广价值。

  18. Clinical Application of High-field MRI in Diagnosis of Anal Fistula%高场磁共振在肛瘘诊断中的临床应用

    Institute of Scientific and Technical Information of China (English)

    余留森; 刘艳玲; 余海霞; 吴淮昌; 贾小强

    2012-01-01

    目的 探讨1.5T高场磁共振成像(MRI)在肛瘘诊断中的应用价值.方法 31例临床诊断为肛瘘的患者,术前应用磁共振体部相控阵线圈进行轴位、矢状位、冠状位的多种序列检查.结果 MRI成像均符合临床诊断,其中经括约肌肛瘘9例,括约肌间肛瘘16例,括约肌外肛瘘1例,括约肌上肛瘘5例;单纯性肛瘘11例,复杂性肛瘘20例;能够正确显示内口位置27例.结论 应用高场MRI能准确定位肛瘘的内口、瘘管的走向及其与肛管直肠括约肌之间的关系,具有重要的临床实用和推广价值.%Objective To explore the application value of 1 .5T magnetie resonance imaging in diagnosis of anal fistula. Methods 31 cases oi anal fistula were examined by MRI in phased array roil using multiple sequences such as axial, sagittal and coronal sections. Results The imaging of MRI all accorded with the clinical diagnosis,including 9 cases of anal fistula, through sphincter, 16 cases of inter sphincter anal fistula, 1 case oi outter sphincter anal fistula, and 5 cases of above sphincter anal fistula; there were 1 1 cases diagnosed as simple anal fistula,20 cases as complex anal fistula. 27 cases could be located the internal opening by MRI. Conclusion High-field MRI can locate the internal opening of anal fistula,form oi anal fistula,and the relation of anal fistula with sphincter, which has important clinical utility and promotional value.

  19. Analysis of Internal Opening Expression and Etiological about Anal Fistula%肛瘘内口表达和病因分析

    Institute of Scientific and Technical Information of China (English)

    张波; 沈云天; 王丽群; 毛宽荣

    2014-01-01

    目的:通过临床观察,验证肛瘘病因假说,及其对临床的指导意义。方法根据113例肛瘘患者的内口表达的不同分为三组,观察其所占比例和治疗后的效果。结果内口隐性表达的病例占69.91%,各组的治愈率方面无显著性差异。结论“腺源”学说存在临床质疑,但是“隐窝感染”还是肛瘘发生的重要原因。妥善处理“内口”仍然是治疗肛瘘的重点。%Objective To verified the anal fistula internal opening hypothesis and its clinical significance through clinical observation.Methods One hundred and thirteen cases of anal fistula patients were divided into three groups according to the different internal opening expression.Three groups were observed in the proportion and the effect of treatment.Results Cases of the internal opening recessive expression accounted for 69.91%.There was no significant difference between the groups of cure rate.Conclusion "Gland source" theory existence clinical questions."Crypt infection" theory is important reason of anal fistula. Properly handle the" Internal Opening " is the focus in the treatment of anal fistula.

  20. 68 Cases of Preoperative and Postoperative Anal Fistula Patients Research%肛瘘患者术前术后68例研究

    Institute of Scientific and Technical Information of China (English)

    李雪; 夏冬玲

    2013-01-01

    目的:分析肛瘘患者术前术后的护理方式。方法对于肛瘘患者采用的护理方法包括:心理护理,术前准备,病情观察,坐浴以及换药的护理,术后护理,出院指导。结果68例肛瘘患者,67例患者治愈出院,复发1例,痊愈率为98.5%。结论对肛门患者术前术后采取多种护理措施,患者积极配合医生的治疗,能够减少肛瘘的复发情况,使患者早日康复。%Objective:to analysis of postoperative anal fistula patients with preoperative nursing mode. Methods:the nursing methods for patients with anal fistula using include:psychological nursing,preoperative preparation,observation,sitz bath and dressing nursing,postoperative nursing and discharge guidance. Results:68 patients with anal fistula, 68 patients were cured and discharged,1 case of recurrence,the recovery rate was 98.5%. Conclusion:the preoperative patients with postoperative anus take a variety of nursing measures,actively cooperate with the doctor's treatment,patients can reduce the recurrence of anal fistula,make the patient recover soon.

  1. 40 Cases of Recurrent Anal Fistula of Clinical Diagnosis and Treatment Experience%40例复发性肛瘘临床诊疗体会

    Institute of Scientific and Technical Information of China (English)

    李国栋; 袁正; 笪霞

    2014-01-01

    目的探讨复发性肛瘘的诊疗对策。方法对40例复发性肛瘘患者分析病因及个体化治疗。结果34例一次手术痊愈;3例炎症性肠病患者,一期控制肠道炎症,肛周局部引流,二期手术痊愈;2例肺外结核患者行手术及抗结核治疗后痊愈;1例骶前囊肿外院不当手术后合并形成高位肛瘘患者,治疗后无效,行高位挂线引流保守治疗。结论复发性肛瘘病因复杂,临床完善的术前检查,合理的个性化治疗是保证诊治成功的关键。%Objective To study the recurrent anal fistula and treatment countermeasures. Methods 40 cases of patients with recurrent anal fistula analyze the etiology and individual treatment. Results 34 cases by surgery; 3 cases of inflammatory bowel disease, a phase control intestinal inflammation and crissum local drainage, phase i by surgery; 2 cases of extrapulmonary tuberculosis patients after surgery and anti-tuberculosis treatment cured; 1 case of sacral cyst outer court before joined to form a high anal fistula patients after the operation, improper treatment is invalid, hanging line drainage line high conservative treatment. Conclusion The recurrent cause complex anal fistula, clinical perfect preoperative examination, reasonable individualized treatment is the key to successful treatment.

  2. Atresia anal, fístula uretrorretal congênita, bolsa escrotal acessória e pseudo-hermafroditismo em bezerro mestiço Anal atresia, congenital urethrorectal fistula, accessory scrotum and pseudohermafroditism in a crossbred calf

    Directory of Open Access Journals (Sweden)

    Thaís Gomes Rocha

    2010-05-01

    Full Text Available Neste trabalho, é descrito o caso de um bezerro mestiço recém-nascido que apresentava atresia anal tipo 2, fístula uretrorretal congênita, bolsa escrotal bífida e pseudo-hermafroditismo masculino. O principal sinal clínico era a eliminação de fezes por meio do óstio prepucial, uma apresentação incomum em casos de fístula uretrorretal em animais machos. Apesar de o quadro de atresia anal ser relativamente comum nessa espécie, os outros defeitos congênitos encontrados são pouco frequentes.In this study, the case of a newborn calf, which presented type 2 anal atresia, congenital urethrorectal fistula, bifid scrotum and male pseudohermafroditism is described. The main clinical sign was the elimination of feces by the prepucial ostium, an unusual finding in cases of urethrorectal fistula in male animals. Although anal atresia is relatively common in bovines, the other congenital defects found in this case are uncommon.

  3. 高频超声检查在低位肛瘘诊断中的应用价值%Application Value of High Frequency Ultrasound in the Diagnosis of Anal Fistula

    Institute of Scientific and Technical Information of China (English)

    裴峰; 朱昱思; 董勤; 陈家友; 丁晶

    2016-01-01

    Objective To discuss the clinical application value of high frequency ultrasound in diagnosis of low anal fistula.Methods Acoustic image data of 79 cases of anal fistula in patients with preoperative high-frequency ultrasound contrast analysis of surgical results.Results High frequency ultrasound diagnosis of low simple anal fistula and fistula mouth diagnosis coincidence rate was 100%,and of low complexity anal fistula fistula and fistula diagnosis accord with rate of 83.3%.Conclusion High frequency ultrasound can observe low anal fistula fistula walk and branches,fistula location,to provide more accurate and reliable information for the surgical treatment.%目的探讨高频超声检查在低位肛瘘术前诊断中的临床应用价值。方法对照手术结果回顾性分析79例低位肛瘘患者的术前高频超声检查的声图像资料。结果高频超声诊断对低位单纯性肛瘘的瘘管及瘘口诊断的符合率为100%,对低位复杂性肛瘘的瘘管及瘘口诊断的符合率为83.3%。结论高频超声能够观察低位肛瘘的瘘管走行及分支、瘘口的位置,为外科治疗提供较为准确、可靠的信息。

  4. Management of low transsphincteric anal fistula with serial setons and interval muscle-cutting fistulotomy

    Institute of Scientific and Technical Information of China (English)

    Chen Wang; Lester Rosen

    2016-01-01

    This study evaluates low transsphincteric anal ifstula managed by serial setons and interval ifstulotomy, with attention to healing without recurrence and preservation of continence.Folowing Institutional Review Board approval, consecutive anal ifstula operations performed by a single surgeon from January 1, 2009 to December 31, 2013 were retrospectively reviewed using electronic medical records and telephone interviews for patients lost to folow up. Of the 71 patients, 26 (37%) had low transsphincteric ifstula (23 males and 3 females; mean age: 46 years), treated at our institution by seton placement folowed by interval surgical muscle cutting and subsequent seton replacement or ifnal ifstulotomy. Of the 26 patients, 22 (85%) were initialy referred due to previous failed treatment, with a 30.6 month mean duration of ifstula prior to referral and a mean of 2.2 (range: 0–6) prior anorectal surgeries. At a mean folow-up of 11.9 months, none of the 21 patients experienced recurrence or fecal incontinence. Serial seton with interval muscle-cutting sphincterotomy folowed by complete ifstulotomy is an effective treatment for the management of patients who are either initialy seen for low transsphincteric ifstula, or referred after failed anorectal surgery for that condition.

  5. 切开缩创缝合治疗肛瘘的临床分析%Cut clinical analysis of suture in the treatment of anal fistula

    Institute of Scientific and Technical Information of China (English)

    张配远

    2014-01-01

    将60例肛瘘患者均采用切开缩创缝合治疗,60例均一次性痊愈。治愈率100%,46例患者术后无明显疼痛,5例术后疼痛,3例术后尿潴留。60例患者均无发生肛门失禁、肛管直肠狭窄或肛门畸形等。随访无复发。结果表明,切开缩创缝合法治疗肛瘘疗效显著,值得在临床上推广应用。%60 cases of anal fistula patients were treated with open debridement for the treatment of 60 cases of shrinkage, are one-time cure. The cure rate was 100%, 46 cases of patients with no significant postoperative pain, pain in 53 cases of uroschesis after operation. 60 patients had no occurrence of anal incontinence, anorectal stenosis or anal deformity. There was no recurrence. The results show that the shrinkage, open a suture in the treatment of anal fistula significant curative effect, and worth of clinical application.

  6. 99例肛瘘切除I期缝合术治疗低位单纯性肛瘘的临床疗效%Clinical Effi cacy of 99 Patients with Low Anal Fistula Treated by Simple Suture of Stage I Anal Fistula Removal

    Institute of Scientific and Technical Information of China (English)

    李津; 叶文峰; 朱沛劲

    2012-01-01

    Objective:Excision of anal fistula closure in the treatment of stage I anal fistula simple low clinical efficacy. Methods:Retrospective analysis of our hospital in January 2009 ~ May 2010 were treated 99 cases of the use of simple low anal fistula anal fistula excision and suture in the treatment of stage I patients with information, summarize the patient's recovery, postoperative complications. Results:99 patients in Grade healing in 72 cases, accounting for 72.73%; B healed in 20 cases, accounting for 20.20%; C healed in 7 cases, accounting for 7.07%. All patients had no incontinence, anal sphincter dysfunction, and anal stenosis happen. Conclusion:Resection with fistula closure in the treatment of stage I of simple low anal fistula can achieve good results, mostly in patients with grade healing, postoperative complications, less worthy of clinical use.%目的:探讨肛瘘切除I期缝合术治疗低位单纯性肛瘘的临床疗效.方法:回顾性分析我院2009年1月~2010年5月收治的99例低位单纯性肛瘘并采用肛瘘切除I期缝合术治疗的患者资料,总结患者的痊愈情况,术后并发症情况.结果:99例患者中,甲级愈合72例,占72.73%;乙级愈合20例,占20.20%;丙级愈合7例,占7.07%.所有患者均无大小便失禁、肛门括约肌功能障碍和肛门狭窄等情况发生.结论:采用肛瘘切除I期缝合术治疗低位单纯性肛瘘能取得较好的效果,患者多为甲级愈合,术后并发症较少,值得在临床推广使用.

  7. Value of DWI combined with routine MR sequence for the diagnosis of anal fistula%DWI联合常规MR扫描对肛瘘的诊断价值

    Institute of Scientific and Technical Information of China (English)

    李美芹; 张现坡; 孙新海; 李娴; 盛华强; 胡喜斌; 徐洁

    2011-01-01

    目的:评价DWI联合常规MR扫描对肛瘘的诊断价值.方法:选取20例临床怀疑肛瘘或有肛瘘手术史患者行常规MR扫描及DWI检查,比较肛瘘内、外瘘口,瘘管分支及脓肿的显示率.结果:常规MR扫描序列共显示瘘管22个、内口14个、外口22个、脓肿14个;DWI检查共显示瘘管25个、内口16个、外口23个、脓肿17个.结论:DWI联合常规MR扫描可提供肛瘘合并肛周脓肿的检出率,为外科手术提供可靠的影像学依据.%Objective : To explore the value of DWI combined with routine MR sequence for the diagnosis of anal fistulaMethods: 20 patients with suspected anal fistula were examined with routine MR sequence and DWI,and the display rates of anal inner and outer fistula,fistula branch and abscesses were compared. Results : Routine MR sequence displayed fistula 22 , inside mouth 14 , outside mouth 22 , abscesses 14 : DWI displayed fistula 25 ,inside mouth 16 ,outside mouth 23 , abscesses 17. Conclusion: DWI combined with routine MRI is a sensitive diagnostic method for anal fistula examination,it can provide important informations about anal fistula. Especially it can improve the detection rate of fistula combined with perianal abscess.

  8. Analysis of three kinds of operation in the treatment of anal fistula clinical curative effect%三种手术治疗肛瘘临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    苏卫平

    2015-01-01

    Objective In order to compare the incision and thread drawing technique, anal fistula, incision and drainage of stripping ligation three kinds of operation treatment of anal fistula, treatment of anal fistula operation mode selection. Methods 60 patients with anal fistula were randomly divided into 3 groups, 20 cases in each group, the treatment group (group A) with anal fistula Seton therapy, control group 1 (group B) with anal fistula incision and drainage for the treatment, control group 2 (group C) by stripping ligation in the treatment of anal fistula, and to compare its efficacy. Results In the treatment group and two in control group in the cure rate, recurrence rate had significant difference (P<0.05). Conclusion The results show that, the incision line of the exact curative effect in the treatment of anal fistula, anal fistula is easy to operate;stripping ligation anal function less damage, high recurrence rate, development prospect.%目的:为了比较切开挂线术、切开引流术、肛瘘剥离结扎术三种手术治疗肛瘘效果,探讨治疗肛瘘手术方式的选择。方法:将60例低位肛瘘患者随机分为3组,每组20例,治疗组(A组)采用肛瘘切开挂线术治疗,对照1组(B组)采用肛瘘切开引流术治疗,对照2组(C组)采用肛瘘剥离结扎术治疗,并比较其疗效。结果:治疗组与两对照组在治愈率、复发率有显著性差异(P<0.05)。结论:结果表明,切开挂线术治疗肛瘘疗效确切,易于操作;肛瘘剥离结扎术肛门功能损伤较少,复发率较高,有发展的前景。

  9. Fistula Tunnel Method to Suture a Period of Treatment, the Clinical Effect of the Treatment of Anal Fistula%瘘管隧道法切除一期缝合术治疗肛瘘的临床疗效

    Institute of Scientific and Technical Information of China (English)

    杨本军

    2016-01-01

    目的:探讨利用瘘管隧道法切除一期缝合术进行肛瘘治疗的临床疗效。方法方便选取2013年1月—2014年1月期间入住该院治疗肛瘘的120例患者,按治疗方法不同将其随机分为A、B、C 3组各40例,A组采用瘘管隧道切除一期缝合术,B组采用肛瘘切除缝合术,C组采用肛瘘切除术,对比3个组患者创面愈合时间、术后伤疤情况、感染情况以及肛门的括约肌功能恢复等。结果 A、B两组患者手术后伤口的愈合时间分别为(4±11)d和(5±12)d,相比于C组的愈合时间(9±18)d要更短,疤痕也较小,P<0.05;在手术后伤口出现感染情况以及复发情况的比较上,A组1例,B组15例,C组5例,B组又比A、C两组更高,P<0.05;肛门的变形数量方面A组2例,B组3例,C组18例,A、B两组明显比C组少,P<0.05;另外,A、B两组患者都没有出现因为肛门括约肌损伤而导致大小便时常的病例。结论治疗肛瘘疾病采用瘘管隧道法切除一期缝合术,有效减少了患者伤口创面痊愈的时间,且手术后的疤痕比较小,手术复发率低,最大限度的保护了患者肛门括约肌的功能,提高治疗肛瘘的疗效,值得在临床上广泛推广和应用。%Objective To study the fistula tunnel method is used to suture the first phase of treatment for anal fistula of clinical efficacy. Methods Convenient selection between January 2013 to January 2014 during the period of stay in the hos-pital for the treatment of anal fistula, 120 patients in treatment methods, based on the random divided into A, B, C three groups (40 cases, group A with fistula tunnel suture issue, group B with anal fistula resection decompression, group C with anal fistula resection, compare the three groups of patients with wound healing time, postoperative scar size, postoperative wound infection situation and anal deformation of anal sphincter function, and the postoperative recurrence 2 years of fol-low-up, and statistical analysis

  10. 肛门括约肌间瘘管结扎术治疗复杂性肛瘘效果观察%Fistula Ligation of Anal Sphincter in the Treatment of Complicated Anal Fistula:An Observation of Its Clinical Effect

    Institute of Scientific and Technical Information of China (English)

    赵剑军

    2015-01-01

    Objective:to explore the anal intersphincteric fistula ligation in the treatment of complex anal Fistula: a clinical effect.Methods: retrospective analysis of July 2011 ~2012 year in July at my hospital for treatment of 80 cases of anal fistula patients, divided into two groups according to the treatment and observation of 40 cases, fistula ligation in the treatment of the anal sphincter, and 40 patients in the control group, treated using conventional methods.Comparison of clinical efficacy.Result:to observe the clinical curative effect was significantly better than the control group, there was a statistically significant differ-ence (P<0.05) .Observation of adverse reaction incidence was significantly lower than the control group (P<0.05) , the differ-ence was statistically significant.Conclusion: when clinical treatment of complex anal fistula, fistula ligation for treatment of the anal sphincter, access to satisfactory clinical efficacy and postoperative pain is light, fast recovery, so you can consider further popularized in clinical practice.%目的:探讨肛门括约肌间瘘管结扎术治疗复杂性肛瘘的临床疗效。方法:回顾性分析2011年7月至2012年7月在我院接受治疗的复杂性肛瘘患者80例,根据治疗方法分为两组,观察组40例,采用肛门括约肌间瘘管结扎术治疗,对照组40例,采用常规方法治疗。比较两组的临床疗效。结果:观察组临床疗效明显优于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率明显低于对照组(P<0.05),差异有统计学意义。结论:临床治疗复杂性肛瘘时,采用肛门括约肌间瘘管结扎术进行治疗,能够获得满意的临床疗效,且术后疼痛感比较轻,患者恢复快,因此可以考虑在临床上进一步推广应用。

  11. 3D-EAUS and MRI in the Activity of Anal Fistulas in Crohn’s Disease

    Directory of Open Access Journals (Sweden)

    Maria Eleonora Alabiso

    2016-01-01

    Full Text Available Aim. This study aspires to assess the role of 3D-Endoanal Ultrasound (3D-EAUS and Magnetic Resonance Imaging (MRI in preoperative evaluation of the primary tract and internal opening of perianal fistulas, of secondary extensions and abscess. Methods. During 2014, 51 Crohn’s disease patients suspected for perianal fistula were enrolled. All patients underwent physical examination with both the methods and subsequent surgery. Results. In the evaluation of CD perianal fistulas, there are no significant differences between 3D-EAUS and MRI in the identification of abscess and secondary extension. Considering the location, 3D-EAUS was more accurate than MRI in the detection of intersphincteric fistulas (p value = 10−6; conversely, MRI was more accurate than 3D-EAUS in the detection of suprasphincteric fistulas (p value = 0.0327 and extrasphincteric fistulas (p  value=4⊕10-6; there was no significant difference between MRI and 3D-EAUS in the detection of transsphincteric fistulas. Conclusions. Both 3D-EAUS and MRI have a crucial role in the evaluation and detection of CD perianal fistulas. 3D-EAUS was preferable to MRI in the detection of intersphincteric fistulas; conversely, in the evaluation of suprasphincteric and extrasphincteric fistulas the MRI was preferable to 3D-EAUS.

  12. 磁共振成像对肛瘘及其分型的诊断价值%MRI Values of Diagonsing in Anal Fistulas and its Typing

    Institute of Scientific and Technical Information of China (English)

    张旭升; 何锡华; 郑晓林; 方学文

    2013-01-01

    Objectives To evaluate MRI values in diagnosing anal fistulas and the typing.Methods Ninety-two patients suffered from anal fistulas who experiened MR plane scan and enhancement were approved by operation.According to Parks type,the MRI manifestations were obsvered and collated with operation.The MRI correctness of the fistulas typing and dispaying the fistula,the internal opening,primary tract,secondary tract,abscess were evaluated.Results The MRI manifestations of 92 cases:fistulas were high signals in T2WI and T2WI-fs and were slightly low signals or middle signals in T1WI.The internal opening and abscess could be dispayed.The walls of fistula were evidently intensified after injecting contrast-agent.In type,35 between sphincteric fistul,18 transsphincteric,4 supra-sphincteric,3 extra-sphincteric,7 endermic and 25 complex anal fistula were diagnosed by MRI and the coincidental rate was 96.7%,89/92,with surgical comparying.The coincidental rates dispaying the internal opening,primary tract,secondary tract and abscess were 97.1%,98.3%,80.7% and 100% respectively.Conclusions MRI Parks typing of anal fistulas in operating-front was consistent with operating that could provide with correctly anatomical information for surgery and had applied values.%目的 旨在探讨MRI对肛瘘的分型及诊断准确率方面的价值.方法 收集9 2例MRI诊断为肛瘘患者,所有病例均行MR平扫+增强检查,并经手术证实.根据Parks分型法,观察其MRI表现,与手术所见对照,评价MRI对肛瘘的分型及瘘管、内口、支管、脓肿的诊断准确性.结果 92例瘘管MRI表现:T2WI及T2WI-fs为高信号,T1WI呈条状等到或稍低信号,增强扫描瘘管壁有明显强化,并能显示病变内口和脓肿.MRI诊断为约肌间型35例、经括约肌型1 8例、括约肌上型4例、括约肌外型3例、皮下型7例、复杂型肛瘘25例,与手术所见对照,准确率为96.7%(89/9 2);显示肛瘘内口、主管、支管

  13. 360°直肠腔内超声检查在肛瘘的应用研究——直肠肛管横断面解剖对肛瘘诊疗的指导%360° rectalendosonography in anal fistula applied research-Rectum and anal canal cross-sectional anatomy of the guidance on diagnosis and treatment of anal fistula

    Institute of Scientific and Technical Information of China (English)

    张秀; 秦澎湃; 熊芳; 黄斌; 李志祥

    2012-01-01

    目的 探讨360°直肠腔内超声检查在肛瘘诊疗中的应用价值.方法 200例拟手术治疗的肛瘘患者随机进行两种直肠腔内超声检查,其中103例使用360°旋转探头(旋转组),97例应用端扫式凸阵探头(端扫组),临床医师参考超声报告设计手术方案进行手术,分析两种检查方法的结果.结果 两组在诊断肛瘘的灵敏度上差异无统计学意义,对指导临床医师诊断肛瘘及手术的帮助作用存在差异,有统计学意义.结论 360°旋转探头与端扫式腔内探头在肛瘘的诊断灵敏度均较高,但是360°旋转探头超声能更准确的指导临床医师制定手术方案,提高手术成功率.%Objective For patients with anal fistula rectal cavity of 360?rotating ultrasonic probe examination, anorectal and get continuous cross-sectional ultrasound images of the surrounding tissue, cross sectional shape changes hy clinicians to determine the location of the Traveling anal fistula, guided surgery. Methods 200 cases of anal fistula surgery patients to he randomized to two kinds of transrectal ultrasound, in which 103 cases with 360° rotating probe, 97 patients were treated side-hroom convex array probe, clinicians report reference ultrasound surgery surgery program design, analysis, two types of inspection Methods results. Results 360° rotating cavity with side broom cavity probe sensor sensitivity in the diagnosis of anal fistula were no statistically significant difference, to guide clinicians and diagnosis of anal fistula surgery with the help of role differences, there are statistically significant. Conclusion 360° rotating probe with side broom cavity probe sensitivity in the diagnosis of anal fistula were higher, but the 360° rotating ultrasound probe to guide clinicians to more accurate surgical planning, surgical guidance.

  14. Three-dimensional Anorectal Ultrasound Scanning Combining with Fistula Imaging Localization Diagnosis of Anal Fistula of Clinical Research%三维肛肠超声扫描结合瘘管造影定位诊断肛瘘临床研究

    Institute of Scientific and Technical Information of China (English)

    李瑞

    2016-01-01

    目的:探讨三维肛肠超声扫描结合瘘管造影定位诊断肛瘘的临床研究情况。方法整群选取该院2015年4月—2016年4月收治的118例经手术确诊肛瘘的患者作为研究对象,分为观察组和对照组。给予对照组实施三维肛肠超声扫描的方法诊断肛瘘,观察组在对照组的基础上实施瘘管造影定位的方法诊断肛瘘。结果观察组检测出单纯性肛瘘的例数为38例,占比64.41%,检测出复杂性肛瘘的例数为21例,占比35.59%;对照组检测出单纯性肛瘘的例数为50例,占比84.74%,检测出复杂性肛瘘的例数为9例,占比15.25%,两组在诊断肛瘘分型上的对比差异有统计学意义(P﹤0.0.5)。结论三维肛肠超声扫描结合瘘管造影定位的方式在肛瘘诊断中的应用,能够有效诊断出肛瘘的类型,对于患者肛瘘疾病的治疗具有重要的借鉴价值。%Objective To investigate the three-dimensional anorectal ultrasound scanning combined with the clinical re-search of fistula imaging localization diagnosis of anal fistula. Methods Group selection in our hospital from April 2015 to April 2016 118 cases were confirmed by surgery of anal fistula patients as the research object, for the observation group and control group. Give control to implement the three dimensional anorectal ultrasound scan method in the diagnosis of anal fistula, observation group in the control group on the basis of implementing fistula angiography positioning method in the di-agnosis of anal fistula. Results The observation group detected simple anal fistula cases for 38 cases, accounted for 64.41%, detect the complexity anal fistula cases for the 21 cases, accounted for 35.59%; Control group detected cases of simple anal fistula of 50 cases, accounted for 84.74%, detect the complexity anal fistula cases for 9 cases, accounted for 15.25%, two groups in the diagnosis of anal fistula classification comparison on difference was

  15. Is routine endoanal ultrasound useful in anal fistulas? ¿Es útil la ecografía endoanal de rutina en las fístulas perianales?

    Directory of Open Access Journals (Sweden)

    I. Pascual Migueláñez

    2005-05-01

    Full Text Available Objective: to evaluate the effectiveness of endoanal ultrasound with hydrogen peroxide enhancement in the assessment of anal fistula (tract and internal opening, and to value the utility of this examination for anal or perianal suppuration when performed by a colorectal surgeon trained in this technique. Patients: endoanal ultrasound was performed in 103 patients with anal or perianal suppuration. Twenty patients were excluded: 9 had the external opening closed, and 11 had cryptoglandular abscesses. All ultrasound scans were performed by the same explorer using a B&K Diagnostic Ultrasound System with a 7 MHz endoprobe. The examination was based on the identification of the three anal planes, then hydrogen peroxide was infused and the procedure was repeated. Results: out of 83 patients included, 11 had a perianal sinus and 72 an anal fistula. In all fistulas the main tract was found: 24 were inter-sphinteric (33.33%, 33 trans-sphincteric (45.83%, 3 supra-sphincteric (4.17%, and 12 extra-sphincteric (16.67%. An internal opening was identified in 69 (95.83%. Conclusions: endoanal ultrasound with hydrogen peroxide enhancement is an effective examination to visualize fistulous tracts and internal openings. We think it is highly useful for anal or perianal suppuration to identify abscesses, to recognize a perianal sinus, to check the sphincteric condition, and to plan subsequent surgery.Objetivo: evaluar la efectividad de la ecografía endoanal contrastada con inyección de agua oxigenada para establecer la topografía fistulosa (trayecto y localización del orificio interno y valorar la conveniencia de esta exploración en la supuración anal o perianal cuando es realizada por un cirujano general dedicado a coloproctología y entrenado en esta técnica. Pacientes: se hizo ecografía endoanal a 103 pacientes con supuración anal o perianal. Se excluyeron 20 pacientes del estudio: 9 tenían el orificio externo de la fístula cerrado y 11 presentaban

  16. Clinic applicative value of MRI in the diagnosis of complex anal fistula%MRI诊断复杂性肛瘘的临床应用价值

    Institute of Scientific and Technical Information of China (English)

    王军大; 李映

    2014-01-01

    Objective To evaluate the clinical value of MRI examination in the diagnosis and guidance of operation complexity a-nal fistula.Methods Preoperative MRI findings of 32 patients with complex anal fistula confirmed by operation were analyzed ret-rospectively,and compared with the operation results.Results The pre-operation MRI results of 32 patients with complex anal fis-tula revealed that there were 43 fistulas,10 anus week abscesses,58 orificium fistulas,comparing the MRI diagnosis with operation results,coincidence rate of fistula,anus week abscesses,orificium fistula was 100.0%,100.0%,89.3%,respectively.MRI manifes-tations of fistula were that T1 WI manifestations of fistula was or low signal,T2 WI and T2 WI fat suppression sequence manifesta-tions of fistula was high signal,fistula presented a tubular shape obviously as T1 WI enhancement scanning,internal opening repre-sented as intensive dot,complicated embranchment,two type signal of fistula appeared at the same time.MRI manifestations of ab-scesses were that circular,ellipse,irregular form and horseshoe-shape,T1 WI manifestations of abscesses was low signal,there was gas in abscess cavity of some patients;intestinal tube surrounding of some patients were involved by abscess cavity,and up through the edge of bladder to the perineum.Conclusion MRI examination could accurately display the number of complex anal fistula,fis-tula walking and branch,the position of internal opening,correlativity between fistula and surrounding muscles,status of abscess, which could provide guidance for anorectal surgery.%目的:评价 MRI检查在复杂性肛瘘术前诊断及指导手术方面的临床应用价值。方法回顾性分析32例经手术证实为复杂性肛瘘患者的术前 MRI表现,并与手术结果进行对比研究。结果32例复杂性肛瘘患者术前 MRI显示有瘘管43条、肛周脓肿10个、瘘口58个,MRI诊断与手术结果对照,符合率分别为瘘管100.0%、脓肿100.0

  17. Gore BioA Fistula Plug in the treatment of high anal fistulas – initial results from a German multicenter-study [Gore BioA Fistel Plug zur Behandlung hoher Analfisteln – erste Ergebnisse einer deutschen Multicenter-Studie

    Directory of Open Access Journals (Sweden)

    Ommer, A.

    2012-09-01

    Full Text Available [english] Background: Treatment of high anal fistulas may be associated with a high risk of continence disorders. Beside traditional procedure of flap-reconstruction the occlusion of the fistula tract using fistula-plugs offers a new sphincter-saving treatment option. In this study for the first time results from Germany are described.Patients and method: 40 patients (30 male, 10 female, age 51±12 years underwent closure of a high trans-sphincteric (n=28 or supra-sphincteric (n=12 fistula with Gore BioA Fistula Plug in three surgical departments. The surgical procedures had been performed by five colorectal surgeons. Four patients had Crohn’s disease. Preoperatively 33 patients were completely continent; seven patients complained of minor continence disorders. Treatment of the patients was performed on a intent-to-treat basis and evaluation of the results was retrospective using pooled data from each center.Results: Postoperatively one patient developed an abscess, which had to be managed surgically. In two patients the plug had fallen out within the first two weeks postoperatively. Six months after surgery the fistula has been healed in 20 patients (50.0%. Three additional fistulas healed after 7, 9 rsp. 12 months. The overall healing-rate was 57.5% (23/40. The healing rate differs considerably between the surgeons from 0 to 75% and depends on the number of previous interventions. In patients having only drainage of the abscess success occurred in 63.6% (14/22 whereas in patients after one or more flap fistula reconstruction the healing rate decreased slightly to 50% (9/18. No patient complained about any impairment of his preoperative continence status.Conclusion: By occlusion of high anal fistulas with a plug technique definitive healing could be achieved in nearly every second patients. Previous surgery seems to have a negative impact on success rate. We have not observed any negative impact on anal continence. From that point of view

  18. 肛瘘切开引流治疗肛瘘的疗效及患者手术前后肛肠动力学变化特点%Efficacy of anal fistula incision and drainage in the treatment of anal fistula and change characteristics of patients' anorectal dynamics before and after the operation

    Institute of Scientific and Technical Information of China (English)

    刘大鹏

    2016-01-01

    目的 探讨肛瘘切开引流治疗肛瘘的疗效及患者手术前后肛肠动力学变化特点.方法 选取2013年3月至2015年2月我院收治的高位复杂性肛瘘患者84例为研究对象,采用随机数表法分为观察组和对照组各42例,对照组采取常规脓肿切开引流术,观察组采取肛瘘切开引流术,比较两组治疗有效率,采用肛肠测压仪检测两组肛管最大收缩压(AMCP)、肛管最长收缩时间(ALCT)、直肠静息压(RRP)、肛管静息压(ARP),同时记录6个月复发率.结果 观察组治疗有效率高于对照组(95.2% vs.81.0%;P< 0.05).治疗前后两组AMCP、ALCT、RRP、ARP比较均无统计学差异(P>0.05).术后6个月观察组复发率低于对照组(2.4% vs.14.3%;P<0.05).结论 肛瘘切开引流可有效治疗肛瘘,且对患者肛肠动力学影响小,值得在临床推广应用.%Objective To explore the efficacy of anal fistula incision and drainage in the treatment of anal fistula and change characteristics of patients' anorectal dynamics before and after the operation.Methods 84 cases of high complex anal fistula treated in our hospital from March 2013 to February 2015 were selected as the research objects,and divided into observation group and control group by the random number table,42 cases in each group.Control group received routine abscess incision and drainage operation,while observation group received anal fistula incision and drainage operation.The effective rate of treatment in two groups were compared,anorectal pressure measuring instrument was used to detect anal maximal contraction pressure (AMCP),anal longest contraction time (ALCT),rectal resting pressure (RRP),and anal resting pressure (ARP) in two groups,the recurrence rate in 6 months was recorded.Results The effective rate of treatment in observation group was significantly higher than that in control group (95.2% vs.81.0%,P<0.05).There were no statistically significant differences in AMCP

  19. Allogenic acellular extracellular matrix repairs high anal fistula%脱细胞异体真皮基质填塞修复高位肛瘘

    Institute of Scientific and Technical Information of China (English)

    王健诚; 王炜; 张科; 邹世镇

    2014-01-01

    背景:治疗高位肛瘘的方法有瘘管剔除、切开挂线、选择性黏膜瓣推移、生物蛋白胶封堵、括约肌间瘘管结扎等,大都存在创面愈合间长、一次成功率较低、复发率偏高的不足,术后并发症发生率高。  目的:观察应用脱细胞异体真皮基质治疗高位肛瘘的临床疗效,探讨治疗高位肛瘘的微创治疗新方法。  方法:选择100例高位肛瘘患者,根据患者意愿分2组治疗,治疗组采用脱细胞异体真皮基质填塞治疗,对照组采用传统的肛瘘低位切开并高位挂线治疗,比较两组手术时间、术中出血量、术后目测类比评分、术后疼痛持续时间、肛门失禁严重程度评分、创面愈合时间、一期手术成功率、治愈率及复发率。  结果与结论:治疗组手术时间、术中出血量、创面愈合时间、术后目测类比评分、术后疼痛持续时间、肛门失禁严重程度评分均低于对照组(P OBJECTIVE:To observe the clinical effect of acelular extracelular matrix in the treatment of high anal fistula, and to explore a minimaly invasive treatment for high anal fistula. METHODS: Totaly 100 cases of high anal fistula were randomly divided into treatment group and control group, 50 cases in each group. Treatment group were treated with alogenic acelular extracelular matrix, and control group were treated with traditional low incision with high thread-drawing. Then, we observed and compared the operation time, bleeding volume, postoperative pain score (visual analog scale score), postoperative pain duration, anal incontinence severity score (Wexner score), wound healing time, one-stage success rate, cure rate, recurrence rate. RESULTS AND CONCLUSION: Compared with the control group, the treatment group showed lower scores in the operation time, bleeding volume, wound healing time, visual analog scale score, postoperative pain duration, and anal incontinence severity score

  20. Oesophageal atresia with tracheoesophageal fistula and anal atresia in a patient with a de novo microduplication in 17q12

    NARCIS (Netherlands)

    Smigiel, R.; Marcelis, C.L.M.; Patkowski, D.; Leeuw, N. de; Bednarczyk, D.; Barg, E.; Mascianica, K.; Maria Sasiadek, M.; Brunner, H.G.

    2014-01-01

    Oesophageal atresia (OA) and tracheoesophageal fistula (TOF) are foregut malformations with a heterogeneous etiology. OA/TOF may occur as an isolated anomaly or as part of a syndrome. Chromosomal anomalies have been reported in 6-10% of OA/TOF. Several genes have been implicated in cases of syndromi

  1. Clinical Observation of Simple Anal Fistula Treated by Thread Dragging Through Fistula%隧道式拖线术治疗单纯性肛瘘疗效观察

    Institute of Scientific and Technical Information of China (English)

    徐晓波

    2016-01-01

    Objective To observe the effect of simple anal fistula treated by thread dragging through fistula. Methods 106 cases of patients with perianal abscess at our hospital from October 2012 to October 2015 were selected as the object of study. The patients were randomly divided into two groups, each group had 53 cases. The control group was treated by ligation therapy, and the treatment group was treated by thread dragging through fistula, the clinical effect, cure period and treatment charge of two groups were compared and analyzed. Results The total treatment effective rate of the treatment group was significantly higher than the control group (94.34%>73.58%), there was statistical significance (P<0.05). The cure period of the treatment group was significantly shorter than the control group, the treatment charge was significantly less than the control group, there was statistical significance (P<0.05). Conclusion That has better clinical effect of the simple anal fistula treated by thread dragging through fistula, and able to effective expedite the treatment process, reduce the treatment charge, thus to alleviate the financial burden of patients, that is worth for promotion.%目的:观察隧道式拖线术治疗单纯性肛瘘的临床疗效。方法选择2012年10月~2015年10月我院收治的106例单纯性肛瘘患者作为研究对象,将其随机分为两组,各53例。对照组行挂线疗法治疗,观察组行隧道式拖线术治疗。对两组患者临床疗效、治愈时间及治疗费用展开对比分析。结果观察组临床治疗总有效率明显高于对照组(94.34%>73.58%),差异显著(P <0.05);观察组治愈时间明显短于对照组,治疗费用明显低于对照组,差异显著(P <0.05)。结论隧道式拖线术治疗单纯性肛瘘较挂线疗法临床疗效更为显著,且能够有效加速治疗进程,减少治疗费用,从而减轻患者经济负担,值得临床推广。

  2. 肛瘘手术方式的选择和术后切口管理%Choice of surgical procedure and management of postoperative incision for anal fistula

    Institute of Scientific and Technical Information of China (English)

    陈朝文; 彭勃

    2015-01-01

    肛瘘是外科常见疾病,一旦出现,很难自愈,手术是其最主要的治愈方式.由于肛瘘的形态和分类等不同,手术方式及术后切口管理方式也不应相同.根据患者具体情况选择合适的手术方式及术后切口管理方式,既可以使肛瘘有效愈合、又可以保护肛门括约肌功能,进而提高患者术后生活质量.现就治疗肛瘘的手术方式及术后切口管理方式综合评价如下.%Anal fistula is a common disease in general surgery. It is difficult to heal without intervention and surgical treatment is the major treatment. Method of surgical treatment and management of postoperative incision are based on features and classifications of anal fistula. Choosing the appropriate approach in accordance with specific conditions of patients can obtain effective healing and proper protection against anal sphincter, along with the improvement of life quality. Comprehensive evaluation on methods of surgical treatment and managements of postoperative incision for anal fistula is presented in this paper.

  3. MRI Diagnosis of Anal Fistula%磁共振肛瘘成像的术前诊断价值

    Institute of Scientific and Technical Information of China (English)

    魏来; 赵泽华; 彭屹峰

    2015-01-01

    目的:探讨磁共振肛瘘成像技术在术前分型诊断及预后评估的应用价值。方法对43例肛瘘患者于术前行MRI检查,根据图像判断内、外口的位置及瘘管的走行,为临床治疗及手术方案的制订提供影像学依据。结果磁共振肛瘘成像对于病变的检出敏感性较高(37/43)。对于大部分的肛瘘病例,均能较好的显示瘘管的走行情况及开口位置(32/37)。MRI分级与预后有良好的相关性。结论 MRI是目前用于肛瘘术前评估的最佳影像学方法。MRI可以准确显示病变范围、评估预后,有助于治疗方案的制定和疗效监测。%Objective To discuss MRI manifestations and diagnostic value of anal ifstula.Methods MRI was performed in 43 patients with anal ifstula. MRI manifestations of the anal ifstulas that were compared with the operation results.Results 37 of anal ifstula were showed by MRI. We can tel the internal ostia and external ostia on MRI in 32 patients. Parks IV was seldom detected on MRI. The MRI ranks of anal ifstula have relevance with prognosis.Conclusion MRI can accurately detect the ifstula and abscesses of anal ifstula. MRI has clinical signiifcance in the auxiliary diagnosis and prognosis for anal ifstula. It is a useful diagnostic method for anal ifstula.

  4. HCPT Minimally Invasive Surgery in the Treatment of Anal Fistula in 40 Cases%HCPT微创术治疗肛瘘40例

    Institute of Scientific and Technical Information of China (English)

    王宏波; 闫树勋; 薄超刚; 周秀芳; 谢桂珍; 王艳梅

    2013-01-01

    Objective:To investigate the multi-functional therapeutic instrument ( HCPT) methods and clinical efficacy in the treat-ment of anal fistula .Methods:40 patients in need of anal fistula operation were treated using HCPT minimally invasive surgery .We ob-serve the operation time , stool bleeding ,and recovery time , postoperative follow-up one year , clinical observation .Results:All patients in this group operation time is 10 ~20min, an average of 16min.No intraoperative bleeding, no postoperative pain, postoperative 24h defecation, defecation no bleeding , no pain.Recovery time is 7 ~11d, an average of 9D, the cure rate of 100%.All patients recovered to normal work, study and life, no complications, no cases of infection, anal function properly.Follow-up of 1 years, no recurrence to achieve radical purposes .Conclusion:multifunctional anorectal therapeutic apparatus in the treatment of anal fistula operation is simple , shorter operative time, less bleeding, no pain, patients do not need hospitalization , low cost, quick recovery, no obvious scars after re-covery without sequels and complications , efficacy, it is worthy of popularization and application .%目的:探讨多功能肛肠治疗仪( HCPT )治疗肛瘘的方法和临床疗效。方法:将需要手术的肛瘘患者40例采用HCPT微创术进行治疗,观察其手术时间、大便出血情况、及恢复时间,随访1年,观察疗效。结果:本组全部患者手术时间为10~20分钟,平均16分钟。术中无出血,术后无疼痛,术后24小时排便,排便后无出血、无疼痛。恢复时间7~11天,平均9天,治愈率100%。全部患者恢复正常的工作、学习和生活,无并发症,无感染病例,肛门功能正常。术后随访1年,无1例复发,达到根治目的。结论:多功能肛肠治疗仪治疗肛瘘操作简单、手术时间短、不出血、无痛苦,患者不需住院,费用低廉,恢复快,且恢复后无明显瘢痕

  5. Clinical curative effect analysis of different operation methods in the treatment of complex anal fistula%不同手术方法治疗复杂性肛瘘的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    吴根良

    2015-01-01

    目的:探讨不同手术方式在复杂性肛瘘治疗中的临床疗效及优点。方法:2002年4月-2014年1月收治复杂性肛瘘患者255例,其中行切缝内口引流术64例,切开挂线术68例,瘘管旷置术58例,瘘管摘除缝合术65例。对255例复杂性肛瘘进行术后随访。结果:255例患者随访时间7个月~3年,平均(11.8±4.8)个月。切缝内口引流术复发6例(9.4%),平均愈合时间(19.4±5.6)d;切开挂线术复发2例(2.9%),平均愈合时间(20.1±5.3)d;瘘管旷置术复发7例(12.1%),平均愈合时间(28.8±7.2)d;瘘管摘除缝合术复发9例(13.8%),平均愈合时间(24.7±6.9)d。结论:高位的复杂性肛瘘常采用瘘管旷置术和切开挂线术,低位的复杂性肛瘘常采用瘘管摘除缝合术和切缝内口引流术。%Objective:To explore the clinical curative effect and advantages of different operation methods in the treatment of complex anal fistula.Methods:255 patients with complex anal fistula were selected from April 2002 to January 2014.64 cases were given cutting seam endostoma drainage,68 cases were incision hang line operation,58 cases were fistula putting-aside operation, 65 cases were fistula removed suture operation.255 cases of complex anal fistula were followed up postoperatively.Results:255 patients were followed up for 7 months to 3 years,the average was (11.8 ± 4.8)months.6 cases(9.4%) were recurrence in cutting seam endostoma drainage,the mean healing time was (19.4 ± 5.6)days.2 cases(2.9%) were recurrence in incision hang line operation,the mean healing time was (20.1±5.3)days.7 cases(12.1%) were recurrence in fistula putting-aside operation,the mean healing time was (28.8±7.2)days.9 cases(13.8%) were recurrence in fistula removed suture operation,the mean healing time was (24.7 ± 6.9)days.Conclusion:The elevatus complex anal fistula often adopts fistula putting-aside operation and incision hang line operation,the low-order complex anal

  6. Diagnostic Value of High-frequency Ultrasound in Identifying Perianal Abscess and Anal Fistula%高频超声对肛周脓肿、肛瘘的诊断价值

    Institute of Scientific and Technical Information of China (English)

    王玉双

    2015-01-01

    Objective: To investigate the value of high-frequency ultrasound in identifying perianal abscess and anal fistula. Methods:Ninety cases of perianal abscess or anal fistula are examined by high-frequency color Doppler ultrasound. And comparing these results with the outcomes of the surgery.Results:The diagnostic specificity, the sensitivity the positive predictive value of perianal abscess diagnose are all 100%; the diagnostic specificity and the positive predictive value of anal fistula are 95.5% and 95.8%, the sensitivity 88.5%.Conclusion: High-frequency ultrasound canappropriately identify the perianal abscess and anal fistula directly and conveniently with no pain.%目的:探讨超声诊断肛周脓肿与肛瘘的应用价值。方法使用高频彩色多普勒超声对90例肛周脓肿或肛瘘患者进行检查,并将检查结果与手术结果对照。结果对肛周脓肿的诊断特异度、灵敏度、阳性预测均是100%;对肛瘘的诊断特异度与阳性预测值分别为95.5%、95.8%,灵敏度为88.5%。结论高频超声能方便、直接、无痛苦、较为准确地诊断肛周脓肿和肛瘘。

  7. 中西医结合治疗肛瘘的研究进展%The progress in the Treatment of Anal Fistula with Integrated Traditional Chinese and Western Medicine

    Institute of Scientific and Technical Information of China (English)

    王刚

    2008-01-01

    This article overviewed reports on the ureaunent of anal fistula with integrated traditional Chinese and western medicine in the recent ten years.hoping to providence for clinical treaUrnent of this disease.%本文综述了近十年来中西医结合治疗肛瘘的相关报道,为中西医结合治疗肛瘘提供参考.

  8. Clinical Treatment and Nursing Care for Diabetic Patients with Anal Fistula%糖尿病患者合并肛瘘的临床治疗及其护理

    Institute of Scientific and Technical Information of China (English)

    潘景英; 李楠; 张建英

    2015-01-01

    目的:探讨糖尿病患者合并肛瘘的临床治疗及其护理。方法选取我院2013年11月和2014年11月收治的60例肛瘘患者为研究对象,回顾手术治疗方法和护理方法。结果对60糖尿病患者合并肛瘘患者的治疗疗效进行分析,发现痊愈患者有45(75.0%)例,有效患者11(18.3%)例,无效患者4(6.7%)例。总有效率为93.3%结论手术治疗治疗糖尿病合并肛瘘效果较好,同时合理的临床护理有助于手术治疗和术后恢复。%Objective To investigate the clinical treatment and nursing for diabetic patients with anal fistula.Methods 60 patients with anal fistula admitted in our hospital between November 2013 and November 2014 were selected as the subjects. And the methods of surgery and nursing for the patients were reviewed.Results The result of the treatment effect of 60 diabetic patients with anal fistula showed that 45 cases(75.0%) were cured, the treatment was effective in 11 cases(18.3%), and that was invalid in 4 cases(6.7%), the overall response rate was 93.3%.Conclusion For diabetes complicated by anal fistula, surgical treatment has good effect, and proper clinical nursing is conducive to the surgical treatment and postoperative recovery.

  9. The Effect of Local Injections of Bupivacaine Plus Ketamine, Bupivacaine Alone, and Placebo on Reducing Postoperative Anal Fistula Pain: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Alireza Kazemeini

    2014-01-01

    Full Text Available Background and Objective. This study aimed to compare the effects of different local anesthetic solutions on postoperative pain of anal surgery in adult patients. Method. In this randomized double-blind prospective clinical trial, 60 adult patients (18 to 60 years old with physical status class I and class II that had been brought to a university hospital operating room for fistula anal surgery with spinal anesthesia were selected. Patients were randomly divided into 4 equal groups according to table of random numbers (created by Random Allocation Software 1. Group 1 received 3 mL of normal saline, group 2, 1 mL of normal saline plus 2 mL of bupivacaine 0.5%, group 3, 1 mL of ketamine plus 2 mL of bupivacaine 0.5%, and group 4, no infiltration. Intensity of pain in patients was measured using visual analogue scale (VAS at 0 (transfer to ward, 2, 6, 12, and 24 hours after surgery. Time interval to administration of drugs and overall dose of drugs were measured in 4 groups. Results. Mean level of pain was the lowest in group 3 at all occasions with a significant difference, followed by groups 2, 4, and lastly 1 (P<0.001. Furthermore, groups 2 and 3 compared to groups 1 and 4 had the least overall dose of analgesics and requested them the latest, with a significant difference (P<0.05. Conclusion. Local anesthesia (1 mL of ketamine plus 2 mL of bupivacaine 0.5% or 1 mL of normal saline plus 2 mL of bupivacaine 0.5% combined with spinal anesthesia reduces postoperative pain and leads to greater comfort in recovering patients.

  10. VACTERL (vertebral anomalies, anal atresia or imperforate anus, cardiac anomalies, tracheoesophageal fistula, renal and limb defect spectrum presenting with portal hypertension: a case report

    Directory of Open Access Journals (Sweden)

    Losa Ignatius

    2010-05-01

    Full Text Available Abstract Introduction We report for the first time a unique case of VACTERL (vertebral anomalies, anal atresia or imperforate anus, cardiac anomalies, tracheoesophageal fistula, renal and limb defect spectrum associated with portal hypertension. The occurrence of both VACTERL spectrum and extrahepatic portal hypertension in a patient has not been reported in the literature. We examined whether or not there was any association between extrahepatic portal hypertension and VACTERL spectrum. Case Presentation A two-and-half-year-old Caucasian girl with VACTERL spectrum presented with hematemesis and abdominal distension. She had caput medusae, ascites, splenomegaly, gastric and esophageal varices. Her liver function tests were within normal limits. Magnetic resonance imaging of the liver with contrast showed a thready portal vein with collateral vessels involving both right and left portal veins without intrahepatic duct dilation. Conclusion A thready portal vein, with features of extrahepatic portal hypertension, is a rare non- VACTERL-type defect in patients with VACTERL spectrum. Understandably, clinicians should give low priority to looking for portal hypertension in VACTERL spectrum patients presenting with gastrointestinal bleeding. However before routinely looking for a thready portal vein and/or extrahepatic portal hypertension in asymptomatic VACTERL spectrum patients, we need further evidence to support this rare association.

  11. Clinical value of high-frequency color Doppler ultrasound in diagnosing perianal abscess and anal fistula%高频彩色多普勒超声在肛周脓肿、肛瘘的应用价值

    Institute of Scientific and Technical Information of China (English)

    董愉

    2012-01-01

    目的 探讨高频彩色多普勒超声诊断肛周脓肿与肛瘘的临床应用价值.方法 使用高频彩色多普勒超声对90例肛周脓肿或肛瘘患者进行检查,并将检查结果与手术结果对照.结果 肛周脓肿与肛瘘的声像图与周围正常组织有明显的区别,对肛周脓肿的诊断特异度、阳性预测均是100%,灵敏度为94.3%;对肛瘘的诊断特异度与阳性预测值分别为95.1%、95.5%,灵敏度为85.7%.结论 高频彩色多普勒超声检查对肛周脓肿的位置、大小、数目、范围及肛瘘瘘管的走行、数目具有很高的诊断价值,且方便、直接、无痛苦、诊断准确、易被患者接受.%Objective To study the clinical value of high-frequency coloc Doppler ultrasound in diagnosing perianal abscess and a-nal fistula. Methods Ninety cases of perianal abscess or anal fistula were inspected by high-frequency color Doppler ultrasound. The inspection results were compared with surgical findings. Results There were significantly differences in the sonogram between the tissue with perianal abscess or anal fistula and surrounding normal tissues. The diagnostic specificity of perianal abscess and the positive predictive value were 100% , the sensitivity was 94. 3% ; the diagnostic specificity of anal fistula the positive predictive value were 95.1% and 95.5% , the sensitivity was 85.7%. Conclusion High-frequency color Doppler ultrasound can ascertain the location, size, number and extent of perianal abscess and clearly estimate the trend and number of anal fistula, and it is simple, direct, painless, with high diagnostic accuracy, easily be accepted by patients.

  12. The Order of Evaluation of PPH Combined with Operation of Anal Fistula Resection and Suture Operation%PPH合并肛瘘切除缝合术的手术顺序评价

    Institute of Scientific and Technical Information of China (English)

    敖百顺; 王海峰; 刘伟

    2015-01-01

    Objective:To study and evaluate the operation sequence of PPH with anal fistula resection and suture operation,to provide the necessary basis for clinical.Method:From Jan 2013 to Jan 2014 in our hospital 100 cases of annular mixed hemorrhoids complicated with low anal fistula patients,under the informed consent of patients,were randomly divided into two groups according to the odd and even number of admission,50 cases in group A received PPH operation again for anal fistula resection and suture operation,50 patients in group B with anal fistula resection and suture operation was first PPH operation again,statistical comparison of operation time,two groups of patients with postoperative complications and postoperative pain degree.Result:The operation time of group A was (20.6±4.5)min,was significantly lower than (24.1±7.2)min of group B,there was significant difference(P<0.05).In the group A,1 case of anastomotic bleeding,1 case of anal fistula anastomotic bleeding,1 case of anal fistula sewing suture bleeding and infection,the complication rate was 6.0%.In the group B,1 case of anastomotic bleeding,9 cases of anal fistula anastomotic bleeding, 8 cases of anal fistula bleeding in suture,2 cases of infection of postoperative recurrence of anal fistula,the complication rate was 40.0%,group A was lower than of the group B,there was significant difference(P<0.05).VAS score of the group A was (3.8±1.1),was significantly lower than (6.2±1.2) of group B,the time of pain of group A was (35.6±6.9)h,was shorter than (46.7±10.4)h of group B,the differences were statistically significant(P<0.05). Conclusion:Annular mixed hemorrhoids complicated with low anal fistula patients in the operation treatment of order selection,recommendations to PPH operation in the treatment of anal fistula resection and suture operation,can effectively reduce the operation time and the incidence of complications,the degree of pain and the duration of pain control of patients after surgery

  13. 自拟白头翁汤用于复杂性肛瘘术后换药40例%Self Pulsatilla Decoction for Complex Anal Fistula Dressing 40 Cases

    Institute of Scientific and Technical Information of China (English)

    成川华; 李五生; 陈卫东; 徐玲; 马亮; 葛曼青

    2013-01-01

    目的:观察自拟白头翁汤用于复杂性肛瘘手术后换药的临床疗效。方法将复杂性肛瘘术后患者40例,分为治疗组和对照组各20例。两组患者都静脉滴注哌拉西林2.5g,bid;奥硝唑1g。患者便后用稀碘伏坐浴1次,治疗组给予自拟白头翁汤液与无菌敷料,制成药纱,塞入肛门,压迫创面。对照组以甲硝唑与无菌敷料,制成药纱,塞入肛门,压迫创面。结果治疗组平均治愈天数为低位复杂性肛瘘愈合时间(15.54±8.3)d,高位复杂性肛瘘愈合时间27d。对照组为低位复杂性肛瘘愈合时间(25.2±10.8)d,高位复杂性肛瘘愈合时间45d (P<0.01);治疗组疼痛不适在10 d以内缓解14例(70.O%),对照组为5例(25.0%)。结论自拟白头翁汤有较强的清热解毒、消肿镇痛、止血生肌的功效,治疗复杂性肛瘘术后疗效确切。%Objective:To observe the clinical ef ects of treating Complex anal fistula with pulsatil a decoction. Methods: patients with Complex anal fistula were randomly divided into two groups, 20 patients in each group. both groups of patients were given piperacil in by intravenous drip 2.5g,bid;ornidazole 1g. Treatment group to give the duck soup liquid with a sterile dressing, made into yarn, into the anus, oppressing the wound, and control group with metronidazole and sterile dressings, gauze, into the anus, oppressing the wound. Results:Treatment group average cure time, low complexity anal fistula healing time (15.54+8.3) d, high complex anal fistula healing time for 27 d. and compared with low complexity anal fistula healing time (25.2+10.8) d, high complex anal fistula healing time 45d (P<0.01);Treatment group could relive discomfort within 10d 14 cases (70.0%), control group for 5 cases (25.0%). Conclusion:Pulsatil a Decoction have stronger heat-clearing and detoxicating, detumescence and analgesic and hemostatic ef ect, Cure complexity anal fistula postoperative curative

  14. 切开挂线对口引流术治疗110例复杂性肛瘘临床观察%Clinical observation of incision line counterparts drainage in treatment of complex anal fistula 110 cases

    Institute of Scientific and Technical Information of China (English)

    茆海兵

    2011-01-01

    目的 观察切开挂线对口引流术治疗复杂性肛瘘的临床疗效.方法 回顾性分析切开挂线对口引流治疗高位复杂性肛瘘110例患者的临床资料.结果本组一次手术治愈102例,二次治愈8例,治愈率100%.疗程15 ~75d,平均30d.术后对110例随访6个月至1年半,无复发、肛门失禁、疤痕畸形、移位、继发感染等后遗症.结论 切开挂线加对口引流术治疗高位复杂性肛瘘,整个术式体现了损伤肛门括约肌少,不影响肛门功能,伤口愈合快,彻底治愈肛瘘的原则,值得临床推广应用.%Objective To observe the incision line counterparts drainage in the treatment of complex anal fistula. Methods A retrospective analysis of their counterparts in drainage incision line treatment of high anal fistula complex clinical data of 110 patients. Results A surgical cure in 102 cases, eight cases of secondary cured, the cure rate was 100%. Course of 15 to 75 days, an average of 30 days. Of 110 patients were followed up after 6 months to 1 year and a half, without recurrence, incontinence , scar deformity, displacement, secondary infection and other complications. Conclusions Canadian counterparts incision drainage line treatment of high complex anal fistula, the surgical damage to the anal sphincter shows a small, does not affect anal function, wound healing, the principle of complete cure of anal fistula, is worthy of clinical application.

  15. 先天性肛门闭锁合并直肠阴道舟状窝瘘的护理%Nursing of congenital anal atresia patients complicated with rectovaginal scaphoid fossa fistula

    Institute of Scientific and Technical Information of China (English)

    朱正云

    2012-01-01

    目的 探讨先天性肛门闭锁合并直肠阴道舟状窝瘘的护理.方法 总结14例先天性肛门闭锁合并直肠阴道道舟状窝瘘围术期护理.护理要点包括:术前心里护理及充分做好肠道准备,术后做好肛周、肛管护理,定期扩肛,观察排便情况,给予健康指导及出院指导.结果 患者中2例术后肛门红肿明显伴有糜烂、流脓.经积极治疗和护理,所有患儿均痊愈出院.结论 充分的术前准备和细致的术后护理及正确扩肛能避免术后并发症的发生,提高患儿生活质量.%Objective To explore the nursing of congenital anal atresia patients complicated with rectovaginal scaphoid fossa fistula. Methods The perioperative nursing of 14 congenital anal atresia patients complicated with rectovaginal scaphoid fossa fistula was summarized. The nursing included preoperative psychological care and adequate bowel preparation and postoperative nursing (perianal and anal canal nursing,regular anal expansion,defecation,health guidance and discharge guidance). Results Two patients had anal swelling accompanied by erosion and pus. After active treatment and nursing,all children were cured and discharged. Conclusion Adequate preoperative preparation,careful postoperative nursing,right anal expansion can avoid complications and improve quality of life of those patients.

  16. 脱细胞异体真皮基质填塞治疗肛瘘的临床体会%Clinical study on anal fistula treatment with acellular extracellular matrix

    Institute of Scientific and Technical Information of China (English)

    安少雄; 黄斌

    2012-01-01

    Objective To observe the effects of the efficacy of acellular extracellular matrix (AEM) treatment for anal fistula. Methods Twelve patients with anal fistula were treated with AEM. The clinical effects were observed. Results Nine cases were cured, but 3 failed and 1 case relapsed after 6 months. The heal rate of anal fistula was 75%. Conclusions This method has advantages of mild traumas and less pain, rapid recovery rapidly, and the most important is that this treatment could protect anal function and appearance. However, the long-term effect needs further study.%目的 探讨脱细胞异体真皮基质填塞治疗肛瘘的临床疗效.方法 采用脱细胞异体真皮基质填塞治疗12例肛瘘患者,观察其临床效果.结果 本组患者瘘管愈合时间7~18 d,平均(13.0±3.3)d.12例患者中治愈9例,治愈率为75%,失败3例,随访6个月复发1例,复发率为8.3%.本组无肛门失禁、肛门畸形发生.结论 脱细胞异体真皮基质填塞治疗肛瘘具有创伤小、疼痛轻、恢复快、不损害肛门功能和外形的优点,但远期效果需进一步观察.

  17. Protective effect of Cassia fistula fruit extract on bromobenzene-induced nephrotoxicity in mice.

    Science.gov (United States)

    Kalantari, Heibatullah; Jalali, Mohammadtaha; Jalali, Amir; Salimi, Abobakr; Alhalvachi, Foad; Varga, Balazs; Juhasz, Bela; Jakab, Anita; Kemeny-Beke, Adam; Gesztelyi, Rudolf; Tosaki, Arpad; Zsuga, Judit

    2011-10-01

    The efficacy of a crude hydro-alcoholic extract of Cassia fistula (golden shower tree) fruit to protect the kidney against bromobenzene-induced toxicity was studied. Negative control mice received normal saline; positive control mice were given 460 mg/kg of bromobenzene; Cassia fistula treated mice received 200, 400, 600 and 800 mg/kg of Cassia fistula fruit extract followed by 460 mg/kg bromobenzene (daily by oral gavage for 10 days). On the 11th day, the mice were sacrificed, blood samples were obtained to assess blood urea nitrogen (BUN) and creatinine levels, and kidneys were removed for histological examination. We found that bromobenzene induced significant nephrotoxicity reflected by an increase in levels of BUN and creatinine that was dose dependently prevented by the Cassia fistula fruit extract. The nephroprotective effect of the Cassia fistula fruit extract was confirmed by the histological examination of the kidneys. To the best of our knowledge, this is the first study to demonstrate the protective effect of Cassia fistula in nephrotoxicity.

  18. Clinical observation of the ligation of intersphincteric fistula tract in the treatment of simple anal fistula%括约肌间瘘管结扎术在单纯肛瘘治疗中的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    田颖; 张忠涛; 安少雄; 贾山; 刘连成; 于洪顺

    2015-01-01

    Objective To investigate the clinical efficacy of ligation of intersphincteric fistula tract (LIFT) in the treatment of simple anal fistula, including transphincteric anal fistula and insphincteric anal fistula. Methods Clinical data of 52 patients with anal fistula receiving surgery treatment in Beijing Anorectal Hospital from January to October 2014 were analyzed retrospectively. Adoption of surgical procedure was based on rectal endoluminal ultrasound and patients′ decision. Patients were divided into LIFT group and seton group. The two groups were compared in terms of operation time, blood loss, postoperative pain score, incidence of urinary retention, wound healing time, cure rate, recurrence, and the anal incontinence score. Results There were 52 patients in the entire cohort including 28 cases of transphincteric anal fistula (14 cases of LIFT and seton placement groups) and 24 cases of intersphincteric anal fistula (12 case of LIFT and seton placement). The operation time was shorter in seton placement group in patients with two simple anal fistula [ ( 23 . 9 ± 5.0) min vs. (46.3±7.7) min, P0.05]. The cure rate of intersphincteric anal fistula was 83.3%(10/12) in LIFT group, and 100%(12/12) in the seton group. The cure rate of transphincteric anal fistula was 78.6% (11/14) in LIFT and 92.9%(13/14) in anal fistula seton group. There was no statistically significant difference (P>0.05). Conclusion In the treatment of transphincteric fistula tract and intersphincteric fistula tract, LIFT procedures should be considered.%目的 探讨括约肌间瘘管结扎术(LIFT)在单纯肛瘘(包括经括约肌肛瘘和括约肌间肛瘘)治疗中的临床疗效.方法 对北京市肛肠医院肛肠外科2014年1-10月期间治疗的52例肛瘘患者临床资料进行回顾性分析. 根据直肠腔内超声诊断结果、患者自愿选择手术方式的原则,分组进行LIFT和肛瘘切开挂线术配对研究,比较两种术式的手术时间、出血量、术后

  19. Clinical study of the treatment tunnel thread in treating patients with simple anal fistula%用隧道式拖线术治疗单纯性肛瘘的效果探析

    Institute of Scientific and Technical Information of China (English)

    林茂; 雷燕; 谢守勇

    2015-01-01

    Objective To investigate clinical effect of the treatment tunnel thread in treating patients with simple anal fistula.Methods 136 cases with high and low simple anal fistula were slected in our hospital during Jan 2013 to Dec 2014, 64 case with high simple anal fistula were randomly divided into observation group and control group, 32 cases in each group; 72 case with simple low anal fistula were randomly divided into observation group and control group, with 36 cases in each group. The control group was treated by traditional incision (thread) operation , the observation group was treated by the treatment tunnel thread surgery. To compare the healing time and cure rate of the two groups. Results The difference of cure rates of simple low or high in patients with anal fistula between observation group and control group was not significant (P>0.05); the healing time of high and low anal fistula patients in observation group was significantly less than control group (P<0.05). Conclusion Tunnel thread technique can effectively reduce the simple anorectal fistula healing time, worthy of clinical application.%目的:探讨用隧道式拖线术治疗单纯性肛瘘的临床效果。方法:对2013年1月~2014年12月期间我院收治的136例单纯性肛瘘患者的临床资料进行回顾性研究。我们将这136例患者随机分为观察组和对照组,每组各有68例患者。我院使用隧道式拖线术对观察组患者进行治疗,使用传统的切开挂线术对对照组患者进行治疗。治疗结束后,比较两组患者治疗的效果和病情痊愈的用时。结果:两组患者治疗的总有效率均为100%,二者相比差异无显著性(P>0.05)。观察组患者病情痊愈的用时明显短于对照组患者,二者相比差异具有显著性(P<0.05)。结论:用隧道式拖线术治疗单纯性肛瘘不仅效果确切,而且能有效地缩短患者康复的时间。因此,进行隧道式拖线术可作为临床

  20. Clinical Significance of Magnetic Resonance Imaging before Complex Anal Fistula Surgery%术前磁共振检查在复杂性肛瘘手术中的临床意义

    Institute of Scientific and Technical Information of China (English)

    孙平良; 陈文福; 李晶; 黄艳; 蒙建兴

    2011-01-01

    目的 探讨术前磁共振(MRI)检查对复杂性肛瘘手术的临床意义.方法 将80例复杂性肛瘘患者分为低位观察组、低位对照组、高位观察组、高位对照组四组,每组20例.低位观察组和高位观察组术前进行MRI检查,记录内口位置、数目,并与术中情况进行比较;低位对照组和高位对照组术前单依靠临床经验诊断,不进行MRI检查.对四组的术后手术次数、再次手术率、愈合时间、半年后复发率进行比较.结果 低位观察组与低位对照组比较,在术中发现内口数量、手术次数、再次手术率、愈合时间及复发情况方面,两组差异均无统计学意义(P>0.05).而高位观察组与高位对照组比较,在术中发现内口数量、手术次数、愈合时间方面,两组差异有统计学意义(P<0.05).高位对照组的再次手术率高于高位观察组,无统计学差异(P>0.05);高位观察组的MRI内口部位准确率高于低位观察组,无统计学意义(P>0.05).结论 术前MRI检查能提高高位复杂性肛瘘的临床疗效,应成为高位复杂性肛瘘的术前常规检查项目.%Objective To explore the clinical significance of magnetic resonance imaging( MRI )before complex anal fistula surgery. Methods 80 cases of complex anal fistula were divided into a low - level fistula observation group, a low -level fistula control group, a high -level fistula observation group and a high -level control group ,20 cases in each one. Before the surgery, MRI was performed in low -level fistula observation group and high - level fistula observation group. The location and number of internal opening were recorded and compared with those discovered in the surgery. In low - level control group and high - level control group, the diagnosis relied only on the clinical experience before the surgery,without MRI performed. The comparison was conducted after the surgery among four groups in terms of the surgical frequency, re - surgical

  1. The Clinical Therapeutic Effects of Different Surgical Methods on High Complex Anal Fistula%不同手术方式治疗高位复杂肛瘘的疗效观察

    Institute of Scientific and Technical Information of China (English)

    方晓东

    2011-01-01

    Objective:To explore the clinical therapeutic effects of different surgical methods on high complex anal fistula. Methods:40 cases of high complex anal fistula selected from June 2008 to June 2010 were randomly divided into control group and observation group,20 patients in each group. Control group received tying therapy on main fistula with external anal fistulate laid aside,then the observation group was performed by cutting and tying therapy on main fistula with the branch suitable drainage treatment.The clinical efficacy,healing time,recurrence and complications were observed in two groups.Results:The cure rate of the observation group(95.00%) was significantly higher than that of the control group (80.00%) P<0.05;The healing time of the control group(32.78 ± 7.94)d was significantly more than that of the observation group (18.46±3.57)d,P<0.05;Cases of recurrence in the control group (3 cases) were more than that in the observation group(0 case),P<0.05;There was no significant difference between the two groups in complications,such as anal deformation(0 case),skin defects(0 case),anal stenosis(0 case),P>0.05.Conclusion:Cutting and tying therapy on main fistula with the branch suitable drainage treatment was a more effective surgical method for high complex anal fistula with fewer complications.%目的:探讨不同手术方式治疗高位复杂肛瘘的临床效果.方法:选择2008 年6月~2010 年6月40 例高位复杂肛瘘患者,随机分为对照组和观察组,每组20 例,对照组采用肛门外瘘旷置加肛管内主管挂线法治疗,观察组应用主管切开挂线支管对口引流治疗.观察两组患者的临床疗效、治愈时间、复发情况以及并发症情况.结果:观察组一次手术治愈率95.00%,明显高于对照组的80.00%,P<0.05; 对照组的治愈时间为(32.78±7.94)d,显著多于观察组的(18.46±3.57)d,P<0.05; 术后随访半年,观察组无1例复发,对照组有3例复发,二者相比有统计学差异,P<0

  2. The clinical effect of evidence-based nursing on patients with anal fistula after surgery.%肛瘘手术患者术后循证护理的临床效果观察

    Institute of Scientific and Technical Information of China (English)

    张国花

    2011-01-01

    Objective : To explore the clinical effect of EBN on patients with anal fistula after surgery. Methods :72 cases of patients with anal fistula after surgery were randomly divided into experimental group and control group. The routine care was used for control group, and EBN was used for experimental group. Results: The complication rate and pain release in experimental group was significantly better than that in control group( P < 0. 05 ). Conclusion :EBN used for the recovery of patients with anal fistula after surgery , is meaningful for prompting recovery of patients and enhancing nursing equality of nurses, so it is a nursing type in clinical work that deserved promotion and application.%目的:探讨循证护理应用于肛瘘患者术后恢复的临床效果.方法:将72例肛瘘术后患者随机分为实验组和对照组,对照组给予常规护理,实验组给予循证护理.结果:实验组并发症发生率和疼痛改善均优于对照组(P<0.05).结论:循证护理应用于肛瘘术后患者的康复护理,对于促进患者术后康复和护理人员改善护理质量是很有意义的,值得在临床上应用和推广.

  3. Nursing Research of High Complex Anal Fistula Seton Surgery in 60 Patients%高位复杂性肛瘘切开挂线术60例患者护理研究

    Institute of Scientific and Technical Information of China (English)

    姜玉芹

    2015-01-01

    目的:研究高位复杂性肛瘘切开挂线术60例患者护理方式。方法本次临床护理研究主要选取在本院接受治疗的高位复杂性肛瘘切开挂线术60例患者作为临床护理研究的对象,进行临床护理的回顾性分析。结果在经过细致的护理之后,60例患者住院时间均没有发生其他并发症状,术后平均住院时间为(25.12±2.33)天,均已康复出院。结论有效的护理在高位复杂性肛瘘切开挂线术患者护理中的应用,能够有效降低患者的术后并发症状发生几率,减少患者的住院时间。%Objective To study the high complex anal fistula Seton surgery 60 patients nursing.Methods The clinical study selected the incision and thread drawing therapy in 60 patients as the object of clinical nursing research in high complex anal fistula in our hospital for treatment, were retrospectively analyzed the clinical nursing. Results After careful nursing, 60 patients hospitalized time there are no other symptoms, the mean postoperative hospital stay was (25.12±2.33) days, have been discharged.ConclusionThe effective nursing care of patients with postoperative incision and application of line in high complex anal fistula, and can effectively reduce the incidence of complications of patients after operation, reducing hospitalization time.

  4. 扩散加权成像结合常规序列在复杂性肛瘘中的应用价值%Application Value of DWI Combined with Generic Sequence in Complex Anal Fistula

    Institute of Scientific and Technical Information of China (English)

    陈均; 陆锦贵; 吴青山; 刘灵灵; 郭明建; 陆杰; 胡振民

    2015-01-01

    目的:评价磁共振扩散加权成像序列(DWI)结合常规序列对复杂性肛瘘显示的准确性,探讨DWI在复杂性肛瘘中的应用价值。方法30例经手术证实的复杂性肛瘘患者术前均行MRI检查,扫描序列包括常规序列横轴位T1WI、T2WI、T2WI脂肪抑制,冠状位、矢状位T2WI脂肪抑制及DWI,以手术结果为标准,分别观察并比较评估常规扫描序列和常规扫描序列+DWI对肛瘘瘘管、内口及脓肿的显示情况。结果30例肛瘘患者,MR常规扫描序列诊断内口灵敏度为81.4%(38/43),阳性预测值为89.7%(35/39);瘘管灵敏度为90.2%(37/41),阳性预测值86.0%(37/43);脓肿灵敏度91.6%(11/12),阳性预测值100%(11/11);常规序列+DWI诊断内口灵敏度95.3%(41/43),阳性预测值95.3%(41/43),瘘管灵敏度92.7%(38/41),阳性预测值97.4%(38/39),脓肿灵敏度100%(12/12),阳性预测值100%(12/12),两种诊断方法比较,常规序列+DWI对肛瘘的诊断效果要优于常规序列,其中对内口的显示灵敏度有统计学差异(P<0.05)。结论磁共振常规序列+DWI显示肛瘘内口、瘘管及脓肿具有较高的临床应用价值,可以作为外科手术前的常规检查。%ObjectiveTo evaluate the accuracy of diffusion weighted imaging (DWI) combined with generic sequence in complex anal fistula and to discuss the application value of DWI in complex anal fistula.Methods 30 cases of patients who were confirmed with complex anal fistula were given MRI before operation. Scan sequences included axial T1WI, T2WI and fat sequence T2WI, and coronal and sagittal fat sequence T2WI and DWI. With surgical results as the standard, conventional sequences and conventional sequences + DWI were compared for anal fistula, internal opening and abscess.Results For 30 cases of patients with anal fistula, sensitivity and positive predict value of MR conventional sequences were 81.4%(38/43) and 89.7%(35/39) respectively for internal opening

  5. Clinical effect of minimally invasive thread-drawing operation via another approach on high horseshoe anal fistula%微创另路挂线术治疗高位蹄形肛瘘的临床效果观察

    Institute of Scientific and Technical Information of China (English)

    杨静; 杨平

    2015-01-01

    Objective To observe the clinical effect of minimally invasive thread-drawing operation via another approach on high horseshoe anal fistula.Methods Seventy-six patients with high horseshoe anal fistula patients were divided into minimally invasive group and control group according to the random number table,with 38 cases in each group.The minimally invasive group received minimally invasive thread-drawing operation via another approach,while the control group received conventional arc-incision drainage.The intraoperative blood loss, operation duration and incision healing time as well as postoperative external anal sphincter electromyography,anal function,pain score,anal drainage score,ankyloproctia degree and anal incontinence score were compared between two group.Results The minimally invasive group gained higher contraction and resting amplitudes of external anal sphincter as well as less myoelectric interval of external anal sphincter after operation compared with control group(all P0.05).Conclusion Minimally invasive thread-drawing operation via another approach achieves favorable effects on high horseshoe anal fistula with less trauma,which might effectively protect the perianal tissues and promote the recovery of anal function.%目的:观察微创另路挂线术治疗高位蹄形肛瘘的临床效果。方法将高位蹄形肛瘘患者76例,按照随机数字表法分为微创组与对照组,每组38例,微创组行微创另路挂线术治疗,对照组行常规的弧形切开引流术。对比两组术中出血量、手术时间、切口愈合时间、术后肛门外括约肌肌电图、肛门功能、疼痛积分、肛门渗液积分、肛门狭窄程度积分、肛门失禁积分。结果微创组术后肛门外括约肌收缩波幅、静息波幅均高于对照组(P均<0.05),肛门外括约肌肌电时程低于对照组(P<0.05),术后6 d疼痛积分、肛门渗液积分少于对照组(P<0.05),两组术后肛门狭

  6. 两种手术方式治疗高位肛瘘的疗效分析%Analysis of the effect of the two kinds of operation mode the treatment of high anal fistula

    Institute of Scientific and Technical Information of China (English)

    袁先仓; 郑魏

    2013-01-01

    Objective To investigate the treatment of moed high anal fistula operation.Methods 110 cases of high anal fistula patients were randomly divided into the incision line selective suture group(treatment group 55 cases) and incision group(55 cases in the control group),on two groups of treatment time,the cure rate,the anal function were analyzed.Results The cure rate of the treatment group and control group were 98 %,86%,respectively,the cure rates of two groups have no significant difference (x2 =1.557,P > 0.05),the healing time and postoperative anal function evaluation in treatment group was superior than those in control group (t =3.440,4.671,all P < 0.01).Conclusion Incisionunder selective suture in the treatment of high anal fistula operation is a better way.%目的 探讨治疗高位肛瘘的手术方式.方法 110例高位肛瘘患者数字表法随机分为切开挂线选择性缝合术组(治疗组55例)和切开挂线组(对照组55例),对两组治疗时间、治愈率、肛门功能进行对比分析.结果 治疗组治愈率为98%,对照组为86%,两组治愈率差异无统计学意义(x2=1.557,P>0.05),治疗组治愈时间和术后肛门功能评分优于对照组(=3.440、4.671,均P<0.01).结论 切开挂线下选择性缝合术是治疗高位肛瘘较好的手术方式.

  7. Value of three-dimensional endoanal ultrasonography for anal fistula assessment%术前三维肛管直肠腔内超声检查对肛瘘的应用价值

    Institute of Scientific and Technical Information of China (English)

    王永刚; 丁健华; 赵克; 冶浩鹏; 赵玉涓; 赵勇; 雷亚楠

    2014-01-01

    目的:探讨三维肛管直肠腔内超声(3D-EAUS)检查在肛瘘术前评估中的应用价值。方法前瞻性纳入2012年3月至2013年3月第二炮兵总医院结直肠肛门外科连续收治的诊断明确、拟行手术的100例肛瘘患者,采用计算机产生随机号的方法随机分为超声组和对照组,每组各50例。超声组术前采用3D-EAUS检查,对照组术前常规检查、采用指诊或探针探查,比较两组肛瘘内口定位、肛瘘分型及是否存在分支瘘管的准确率。结果与对照组比较,超声组的内口定位准确率较高,超声组和对照组分别为96.0%(48/50)和82.0%(41/50)(P=0.02)。超声组与对照组对复杂性肛瘘的诊断分别为96.7%(29/30)比74.1%(20/27)(P=0.021);对肛瘘分型的诊断分别为96.0%(48/50)比78%(39/50)(P=0.01);对是否存在分支瘘管的诊断分别为94.0%(47/50)比84.0%(42/50)(P=0.025)。但对于简单性肛瘘,两组内口定位准确率相当[95.0%(19/20)比91.3%(21/23), P=1.000]。结论三维肛管直肠腔内超声在内口定位、瘘管分型及分支瘘管的诊断方面具有较高的应用价值,尤其对复杂性肛瘘患者,值得在临床推广。%Objective To explore the value of preoperative evaluation with three-dimensional endoanal ultrasonography (3D-EAUS) for anal fistula in order to provide preoperative assessment for anal fistula. Methods One hundred patients diagnosed with anal fistula undergoing surgery between March 2012 and March 2013 in our department were prospectively enrolled. All the patients were randomly divided into the ultrasound group and the control group with fifty patients in each group. The ultrasound group received 3D-EAUS and the control group received routine examinations (digital examination and probe) to assess the position of the internal opening, the type of

  8. Clinical Effect and Safety Evaluation of Thread-dragging Through Fistula in Treatment of Simple anal Fistula%隧道式拖线术治疗单纯性肛瘘的临床疗效及安全性评价

    Institute of Scientific and Technical Information of China (English)

    王国军

    2014-01-01

    Objective To explore the clinical effect and safety evaluation of thread -dragging through fistula in treatment of simple anal fistula .Methods 72 patients with simple anal fistula were randomly divided into thread -dragging through fistula treatment group(observation group)and the incision line treatment group(control group),36 cases in each group,compared the clinical effect of cases in two groups.Results The cured time of cases in observation group was(21.2 ±6.8)d,less than that in control group(29.6 ±10.1)d,there was significant difference between two groups(P0.05).All patients had no complications.Conclusion Taking thread -dragging through fistula in treatment of simple anal fistula has good clinical effect and high safety,worthy of further clinical application.%目的:探讨隧道式拖线术治疗单纯性肛瘘的临床疗效及安全性。方法将72例单纯性肛瘘患者随机分为隧道式拖线术治疗组(观察组)和切开挂线治疗组(对照组),每组各36例,比较两组患者的临床疗效。结果观察组患者治愈时间为(21.2±6.8)d,少于对照组患者的(29.6±10.1)d,组间差异有统计学意义(P<0.05)。观察组患者治疗总有效率为94.4%,对照组患者治疗总有效率97.2%,组间差异无统计学意义(P>0.05)。两组患者术后均未出现并发症。结论隧道式拖线术治疗单纯性肛瘘临床疗效确切,安全性高,值得临床进一步推广使用。

  9. A case of colovesical fistula induced by sigmoid diverticulitis.

    Science.gov (United States)

    Yang, Hwa-Yeon; Sun, Woo-Young; Lee, Taek-Gu; Lee, Sang-Jeon

    2011-04-01

    Colonic diverticulosis has continuously increased, noticeably left-sided diseases, in Korea. A colovesical fistula is an uncommon complication of diverticulitis, and its most common cause is diverticular disease. Confirmation of its presence generally depends on clinical findings, such as pneumaturia and fecaluria. The primary aim of a diagnostic workup is not to observe the fistular tract itself but to find the etiology of the disease so that an appropriate therapy can be initiated. We present here the case of a 79-year-old man complaining of pneumaturia and fecaluria. On abdomen and pelvis CT, the patient was diagnosed as having a colovesical fistula due to sigmoid diverticulitis. After division of the adhesion between the sigmoid colon and the bladder, the defect of the bladder wall was repaired by simple closure. The colonic defect was treated with a segmental resection, including the rectosigmoid junction. The patient is doing well at 6 months after the operation and shows no evidence of recurrence of the fistula.

  10. SETON - AS A GOLD STANDARD TREATMENT FOR HIGH FISTULA IN ANO

    Directory of Open Access Journals (Sweden)

    Kishore Babu

    2015-03-01

    Full Text Available Objective to determine the effectiveness of seton tie as treatment modality in a high anal fistula in contrary to diversion colostomy which also can be used for treating a high anal fistula.

  11. Anal Health Care Basics.

    Science.gov (United States)

    Chang, Jason; Mclemore, Elisabeth; Tejirian, Talar

    2016-01-01

    Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate.Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area.Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases.In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists.

  12. Anal Health Care Basics

    Science.gov (United States)

    Chang, Jason; McLemore, Elisabeth; Tejirian, Talar

    2016-01-01

    Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy. The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate. Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area. Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases. In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists. PMID:27723447

  13. 肛瘘治疗采用双弧形创缘43例临床观察%Take double arc and anal fistula of postoperative clinical observation of 43 cases

    Institute of Scientific and Technical Information of China (English)

    马也

    2015-01-01

    ObjectiveFor the analysis of double arc edge in the anal fistula efficacy and safety of postoperative wound healing.Method86 patients with anal fistula were randomly assigned to observation group and control group, 43 cases in each group,Observation group with double arc edge,the control group uses the“V”shape edge,comparing the two incision healing time after surgery. Edema of anal edge,postoperative granulation clip rate,differences in incidence of postoperative skin varus,etc. The results showed that the two groups of patients in the healing time,the average wound healing rate 14 days after operation,edema of incision,postoperative granulation clip rate,incidence of postoperative skin varus differences have statistical significance(P<0.05).ConclusionThe results show that the double arc edge in the anal fistula postoperative wound healing more reliable curative effect,is worth promoting.%目的:观察双弧形创缘对肛瘘术后创面愈合的疗效及安全性。方法将86例肛瘘患者随机分为观察组和对照组,每组43例,观察组采用双弧形创缘,对照组采用“V”形创缘,比较两种切口在术后愈合时间,切口水肿,术后皮内翻发生率,平均住院日等方面的差异。结果2组患者在术后愈合时间,术后14 d平均创面愈合率,切口水肿,术后皮内翻发生率,平均住院天数方面差异均有统计学意义(P<0.05)。结论双弧形创缘对肛瘘术后创面愈合更可靠,值得推广。

  14. 间断暴露瘘道不挂线法在高位单纯性肛瘘治疗中的应用效果观察%Observation on Application Effect of Continuous Exposure Fistula was not Hanged Line Method in Treatment of High Simple Anal Fistula

    Institute of Scientific and Technical Information of China (English)

    李伟彬

    2016-01-01

    Objective To analysis of intermittent exposure basket road not hanging line method in the treatment of high simple anal fistula. Methods 68 cases of high simple anal fistula were divided into two groups,each group of 34 cases,control group to implement the cut hanged line operation,the observation group implement intermittent exposure basket not hanging line method. Results In the observation group the total efficiency was 94.1%higher than that of the control group(70.6%)(P<0.05),anus pain scores,wound healing time were shorter than that of the control group(P<0.05). Conclusion Intermittent exposure basket road not hanging line method in the treatment of high simple anal fistula effect significantly.%目的:分析间断暴露篓道不挂线法治疗高位单纯性肛瘘的价值。方法将68例高位单纯性肛瘘患者分为两组各34例,对照组实施切开挂线术,观察组实施间断暴露篓道不挂线法。结果观察组治疗总有效率94.1%高于对照组70.6%(P<0.05),肛周术后疼痛评分、创面愈合时间均短于对照组(P<0.05)。结论间断暴露篓道不挂线法治疗高位单纯性肛瘘效果显著。

  15. Study on Clinical Therapeutic Effect on Anal Fistula Patients With Ligation of the Intersphincteric Fistula Technique (LIFT)%肛瘘患者采用结扎括约肌间瘘管术(LIFT)的临床治疗效果研究

    Institute of Scientific and Technical Information of China (English)

    耿润昌

    2015-01-01

    Objective Study on clinical therapeutic effect on Anal ifstula patients with ligation of the intersphincteric fistula technique. Methods Selected 58 patients with anal fistula were divided into two groups, compared the indicators of two groups of patients. Results The observation group with operation, hospitalization and healing time was shorter than the control group, P<0.05, had difference statistically signiifcance. Comparied the function recovery from the anus, the observation group resume was better than the control group P<0.05, had difference statistically significance. Conclusion Ligation sphincter fistula between the curative effect can shorten the operation time and hospital stay effectively, it is beneift to recovery anal morphology and function.%目的:研究肛瘘患者采用结扎括约肌间瘘管术(LIFT)的临床治疗效果。方法选择58例肛瘘患者分为两组,对比两组患者的各项指标。结果从手术时间和住院时间、愈合时间等方面对比,观察组短于对照组, P<0.05,差异具有统计学意义。从肛门功能恢复情况对比,观察组恢复优于对照组,P<0.05,差异具有统计学意义。结论结扎括约肌间瘘管术疗效理想,可以有效缩短手术时间和住院时间,利于肛门形态和功能的恢复。

  16. Puborectal sling interposition combined with seton drainage for pouch-vaginal fistula after rectal cancer surgery with colonic J pouch-anal reconstruction: report of a case.

    Science.gov (United States)

    Kawamoto, Aya; Inoue, Yasuhiro; Okigami, Masato; Okugawa, Yoshinaga; Hiro, Junichiro; Toiyama, Yuji; Tanaka, Koji; Uchida, Keiichi; Mohri, Yasuhiko; Kusunoki, Masato

    2014-01-01

    The management of postoperative rectovaginal fistula (RVF) after rectal cancer surgery is difficult and requires reconstruction of the anastomotic site and fistula. Though various surgical procedures have been reported for the repair of RVFs, the results of surgical repair are often unsatisfactory, and failure of the initial repair leads to difficulty in the later operations. Furthermore, it has been reported that cases associated with local infection result in low success rates. We report a case of an 80-year-old woman with a recurrent colonic J pouch-vaginal fistula after anoabdominal rectal resection with partial internal sphincteric resection, who achieved a good outcome following a repair using a puborectal sling interposition combined with seton drainage. It may be a useful option for RVF management in repair of such pouch-vaginal fistula after coloanal anastomosis with intersphincteric resection.

  17. Controversies in Fistula in Ano

    OpenAIRE

    2012-01-01

    Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major...

  18. High-resolution MRI Diagnosis on crissum abscess and anal fistula%肛门直肠周围脓肿及肛瘘的高分辨MRI诊断

    Institute of Scientific and Technical Information of China (English)

    王伟; 王姗姗; 栾丽

    2015-01-01

    目的 探讨高分辨磁共振成像(MRI)检查在肛周脓肿及肛瘘的临床应用及诊断价值.方法 对2013年6月~2014年12月56例临床疑诊为肛门直肠周围脓肿的患者进行肛门直肠区高分辨MRI扫描.结果 56例可疑肛门直肠周围脓肿患者均经手术证实.高位脓肿(肛提肌以上)15例,低位脓肿(肛提肌以下)41例;其中合并肛瘘者21例,MRI共发现25个原发瘘管、26个内口、33个外口.高分辨MRI对肛门直肠周围脓肿、原发瘘管、内口显示的敏感度分别为100%、92.6%和89.7%,特异度分别为95.0%、84.2%和82.6%.结论 高分辨MRI可清楚显示肛周脓肿和肛瘘以及肛周各肌肉,可对肛周脓肿、肛瘘的部位、大小、走行及是否存在其他病变做出准确判定,为临床手术治疗提供精细的解剖图像,具有很高的应用价值.%Objective To Discuss clinical application and diagnostic value of high-resolution magnetic resonance imaging (MRI) examination on crissum abscess and anal fistula. Methods From June 2013 to December 2014, 56 cases of clinical suspected cases among patients undergoing anal rectum abscess were selected and carried out high-resolution MRI scans around the anus rectum area. Results 56 suspected cases were confirmed through surgery, Among which there were 15 cases belong to high crissum abscess (anal abscess levator above), and there were 41 cases belong to low abscess (below anus levator). Furthermore, there were 21 cases combined with anal fistula. 25 primary fistula, 26 in the mouth, 33 outside the mouth were detected through MRI. Sensitivity of High resolution magnetic resonance imaging (MRI) on the anus rectum abscess, primary fistula, mouth inside display was 100%, 92.6% and 89.7%respectively, and specific degree was 95.0%, 84.2%and 82.6%respectively. Conclusion High-resolution MRI can clearly show crissum abscess, fistula, crissum the muscle and their location, size, direction. MRI can make an accurate detection whether

  19. Epileptic Seizures Induced by a Spontaneous Carotid Cavernous Fistula

    Science.gov (United States)

    Yildirim, Erkan

    2016-01-01

    A 79-year-old woman was admitted to our emergency department with complaints of fainting and loss of consciousness three times during the past month. She was diagnosed with epilepsy and started to be treated with antiepileptic drug. Physical examination showed, in the left eye, chemosis, limited eye movements in all directions, and minimal exophthalmos as unexisting symptoms on admission developed on the sixth day. Orbital magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) imaging revealed a carotid cavernous fistula (CCF). Epileptic attacks and ophthalmic findings previously present but diagnosed during our examinations were determined to ameliorate completely after performing the coil embolization. Based on literature, we present the first case with nontraumatic CCF manifesting with epileptic seizures and intermittent eye symptoms in the present report. PMID:28077946

  20. Clinical Observation on TCM Hip Bath for 60 Patients after the Surgery of Anal Fistula%中药坐浴治疗肛瘘术后60例

    Institute of Scientific and Technical Information of China (English)

    杨惠; 李建明; 张翻翻

    2013-01-01

    目的:观察常规使用头孢唑啉钠、创面清洁换药联合通络活血,清热解毒之中药坐浴治疗肛瘘术后患者的临床疗效。方法:将120例肛瘘术后患者随机分为观察组、对照组各60例,2组术后立即给予头孢唑啉钠,术后第2天行创面清洁换药。观察组在对照组治疗的基础上于患者排便后给予中药坐浴,15 min/次。2组均以治疗7天为1个疗程,治疗2个疗程后评价疗效并观察2组疼痛、水肿、创面渗出物消失时间,创面愈合时间。结果:总有效率观察组为93.33%,对照组为76.67%,2组相比差异有统计学意义(P<0.05)。疼痛、水肿、创面渗出物消失时间,创面愈合时间观察组均短于对照组,2组相比差异有统计学意义(P<0.05)。结论:在常规使用头孢唑啉钠、创面清洁换药等常规治疗的基础上给予通络活血,清热解毒之中药坐浴,有助于提高肛瘘术后临床疗效,缩短疼痛、水肿、创面渗出物消失时间及创面愈合时间。%Objective:To observe cefazolin sodium, wound cleaning, changing the dressing and hip bath with herbs of freeing collaterals, activating blood, heat clearing and detoxifying in treating the patients after the surgery of anal fistula. Method: All 120 patients were randomized into the observation group and the control group. Both groups took cefazolin sodium after the surgery immediately, received wound cleaning and dressing changing at the 2nd day after the surgery. The patients in the observation group were given with hip bath after defection, 15min each time. Seven days were one course of treatment , clinical effects were assessed after two courses of treatment, disappearing time of wound exudates, the pain and edema, healing time of wound in both groups were observed. Result: Total effective rate of the observation group was 93.33%, higher than 76.67% of the control group, the difference between both groups had statistical

  1. 复方角菜酸酯乳膏应用于肛瘘肛周脓肿术后的疗效观察%Efficacy observation of compound carraghenates emulsifiable plaster in postoperative perianal abscess of anal fistula

    Institute of Scientific and Technical Information of China (English)

    张文兵

    2012-01-01

    Objective To observe the clinical efficacy of compound carraghenates emulsifiable plaster in postoperative perianal abscess of anal fistula. Methods Seventy - eight anal fistula patients with perianal abscess in our hospital were selected and randomly divided into control group ( n = 39) and treatment group ( n - 39). The two groups received relevant operation according to their own conditions. The control group received Shengji Yuhong plaster after operation,and the treatment group received compound carraghenates emulsifiable plaster after operation. The pain condition of perianal wound and postoperative wound healing time of the two groups were compared. Results The rate of grade 3 pain in the treatment group was obviously lower than that in the control group (P<0.01). The rate of wound healing with 14 d,21 d in the treatment group were obviously higher than that in the control group (P<0.05). Conclusion Compound carraghenates emulsifiable plaster for postoperative perianal abscess of anal fistula has proved effect on releasing wound pain and promoting wound repair. It s worthy of clinical application.%目的 探讨复方角菜酸酯乳膏应用于肛瘘肛周脓肿术后的临床疗效.方法 选取本院收治的肛瘘肛周脓肿患者78例,随机分为2组,各39例.2组患者均根据自身肛瘘肛周脓肿病情,采取相应的手术治疗,对照组于术后使用生肌玉红膏治疗,治疗组于术后使用复方角菜酸酯乳膏治疗.比较2组术后肛周创面的疼痛情况以及术后创面愈合的时间.结果 治疗组术后Ⅲ级疼痛的比例显著低于对照组,差异有统计学意义(P<0.01).治疗组术后用药后创面在14 d、21d内愈合的比例明显大于对照组,差异有统计学意义(P<0.05).结论 复方角菜酸酯乳膏对肛瘘肛周脓肿术后减轻创面疼痛和促进创面的修复具有确切的临床疗效,值得临床推广.

  2. Gastrointestinal fistula

    Science.gov (United States)

    Entero-enteral fistula; Enterocutaneous fistula; Fistula - gastrointestinal ... Most gastrointestinal fistulas occur after surgery. Other causes include: Blockage in the intestine Infection Crohn disease Radiation to the abdomen (most ...

  3. V-Y Type Flap Internal Opening Duct Drainage In The Treatment Of Complex Anal Fistula Relapse Prevention And Control Points For Operation And Skills%V-Y型皮瓣内口封闭导管引流术治疗复杂肛瘘的临床观察

    Institute of Scientific and Technical Information of China (English)

    高昆; 王进宝

    2013-01-01

    目的 探讨V-Y型皮瓣内口封闭导管引流术治疗复杂肛瘘的可行性.方法 对2010年9月至2012年9月我科收治的复杂肛瘘患者20例,行V-Y型皮瓣内口封闭导管引流术的临床资料作回顾性分析.结果 19例痊愈,1例复发.结论 V-Y型皮瓣内口封闭导管引流术治疗复杂肛瘘是安全有效的,保留了肛门括约肌和肛门的功能,且成功率高.%Objective Through the analysis of the causes of anal fistula,classification,comparison research V-Y type flap internal opening duct drainage in the treatment of complex anal fistula feasibility.Methods clinical collect 20 cases,line V-Y type skin flap internal opening catheter drainage.Results 1 case of recurrence and 19 cases were healed.Conclusion V-Y type flap internal opening duct drainage in the treatment of complex anal fistula is safe and effective,retained the anal sphincter and anal function,high success rate.

  4. Fistula in ano

    DEFF Research Database (Denmark)

    Madsen, S M; Myschetzky, P S; Heldmann, U;

    1999-01-01

    Patients suspected of having perianal suppurative disease often undergo a combination of several potentially painful, invasive procedures to establish or rule out the diagnosis. To evaluate the accuracy of low-field magnetic resonance imaging (MRI) in distinguishing patients with active anal fist...... fistulae and patients with no active fistulation we performed a retrospective study....

  5. Fistula in ano

    DEFF Research Database (Denmark)

    Madsen, S M; Myschetzky, P S; Heldmann, U;

    1999-01-01

    Patients suspected of having perianal suppurative disease often undergo a combination of several potentially painful, invasive procedures to establish or rule out the diagnosis. To evaluate the accuracy of low-field magnetic resonance imaging (MRI) in distinguishing patients with active anal...... fistulae and patients with no active fistulation we performed a retrospective study....

  6. 优质护理对肛瘘患者术后疼痛和护理满意度的影响%Efficacy of high quality nursing on postoperative pain and care satisfaction of patients with anal fistula

    Institute of Scientific and Technical Information of China (English)

    张英

    2013-01-01

    Objective To investigate the efficacy of high quality nursing towards on postoperative pain and nursing satisfaction of patients with anal fistula patents.Methods Forty-six cases of anal fistula were randomly divided into control group and experiment group,with 22 cases in control group and 24 cases in experimental group.The patients in control group were given anal fistula routine nursing while the patients in experimental group were given high-quality care additionally and nurses who are in charge of them.The patients obtained responsibility system for overall care from his responsible nurse with psychological interventions,environmental interventions,reasonable methods to stop the pain,etc.Visual Analogue Scale/Score (VAS) were graded at 6 h after the operation and 4 times in the following 3 days.The patients in the two groups were given pain assessment in order to compare the degree of pain and conduct survey of nursing satisfaction degree before discharge.Results There was no significant difference in the pain degree at 6 h after the operation (P > 0.05).The pain degree of experimental group were significantly lower than that in the control group (P < 0.05) in the following 1-3 days after operation.Conclusions The implementation of high-quality care in patients with anal fistula can significantlv reduce postoperative pain and improve patients' satisfaction degree with care work.%目的 探讨优质护理对肛瘘患者术后疼痛和护理满意度的影响.方法 将46例肛瘘患者随机分为对照组和实验组,对照组22例,实验组24例.对照组行肛瘘患者常规护理.实验组在肛瘘常规护理基础上采取优质护理,让护士分管患者,对患者进行责任制整体护理,责任护士对患者实施心理干预、环境干预、合理止痛等全方位护理服务.术后采用视觉模拟评分法(VAS)进行疼痛评分,分别于术后6h、术后第1~3天连续评分4次,对两组患者进行疼痛评估,比

  7. The experience of evidence-based nursing on patients with anal fistula and diabetes mellitus.%循证护理在糖尿病并发肛瘘患者中的应用体会

    Institute of Scientific and Technical Information of China (English)

    向珏颖; 刘春英; 陈本会

    2011-01-01

    目的:探讨循证护理在糖尿病并发肛瘘患者中的应用效果.方法:将2009年12月~2010年12月在我院手术的36例糖尿病并发肛瘘患者,应用循证护理的方法,在充分评估患者病情的基础上,提出临床问题并检索相关原始文献,根据检索结果,结合患者病情和意愿,制定并实施护理方案.结果:治愈35例,复发1例.电话回访,患者对护理满意度为100%.结论:对糖尿病并发肛瘘患者实施循证护理能促进患者术后康复和提高护理质量.%Objective:To explore the clinical effect of evidence - based nursing on patients with ana6stula and diabetes mellitus after surgery. Methods:36 patients with anal fistula and diabetes mellitus after surgery were used for evidence - based nursing in our hospital from December 2009 to December 2010, based on an adequate assessment of the patients condition, we searched for the best available clinical evidence. According to the current evidence, as well as the patients clinical condition and preference,a comprehensive therapeutic plan was given to the patient. Results:There were 35 patients were healed by one - time - off, one of patient relapsed ,the patients satisfaction was one hundred percent pays a return visit by telephone. Conclusion: Evidence - based nursing used for the recovery of patients with anal fistula and diabetes mellitus after surgery, is meaningful for prompting recovery of patients and enhancing nursing equality of nurses.

  8. How the anal gland orifice could be found in anal abscess operations

    OpenAIRE

    Shahram Paydar; Ahmad Izadpanah; Leila Ghahramani; Seyed Vahid Hosseini; Alimohammad Bananzadeh; Salar Rahimikazerooni; Faranak Bahrami

    2015-01-01

    Background: On an average 30-50% of patients who undergo incision and drainage (I and D) of anal abscess will develop recurrence or fistula formation. It is claimed that finding the internal orifice of anal abscess to distract the corresponding anal gland duct; will decline the rate of future anal fistula. Surgeons supporting I and D alone claim that finding the internal opening is hazardous. This study is conducted to assess short-term results of optional method to manage patients with anal ...

  9. Adaptation of D-P flap to the oro-facial fistula induced by radio-osteomyelitis of mandible

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, E.; Genba, R.; Hayatsu, Y.; Sunakawa, H.; Kohama, G. (Sapporo Medical Coll. (Japan))

    1980-06-01

    Intraoral partial resection of the mandible was performed on 3 patients with radiation-induced ostomyelitis and ostonecrosis of the mandible, and inflammation in the mandible disappeared. Residual oro-facial fistula was closed with D-P flap, and a good result was obtained. Treatments of radiation osteopathy, the time of the treatments, and the period from resection of necrotic mandible to the closure of the fistula with D-P flap and reconstructive surgery for the mouth were also considered.

  10. Evaluation of Anti-Convulsant Activity of Methanolic Extract of Seeds of Cassia Fistula against Pentylenetetrazole induced convulsions in mice

    Directory of Open Access Journals (Sweden)

    Nilesh P. Sawadadkar

    2014-06-01

    Full Text Available Cassia Fistula is a popular Indian herb which is used as tonic, laxative, anti-pyretic, astringent, febrifuge, strong purgative etc. The aim of present study was to evaluate anticonvulsant activity of methanolic extract of seeds of Cassia Fistula against pentylenetetrazol (PTZ induced convulsions in mice. All the animals were divided into four groups of six mice each and were injected PTZ (60mg/kg intraperitonially Group I was served as toxic control, Group II was pretreated with  Gabapentin (200mg/kg P.O.. Group III was pretreated with  methanolic extract of seeds of Cassia Fistula (100 mg/kg P.O. for 7 days. Group IV was pretreated with  methanolic extract of seeds of Cassia Fistula (200mg/kg P.O. for 7 days.The result shows that methanolic extract of seeds of Cassia Fistula significantly reduced duration of clonic convulsions and also delayed the onset of convulsions induced by pentylenetetrazol. The result was expressed as mean ± SEM and were statistically analyzed by one way ANOVA. It is concluded that methanolic extract of seeds of Cassia Fistula can show anticonvulsant activity against pentylenetetrazol induced convulsions in mice.

  11. Fracture and Medium Modeling, by Analizing Hidraulic Fracturing Induced Microseismicity

    Science.gov (United States)

    Gomez Alba, S.; Vargas Jiménez, C. A.

    2014-12-01

    Hydraulic fracturing is an essential technology for most unconventional hydrocarbon resources and many conventional ones as well. The primary limitation on the improvement and optimization of the fracturing process is the minimal access to observe the behavior of the fracture in the subsurface. Without direct observational evidence, hypothetical mechanisms must be assumed and then tested for their validity with indirect information such as wellbore measurements, indirect production and pressure behavior. One of the most important sources of information today is the relation made between micro seismic source mechanisms and fracture behavior. Hydraulic fractures induce some level of micro seismicity when the stress conditions in the Earth are altered by changes in stress during the operations. The result is the sudden movement between rock elements and the radiation of both compressional and shear energy in a seismic range that can be detected and recorded with sensitive receivers. The objective of this work is to provide reasonable information when applying inversion methods in order to estimate the vertical and horizontal spatial heterogeneities in medium and energy radiation distribution of microseisms while fracking operations. The method consist in record microseisms at a previous lineal array of stations (triaxial accelerometers) which are located close to the source coordinates and cover the area of study. The analysis clarify some ideas about what information can be gained from the micro seismic source data and according to the obtained results, what kind of comparisons and associations might be done to evaluate the fracking performance operation. Non uniformities in medium such as faults would be revealed by interpreted scattering coefficients. Fracture properties like distance, velocity and orientation would be also determined by analyzing energy radiation.

  12. 复方亚甲蓝用于痔瘘术后镇痛的疗效观察%The analgesic effect of compound methylene blue for the treatment of anal fistula patients after operation

    Institute of Scientific and Technical Information of China (English)

    钟有芳

    2015-01-01

    目的:观察复方亚甲蓝用于痔瘘术后镇痛的疗效。方法:将128例患者随机分成治疗组和对照组,每组64例。治疗组术后给予创口周围多点注射复方亚甲蓝注射液,对照组创面不用任何药物,观察2组术后换药或排便疼痛程度,疼痛消失时间以及术后尿潴留和肛缘水肿情况。结果:2组患者手术当天,术后第1天、2天、3天、6天镇痛效果明显优于对照组( P<0.05);2组痔瘘术后治疗组尿潴留、肛缘水肿发生率低于对照组,治疗组术后疼痛消失时间、创面愈合时间均较对照组明显缩短,差异有统计学意义( P<0.05)。结论:复方亚甲蓝用于痔瘘术后镇痛疗效确切安全可靠。%Objective]To observe theanalgesiceffectof compound methylene blue for the treatment of anal fistula patients after operation .[Method] 128 patients were randomlydivided into treatmentgroup and control group ,64 cases per group .After opera-tion of anal fistula ,the patients in treatment group were injected through multi sites with compound methylene bluearound the wound . ,while the wound of control group without treatment .The degree of pain in changing fresh dressing for a wound or defecation ,paindisappearing time ,uroschesis after operation and perianal edema were recorded .[Result] The two groups were observed andcomparedon the day of surgery ,1 day ,2 days ,3 days and 6 days after operation .It was shown that analgesicef-fect in the treatment group was superior to that of control group ( P<0 .05 );Compared with the control group ,urinary reten-tion afteroperation , perianal edema , paindisappearing timeor wound healing time of the treatment group was much lower or shorter ( P<0 .01) .[Conclusion]The compound of methylene bluefor the treatment ofpostoperative analgesia of anal fistulais effective .

  13. Evaluation and management of perianal abscess and anal fistula: a consensus statement developed by the Italian Society of Colorectal Surgery (SICCR).

    Science.gov (United States)

    Amato, A; Bottini, C; De Nardi, P; Giamundo, P; Lauretta, A; Realis Luc, A; Tegon, G; Nicholls, R J

    2015-10-01

    Perianal sepsis is a common condition ranging from acute abscess to chronic fistula formation. In most cases, the source is considered to be a non-specific cryptoglandular infection starting from the intersphincteric space. The key to successful treatment is the eradication of the primary track. As surgery may lead to a disturbance of continence, several sphincter-preserving techniques have been developed. This consensus statement examines the pertinent literature and provides evidence-based recommendations to improve individualized management of patients.

  14. 主管改道切开支管开窗引流术治疗高位复杂性肛瘘的临床研究%Clinical research on window drainage operation of cut branch through supervisor diversion in the treatment of high complex anal fistula

    Institute of Scientific and Technical Information of China (English)

    陈开平

    2015-01-01

    目的:探讨主管改道切开支管开窗引流术治疗高位复杂性肛瘘的临床价值。方法:将80例高位复杂肛瘘患者随机分为两组,治疗组给予主管改道切开支管开窗引流术治疗,对照组给予肛瘘切开挂线术治疗。结果:治疗组术后疼痛、创面愈合时间、肛门畸形均优于对照组(P<0.05)。结论:主管改道切开支管开窗引流术治疗高位复杂性肛瘘较切开挂线术效果好。%Objective:To investigate the clinical value of window drainage operation of cut branch through supervisor diversion in the treatment of high complex anal fistula.Methods:80 patients with high complex anal fistula were randomly divided into two groups.Patients in the treatment group were given window drainage operation of cut branch through supervisor diversion,while in the control group were treated with anal fistula incision and thread drawing therapy.Results:The pain degree,the healing time and the anal deformity after operation of the treatment group were better than those of the control group(P<0.05).Conclusion:Window drainage operation of cut branch through supervisor diversion in the treatment of high complex anal fistula is better than incision and thread operation.

  15. 低位切开结合分次紧线挂线法治疗高位肛瘘疗效观察%Observation of low incision combined with fractional tightening line and hanging line in the treatment of high anal fistula

    Institute of Scientific and Technical Information of China (English)

    黄晨容

    2015-01-01

    Objective To compare the efficacy of two different hanging line methods for the treatment of high anal fistula. Method 80 cases of high anal fistula patients were randomly divided into treatment group and control group, treatment group adopted low incision combined with fractional tightening line and hanging line,control group adopted high anal fistula incision hanging line. The effects of two groups were compared. Results The total effective rate, postoperative anal sphincter function in treatment group is more superior to that control group (P<0.05). Conclusion Low incision combined with fractional tight line hanging line may be effective,less postoperative complications in the treatment of high anal fistula,and it is easy to popularized.%目的 比较两种不同挂线方法对高位肛瘘的疗效.方法 随机将80例高位肛瘘患者分为治疗组和对照组,治疗组采用低位切开结合分次紧线挂线法,对照组采用高位肛瘘切开挂线法,比较两组疗效.结果 治疗组在总有效率、术后肛门括约肌功能方面优于对照组(P<0.05).结论 低位切开结合分次紧线挂线法治疗高位肛瘘疗效确切,术后并发症少,便于临床推广.

  16. The impact of strengthening preoperative visit on psychological status of anal fistula patients%强化术前访视对肛瘘手术患者心理状况的影响

    Institute of Scientific and Technical Information of China (English)

    冯梅

    2015-01-01

    Objective To investigate the effect of strengthening preoperative visit on men-tal status,quality of life and efficacy of anal fistula surgery patients.Methods A total of 200 anal fistula patients were randomly divided into observation group and control group,with 100 cases in each group.The control group received routine preoperative visits,while the observation group re-ceived health education after preoperative visit.Hamilton Depression Scale (HAMD),Self-Rating Anxiety Scale (SAS)and Quality of Life Scale were used to evaluate patients’psychological status and quality of life.Results There was no significant difference in HAMD score and SAS score be-tween two groups before visits(P >0.05).HAMD score and AS scores reduced and the reducing degree of the observation group was more significant than that in the control group before one pre-operative hour of surgery and 2 weeks after surgery and the difference was statistically significant (P <0.05).After 2 weeks of surgery ,score of each item and total score of life quality in the ob-servation group were higher than that in the control group (P <0.05).The number of cured cases and total efficiency in the observation group were significantly higher than that in the control group,the difference was statistically significant (P <0.05).Conclusion Strengthening preop-erative visit on patients with anal fistula can effectively improve the psychological status and quality of life and promote postoperative recovery.%目的:探讨加强术前访视对肛瘘手术患者心理状况、术后生活质量及疗效的影响。方法选取本院收治的肛瘘择期手术患者200例为研究对象,按照随机数字表法分为观察组与对照组各100例。对照组给予常规术前访视,观察组则对常规术前访视方案进行优化。采用汉密尔顿抑郁量表(HAMD)、焦虑自评量表(SAS)、肛肠科患者生活质量量表评价2组患者心理状况及术后生活质量。结果访视前,2

  17. 基于 PDCA 循环式护理的肛瘘外科护理模式探讨%Exploration of PDCA cycle nursing of anal fistula surgery

    Institute of Scientific and Technical Information of China (English)

    戴琴花

    2014-01-01

    Objective Ti explire experience if PDCA cycle nursing if anal fistula surgery and effective nursing mide .Methods PDCA nursing experience if 104 patients with liw anal fis-tula were summarized.Nursing guidance included diseases awareness and pricess if iperatiin and rehabilitatiin,intraiperative cimplicatiins and pistiperative life guidance such as diet and defeca-tiin as well as guidance such as traditiinal Chinese medicine bath,dressing,micriwave irradiatiin, and anus functiinal exercises after discharge.Results All the patients were cured withiut pistip-erative bleeding,infectiin and incintinence and ither seriius cimplicatiins.There were ni recur-rent patients in filliw-up visits after 6 ti 12 minths with 100% satisfactiin in patients.Conclu-sion PDCA nursing ciuld imprive the awareness if treatment pricess if anal fistula,eliminate surgical fear,reduce the incidence if pistiperative cimplicatiins and enhance satisfactiin if pa-tient.%目的:探讨 PDCA 循环式护理干预下肛瘘的外科护理经验与有效的护理模式。方法对104例低位肛瘘患者PDCA 循环式护理的外科护理经验予以总结,术前心理指导包括对疾病的认知、手术及康复过程的了解,术中情况及术后并发症的密切观察,术后生活指导护理如饮食、排便等,术后治疗措施指导如中药坐浴、换药、微波照射等,出院后肛门功能锻炼及出院后生活指导,探讨术前、术中、术后护理模式。结果104例患者全部治愈,治愈率100%,未发生术后大出血、术后感染、肛门失禁等严重并发症,术后随访6~12个月,未发现复发病例,患者满意度100%。结论基于 PDCA 循环式护理干预下的有效外科护理模式可以提高患者对肛瘘治疗过程的认识,消除患者对手术的恐惧,减少术后并发症发生,提高患者满意度。

  18. Image Spectrum of Anal Ultrasound in Patients with Peri Anal Disease

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Hae Jeong; Kim, Young Jun; ParK, Hee Sun; Jung, Sung Il; Park, Sang Woo; Choi, Young Chil; Shin, Hyun Joon; Park, Uug Chae [Konkuk University School of Medicine, Seoul (Korea, Republic of); Jin, Yong Hyun [Sung Ae General Hospital, Seoul (Korea, Republic of)

    2009-12-15

    Endoanal ultrasonography has recently emerged as a popular diagnostic modality for mapping and imaging the anal sphincter. This procedure can be performed as an outpatient procedure: it is relatively quick and virtually painless. The imaging typically is performed in a proximal to distal manner with defining a variety of levels of the anal canal as it progresses. Anal ultrasound can provide a detailed image of the anal sphincter musculature. The internal anal sphincter appears endosonographically as a hypoechoic circular band that is most prominently seen at the level of the mid-anal canal. The external anal sphincter appears as a thicker circular mixed echogenic band outside of the hypoechoic internal sphincter. Anal ultrasound can be used to evaluate patients with anal fistulas with or without abscess. Imaging is performed and the fistulous tracts or abscesses are identified by hypoechogenicity within the external sphincter muscle or the ischiorectal fossa. Its ability to clearly image the anal sphincters has allowed its use for the evaluation of anal fistulas. Moreover, anal ultrasound has emerged as the technique of choice for imaging the anal sphincters and for evaluating incontinence. Each of the individual physiologic tests offers valuable information that is relevant to the continence mechanism, and the ultrasound yields results that are complementary to other tests. Ultrasound serves as a surveillance tool to monitor the results after sphincterplasty. We illustrate the endo-anal sonographic features of various anal diseases and the ultrasound-anatomic correlation for the anus

  19. Anal Atresia Associated to Urethrorectal Fistula in a Giant Anteater Myrmecophaga Tridactyla at the Ocarro´S Bio Park (Villavicencio-Colombia

    Directory of Open Access Journals (Sweden)

    Rosa María Viviana Gómez-Carrillo

    2013-05-01

    Full Text Available Congenital malformations have been found in humans and in some domestic species, however in wild species, reports are limited. The knowledge of these illnesses in wild fauna has not been documented; neither it is epidemiological behavior or casuistic level. The case presented in this article was presented in a neonatal female who belongs to the Myrmecophaga tridactyla species. Specifically, this wild animal was born in the Ocarros Biopark, Villavicencio- Colombia, their final diagnosis was type I anal atresia.

  20. Management of fistula-in-ano: An introduction

    Institute of Scientific and Technical Information of China (English)

    AM El-Tawil

    2011-01-01

    Peri-anal fistulae are a worldwide health problem that can affect any person anywhere. Surgical management of these fistulae is not free from risks. Recurrence and fecal incontinence are the most common complica-tions after surgery. The cumulative personal surgical experience in managing cases with anal fistulae is sig-nificantly considered as necessary for obtaining better results with minimal adverse effects after surgery. The purpose for conducting this survey is to facilitate better outcome after surgical interventions in idiopathic anal fistulae' cases.

  1. The Clinical Observation in Wound Healing of Dressing Changes after Anal Fistula Surgery with Gauzes of Sheng Ji Yu Hong Gao%生肌玉红膏纱条换药对肛瘘术后创面愈合的临床观察

    Institute of Scientific and Technical Information of China (English)

    张羽; 王艳逊; 高文帅; 陈雄

    2013-01-01

    目的:观察生肌玉红膏纱条对肛瘘术后换药促伤口愈合的疗效。方法:治疗组83例以生肌玉红膏纱条治疗;对照组83例以0.2%乳酸依沙吖啶纱条治疗。结果:创面愈合天数治疗组为(10.02±3.52)d,对照组为(15.23±4.57)d,P<0.05,有显著性差异。结论:生肌玉红膏纱条对肛瘘术后创面有明显促进伤口愈合、活血行气、生肌止痛的功效。%Objective:Judge the efficacy in wound healing of dressing changes after anal fistula surgery with gauze of Sheng Ji Yu Hong Gao. Methods:The treatment group 83 patients who have dressed changes after anal fistula surgery with the gauzes of Sheng Ji Yu Hong Gao and the control group 83 patients who have dressed changes after anal fistula surgery with the gauzes of ethacridine lactate solution. Results:The wound healing time of treatment group was (10.02±3.52)days and the control group was (15.23±4.57)days,there were significant differences. Conclusions:The gauzes of Sheng Ji Yu Hong Gao have a obvious role such as promoting wound healing, blood circulation of qi and the the growth of fresh granulation and analgesic for wound of anal fistula surgery.

  2. Treatment of 50 Cases of Anal Fistula Patients with Urinary Retention of Water and Observe the Effect of Acupuncture Combined with Electrotherapy Needle%针刺结合水针及电疗治疗50例肛瘘术后患者尿潴留的疗效观察

    Institute of Scientific and Technical Information of China (English)

    张欣; 纪品川; 杜静华; 刘冰; 刘永生; 朱华林

    2014-01-01

    Objective The curative ef ect of acupuncture combined with urinary retention of water needle and electrotherapy treatment of anal fistula after operation. Methods After operation of anal fistula occurred in 50 patients with urinary retention, al cases by acupuncture combined with water needle and electrotherapy. Results 48 patients were cured, ef ective in 1 cases, accounting for 96%;2%;1 cases were inef ective, accounted for 2%. The total ef ective rate was 98%. Conclusion Acupuncture combined with water needle and electrotherapy treatment of anal fistula after operation in patients with urinary retention for clinical application, no danger, is worth the clinical promotion.%目的:针刺结合水针及电疗治疗肛瘘术后患者尿潴留的疗效。方法选择肛瘘术后发生尿潴留患者50例,全部病例采用针刺结合水针及电疗。结果治愈者48例,占96%;有效1例,占2%;无效1例,占2%。总有效率为98%。结论针刺结合水针及电疗治疗肛瘘术后患者尿潴留临床应用方便,无危险,值得临床推广。

  3. Hepatoprotective Activity of Cassia fistula root against Carbon tetrachloride-Induced Hepatic Injury in rats (Wistar

    Directory of Open Access Journals (Sweden)

    SAGAR DAWADA

    2012-04-01

    Full Text Available The protective effects of the alcoholic extract of Cassia fistula root; against CCl4 induced hepatic failure in male albino rats (wistar strain was investigated. For acute and massive invasion of hepatopathy, CCl4 (s.c injection of CCl4+Olive Oil in 1:1 ratio; 2ml/kg was used and the insidious intoxication was evidenced bysignificant turmoil of various biochemical parameters followed by significant (p<0.001 weight loss in toxic control group. The administration of alcoholic root extract (200mg/kg and 100mg/kg of body weight for 7 days, elicited protective action since the elevated levels of marker enzymes (SGOT, SGPT, ALP of liver functionswere found to be decreasing progressively in a dose dependent manner. The final body weight was also significantly (p<0.001 increased when compared with the toxic control group. The serum total protein and theserum albumin were also approaching normal values. The results found in alcoholic extract 200mg/kg treated rat were quite promising and were comparable with a standard drug Silymarin. In the alcoholic extract 200mg/kg treated rat group all the marker enzymes were analyzed to be decreasing significantly. The statistically processed results support the conclusion, that the alcoholic root extract of Cassia fistula root (200mg/kg and 100mg/kg possesses dose dependent, significant protective activity against CCl4 induced hepatotoxicity.

  4. Diagnosis and Treatment of Transsphincteric Perianal Fistulas

    NARCIS (Netherlands)

    D.D.E. Zimmerman (David)

    2003-01-01

    textabstractFistula’ is the Latin word for a reed, pipe or flute. In medicine it implies a chronic granulating track connecting two epithelium lined surfaces. These surfaces may be cutaneous or mucosal. Perianal fistulas run from the anal canal to the perianal skin or perineum. Perianal fistulas are

  5. Identification of epithelialization in high transsphincteric fistulas

    NARCIS (Netherlands)

    L.E. Mitalas (Litza); R.S. van Onkelen (Robbert); K. Monkhorst (Kim); D.D.E. Zimmerman (David); M.P. Gosselink (Martijn Pieter); W.R. Schouten (Ruud)

    2012-01-01

    textabstractBackground At present, transanal advancement flap repair (TAFR) is the treatment of choice for transsphincteric fistulas passing through the upper and middle third of the external anal sphincter. It has been suggested that epithelialization of the fistula tract contributes to the failure

  6. The application value of 3.0T high-resolution MRI in diagnosis of complex anal fistula%3.0T 高分辨率 MRI 诊断复杂性肛瘘的应用价值

    Institute of Scientific and Technical Information of China (English)

    廖华强; 刘文斌; 郑黎; 青明华; 梁英

    2015-01-01

    Objective To study the clinical application of 3.0T high-resolution magnetic resonance imaging (MRI)in diagnosis of complex anal fistula.Methods 32 patients with complex anal fistula confirmed by surgery were retrospectively analyzed,and all pa-tients underwent preoperative 3.0T MRI scan.The MRI findings were compared with surgical results.Results In 32 cases of pa-tients,54 anal fistulas and 54 inner outlets were found by MRI with accuracy of 93.10% in comparison with surgery results with 58 fistulas and 58 inner outlets.48 outer outlets with accuracy of 100% were found by MRI,which were consistent with surgical re-sults.8 branch fistulas with accuracy of 72.70% were found by MRI in comparison with 1 1 fistulas by surgery.Conclusion 3.0T high-resolution MRI can accurately show the anal fistula,especially the number and direction of complex anal fistula,the branch fis-tula formation and location of the outlet,the relationship of fistula with the surrounding muscles,presence of abscess formation.%目的:探讨3.0T 高分辨率 MRI 在肛门直肠周围复杂性肛瘘诊断中的临床应用价值。方法回顾性分析经手术证实的复杂性肛瘘患者32例,术前均经3.0T MRI 系统行 MR 平扫,然后将 MR 诊断结果与手术结果对照。结果32例患者中术前 MR共发现瘘管54条,手术发现58条,准确率93.10%;内口54个,手术发现58个,准确率93.10%;外口48个,手术发现48个,准确率100.00%;支瘘管8条,手术发现11条,准确率72.70%。结论3.0T 高分辨率 MRI 检查可准确显示肛瘘,特别是复杂性肛瘘的数目、瘘管走行、支管形成及内口的位置和瘘管与周围肌肉关系、有无脓肿形成。

  7. 肛门外括约肌浅部入路手术治疗后位高位复杂性肛瘘疗效观察%Clinical effect of partes superficialis approach operation in the treatment of high complex anal fistula of posterior position

    Institute of Scientific and Technical Information of China (English)

    吴俊荣; 刘建峰; 金晶

    2013-01-01

    目的 探讨肛门外括约肌浅部入路手术治疗后位高位复杂性肛瘘的临床疗效.方法 对2010年-2012年收治的29例后位高位复杂性肛瘘患者经肛门外括约肌浅部入路行切开挂线术、切开挂线旷置术、切开旷置术.结果 29例患者28例治愈,治愈率96.6%.结论 肛门外括约肌浅部入路手术治疗后位高位复杂性肛瘘手术成功率高,不损害肛门功能及外形,对患者造成的痛苦轻.%Objective To explore the clinical effect of partes superficialis (external anal sphincter)approach operation in the treatment of high complex anal fistula of posterior position.Methods Twenty-nine patients with high complex anal fistula of posterior position From 2010 to 2012 were treated by partes superficialis incision thread-drawing,incision and thread-drawing indwelling,open indwelling.Results Twenty-eight patients were cured,and the curative rate was 96.6 %.Conclusion Success rate of partes superficialis approach operation in the treatment of high complex anal fistula of posterior position after operation is high,and it does not damage the anal function and shape,and causes less suffering.

  8. Perianal mucinous adenocarcinoma associated with chronic anaI fistula: case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, ChuI Hi; Yang, Dal Mo; Kim, Jee Eun; Choi, Soo Jin [Gil Medical Center, Incheon (Korea, Republic of)

    2004-09-01

    Perianal mucinous adenocarcinoma is a rare disease. We report here on the CT findings in a case of perianal mucinous adenocarcinoma associated with chronic anal fistula. The CT revealed a low attenuated lesion surrounding the subcutaneous area of chronic anal fistula, anal canal and perirectal area.

  9. Repair of the radiation induced rectovaginal fistulas without or with interposition of the bulbocavernosus muscle (Martius procedure)

    Energy Technology Data Exchange (ETDEWEB)

    Aartsen, E.J.; Sindram, I.S.

    1988-04-01

    Two local repair procedures, one without (9) and the other with (14) a bulbocavernosus muscle graft were performed on 20 patients with a radiation induced rectovaginal fistula. Four patients had two procedures successively. The initial success rate of both procedures was 7/9 and 14/14 respectively. Though the initial result of the bulbocavernosus graft was obviously better, in many of the local repair procedures, subclinical radiation damage progressed, resulting in recurrence of rectovaginal fistula (5), rectovesical fistula (4), pararectal abscess (2) etc. After a mean follow up of around 10 years, the success rate of fistula repair decreased to 5/9 and 13/14 and only 2/9 and 6/14 finally remained without a colostomy. A local repair operation should be restricted to carefully selected cases. The musculus gracilis is proposed as a better vascular graft. If the general condition of the patient does not allow more aggressive reconstructive procedures, fistula repair is better cancelled because there is a high risk of subsequent radiation damage.

  10. Experimental porcine model of complex fistula-in-ano

    Science.gov (United States)

    A Ba-Bai-Ke-Re, Ma-Mu-Ti-Jiang; Chen, Hui; Liu, Xue; Wang, Yun-Hai

    2017-01-01

    AIM To establish and evaluate an experimental porcine model of fistula-in-ano. METHODS Twelve healthy pigs were randomly divided into two groups. Under general anesthesia, the experimental group underwent rubber band ligation surgery, and the control group underwent an artificial damage technique. Clinical magnetic resonance imaging (MRI) and histopathological evaluation were performed on the 38th d and 48th d after surgery in both groups, respectively. RESULTS There were no significant differences between the experimental group and the control group in general characteristics such as body weight, gender, and the number of fistula (P > 0.05). In the experimental group, 15 fistulas were confirmed clinically, 13 complex fistulas were confirmed by MRI, and 11 complex fistulas were confirmed by histopathology. The success rate in the porcine complex fistula model establishment was 83.33%. Among the 18 fistulas in the control group, 5 fistulas were confirmed clinically, 4 complex fistulas were confirmed by MRI, and 3 fistulas were confirmed by histopathology. The success rate in the porcine fistula model establishment was 27.78%. Thus, the success rate of the rubber band ligation group was significantly higher than the control group (P < 0.05). CONCLUSION Rubber band ligation is a stable and reliable method to establish complex fistula-in-ano models. Large animal models of complex anal fistulas can be used for the diagnosis and treatment of anal fistulas. PMID:28348488

  11. Aortoenteric Fistula

    Directory of Open Access Journals (Sweden)

    Shou-Jiang Tang

    2014-04-01

    Conclusions: Diagnosis of aortoenteric fistula requires a high index of suspicion and careful history-taking. Endoscopic findings include adherent clots or bleeding at the fistula opening and/or eroded vascular graft or stent into the bowel.

  12. Analysis on effect of postoperative debridement for promoting incision healing after high anal fistula incision and drain-age%术后扩创对促进高位肛瘘切开引流术后切口愈合的研究

    Institute of Scientific and Technical Information of China (English)

    程跃

    2015-01-01

    Objective To analyze the clinical value of small cut combined with postoperative debridement in promoting postoperative wound healing in high anal fistula incision and drainage .Methods 60 patients with high anal fistula in our hospital were selected and randomly divided into the small cut postoperative debridement group(n= 30) and the traditional cut group (n = 30) .The surgery time ,incision healing time ,rectal resting pressure ,anal resting pressure ,maximum systolic pressure of anal tube ,incidence rates of postoperative anal pain ,anal bulge ,retention of u‐rine ,incision blood exudation and clinical effect in the two groups were observed and analyzed .Results The surgery time and the incision healing time in the small cut postoperative debridement group were significantly shorter than those in the traditional incision group(P< 0 .05) ;the postoperative rectal resting pressure ,anal resting pressure ,max‐imum systolic pressure of anal tube were significantly higher than those in the traditional incision group(P< 0 .05) ;the incidence rates of postoperative anal pain ,anal bulge ,retention of urine and blood exudation of incision in the small cut postoperative debridement group were lower than those in the traditional incision group(P< 0 .05) ,moreo‐ver the clinical effect was significantly higher than that in the traditional incision group(P< 0 .05) .Conclusion Small cut combined with postoperative debridement can shorten the healing time of incision ,protects the anal function ,re‐duces the postoperative complications and improves the clinical effect of high anal fistula .%目的:分析小切口联合术后扩创对促进高位肛瘘切开引流术后切口愈合的价值。方法将高位肛瘘患者60例,随机分为小切口术后扩创组(n=30)和传统切口组(n=30),观察分析2组手术时间、切口愈合时间、直肠静息压、肛管静息压及肛管最大收缩压、术后肛门疼痛、肛门坠胀、尿潴留及

  13. How the anal gland orifice could be found in anal abscess operations

    Directory of Open Access Journals (Sweden)

    Shahram Paydar

    2015-01-01

    Full Text Available Background: On an average 30-50% of patients who undergo incision and drainage (I and D of anal abscess will develop recurrence or fistula formation. It is claimed that finding the internal orifice of anal abscess to distract the corresponding anal gland duct; will decline the rate of future anal fistula. Surgeons supporting I and D alone claim that finding the internal opening is hazardous. This study is conducted to assess short-term results of optional method to manage patients with anal abscess and fitula-in-ano at the same time. Materials and Methods: In this cross-sectional descriptive study 49 from 77 patients with anal abscess whose internal orifice was not identified by pressing on the abscess, diluted hydrogen peroxide (2% and methylene blue was injected into the abscess cavity and the anal canal was inspected to find out the internal opening. Once the opening was distinguished, an incision was given from the anal verge to the internal opening. Results: The internal orifice was identified in 44 out of 49 patients (90% who underwent this new technique. Up to 18 months during follow-up, only 2.5% of patients with primary fistulotomy developed fistula on the site of a previous abscess. Conclusion: Conventional method to seek the internal orifice of anal abscesses is successful in about one-third of cases. By applying this new technique, surgeons would properly find the internal opening in >90% of patients. Needless to say, safe identification of the anal gland orifice in anal abscess disease best helps surgeons to do primary fistulotomy and in turn it would significantly decrease the rate of recurrence in anal abscess and fistula formation.

  14. Colovesicular Fistula

    OpenAIRE

    2012-01-01

    A fistula is an atypical connection between two epithelial surfaces, in the case of an enterovesical fistula between the urinary and gastrointestinal systems. These may be the result of a number of causes including: 1. Congenital abnormalities 2. Inflammatory diseases of the bowel (such as diverticulitis and Crohn’s Disease) 3. Cancer 4. Infection 5. Trauma 6. Iatrogenic (such as a post-operative complication) [3] A colovesical fistula (colovesicular fistula), an abnor...

  15. [Strategies on perianal abscess and fistula-in-ano: interpretation of the guidelines from USA and German].

    Science.gov (United States)

    Ding, Shu-qing; Ding, Yi-jiang

    2012-12-01

    The Practice Parameters for the Management of Perianal Abscess and Fistula-in-ano from USA(2011) and German guidelines for anal abscess (2012) are based on the evidence and specialists consensus from colorectal field. Standardization of the anal abscess management may simplify the anal fistula treatment. This review is to concepts from other countries and guide the treatment in China.

  16. Operative considerations for rectovaginal fistulas

    Institute of Scientific and Technical Information of China (English)

    Kevin; R; Kniery; Eric; K; Johnson; Scott; R; Steele

    2015-01-01

    To describe the etiology, anatomy and pathophysiology of rectovaginal fistulas(RVFs); and to describe a systematic surgical approach to help achieve optimal outcomes. A current review of the literature was performed to identify the most up-to-date techniques and outcomes for repair of RVFs. RVFs present a difficult problem that is frustrating for patients and surgeons alike. Multiple trips to the operating room are generally needed to resolve the fistula, and the recurrence rate approaches40% when considering all of the surgical options. At present, surgical options range from collagen plugs and endorectal advancement flaps to sphincter repairs or resection with colo-anal reconstruction. There are general principles that will allow the best chance for resolution of the fistula with the least morbidity to the patient. These principles include: resolving the sepsis, identifying the anatomy, starting with least invasive surgical options, and interposing healthy tissue for complex or recurrent fistulas.

  17. Comparative Study of LAVA-EnhancedMRI and High Frequency Cavity B Ultrasound in High Complex anal Fistula Preoperative Examination%LAVA增强磁共振检查与高频腔内B超在高位复杂性肛瘘术前检查中的对比研究

    Institute of Scientific and Technical Information of China (English)

    王庭红; 顾建平; 王丽萍

    2015-01-01

    Objective To investigate the value of LAVA-enhanced magnetic resonance imaging and high frequency cavity B ultrasound of high complex anal fistula preoperative diagnosis. Methods a retrospective analysis of 50 cases verified by operation of high complex anal fistula B ultrasound image and MRI image, the operation results as the standard, comparison of LAVA-Enhanced magnetic resonance imaging and high frequency cavity B ultrasound results. Results the operation result as the standard, high frequency cavity B ultrasound and LAVA-Enhanced magnetic resonance imaging results compared, accuracy rate of export orientation in the anal fistula were 91.1% and 82.2%(X2=1.53, P>0.05), branch display rate was 62.2%and 88.8%(X2=8.66, P0.05), other complications display rate (50% and 100%) (X2=8.6, P<0.01). export orientation in the anal fistula and perianal abscess localization accuracy without significant difference. Branch and other complications showed highly significant difference. Conclusion high frequency cavity B ultrasound diagnosis for simple anal fistula preoperative diagnosis, whereas LAVA-enhanced MRI is more suitable for high complex anal fistula preoperative.%目的:探讨LAVA增强磁共振检查与高频腔内B超对高位复杂性肛瘘的术前诊断价值。方法回顾分析经手术证实的50例高位复杂性肛瘘的MRI图像及B超图像,以手术结果为标准,比较术前LAVA增强磁共振检查与高频腔内B超的结果。结果以手术结果为标准,高频腔内B超与LAVA增强磁共振检查的结果相比较,肛瘘内口定位准确率分别为91.1%和82.2%(X2=1.53,P>0.05),支管显示率为62.2%和88.8%(X2=8.66,P<0.01),肛周脓肿显示率为(95%和100%) X2=1.07,P>0.05),其它并发症显示率(50%和100%)(X2=8.6,P<0.01),肛瘘内口及肛周脓肿定位准确率差别无统计学意义,支管及其它并发症显示率差别具有高度统计学意义。结论高频腔内B超适用于单纯

  18. Application research of hlgh-frequency ultrasound on perianal abscess and anal fistula of pre-operative assessment%高频超声在直肠肛管周围脓肿术前评估中的应用研究

    Institute of Scientific and Technical Information of China (English)

    董愉

    2013-01-01

    Objective To explore the value of hlgh-frequency ultrasound on the perianal abscess and anal fistula of pre -operative assessment.Methods Totally 188 patients with perianal inflammatory disease were examined with hlgh-frequency.The diagnostic results were confirmed by clinical diagnosis,including operative and pathological detection.Results All cases were correctly diagnosed.Perianal abscess 120 cases,anal fistula 47 cases were confirmed by operation,other 21 cases underwend ultrasound were not fourd any abnormal and were cured by anti-inflammatory.Conclusions Application of per perineal high-frequency ultrasound examination has great practical value for ascertaining the trend and internal orifice location of anal fistula,location of perianul abscess.%目的 探讨高频超声在肛周脓肿、肛瘘术前评估中的应用价值.方法 通过对188例肛周感染性疾病患者选用高频超声进行肛管及周围超声扫查.并将检查结果与手术所见及病理结果相对照.结果 超声检查结果均与临床诊断相符合,肛周脓肿120例,及肛瘘47例,均经手术可以证实,其余21例超声未见异常,未经手术经消炎输液即治愈.结论 应用经会阴高频超声检查,对肛瘘的走行及内口的定位、肛周脓肿的定位有非常高效的临床诊断价值.

  19. Idiopathic fistula-in-ano

    Institute of Scientific and Technical Information of China (English)

    Sherief Shawki; Steven D Wexner

    2011-01-01

    Fistula-in-ano is the most common form of perineal sep- sis. Typically, a fistula includes an internal opening, a track, and an external opening. The external opening might acutely appear following infection and/or an abs-cess, or more insiduously in a chronic manner. Mana-gement includes control of infection, assessment of the fistulous track in relation to the anal sphincter muscle, and finally, definitive treatment of the fistula. Fistulo-tomy was the most commonly used mode of manage-ment, but concerns about post-fistulotomy incontinence prompted the use of sphincter preserving techniques such as advancement flaps, fibrin glue, collagen fistula plug, ligation of the intersphincteric fistula track, and stem cells. Many descriptive and comparative studies have evaluated these different techniques with variable outcomes. The lack of consistent results, level I eviden-ce, or long-term follow-up, as well as the heterogeneity of fistula pathology has prevented a definitive treatment algorithm. This article will review the most commonly available modalities and techniques for managing idio-pathic fistula-in-ano.

  20. Left subclavian artery-esophageal fistula induced by a paper star: a case report

    OpenAIRE

    Lin, Chen-Sheng; Lin, Cheng-Wen

    2016-01-01

    A subclavian artery-esophageal fistula usually occurs on the right side of an aberrant subclavian artery. It also rarely appears in the site between a non-aberrant subclavian artery and the esophagus due to the ingestion of a foreign body. Upper gastrointestinal bleeding in the case of a subclavian artery-esophageal fistula is rare but often fatal. Here, we report on a 62-year-old male patient with a left subclavian arteryesophageal fistula complicated by hemorrhagic shock. He swallowed a for...

  1. Dural arteriovenous fistula-induced thalamic dementia: report of 4 cases.

    Science.gov (United States)

    Holekamp, Terrence F; Mollman, Matthew E; Murphy, Rory K J; Kolar, Grant R; Kramer, Neha M; Derdeyn, Colin P; Moran, Christopher J; Perrin, Richard J; Rich, Keith M; Lanzino, Giuseppe; Zipfel, Gregory J

    2016-06-01

    Nonhemorrhagic neurological deficits are underrecognized symptoms of intracranial dural arteriovenous fistulas (dAVFs) having cortical venous drainage. These symptoms are the consequence of cortical venous hypertension and portend a clinical course with increased risk of neurological morbidity and mortality. One rarely documented and easily misinterpreted type of nonhemorrhagic neurological deficit is progressive dementia, which can result from venous hypertension in the cortex or in bilateral thalami. The latter, which is due to dAVF drainage into the deep venous system, is the less common of these 2 dementia syndromes. Herein, the authors report 4 cases of dAVF with venous drainage into the vein of Galen causing bithalamic edema and rapidly progressive dementia. Two patients were treated successfully with endovascular embolization, and the other 2 patients were treated successfully with endovascular embolization followed by surgery. The radiographic abnormalities and presenting symptoms rapidly resolved after dAVF obliteration in all 4 cases. Detailed descriptions of these 4 cases are presented along with a critical review of 15 previously reported cases. In our analysis of these 19 published cases, the following were emphasized: 1) the clinical and radiographic differences between dAVF-induced thalamic versus cortical dementia syndromes; 2) the differential diagnosis and necessary radiographic workup for patients presenting with a rapidly progressive thalamic dementia syndrome; 3) the frequency at which delays in diagnosis occurred and potentially dangerous and avoidable diagnostic procedures were used; and 4) the rapidity and completeness of symptom resolution following dAVF treatment.

  2. Chemotherapy-induced enterocutaneous fistula after perineal hernia repair using a biological mesh: a case report

    Directory of Open Access Journals (Sweden)

    Eriksen MH

    2014-01-01

    Full Text Available MH Eriksen, O Bulut Department of Surgical Gastroenterology, Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark Abstract: This is the first reported case of an enterocutaneous fistula as a late complication to reconstruction of the pelvic floor with a Permacol™ mesh after a perineal hernia. A 70-year-old man had a reconstruction of the pelvic floor with a biological mesh because of a perineal hernia after laparoscopic abdominoperineal resection. Nine months after the perineal hernia operation, the patient had multiple metastases in both lungs and liver. The patient underwent chemotherapy, including bevacizumab, irinotecan, calcium folinate, and fluorouracil. Six weeks into chemotherapy, the patient developed signs of sepsis and complained of pain from the right buttock. Ultrasound examination revealed an abscess, which was drained, guided by ultrasound. A computed tomography scan showed a subcutaneous abscess cavity located in the right buttock with communication to the small bowel. Operative findings confirmed a perineal fistula from the distal ileum to perineum. A resection of the small bowel with primary anastomosis was performed. The postoperative course was complicated by fluid and electrolyte disturbances, but the patient was stabilized and finally discharged to a hospice for terminal care after 28 days of hospital stay. It seems that hernia repairs with biological meshes have lower erosion and infection rates compared with synthetic meshes, and so far, evidence suggests that biological grafts are safe and effective in the treatment of pelvic floor reconstruction. There have been no reports of enteric fistulas after pelvic reconstruction with biological meshes. However, the development of intestinal fistulas after chemotherapy with bevacizumab has been described in the literature. Our case report supports this association between bevacizumab and fistula formation among rectal cancer patients, as symptoms of a

  3. Defensive anality and anal narcissism.

    Science.gov (United States)

    Shengold, L

    1985-01-01

    This paper aims at demonstrating a currently beleaguered assumption: the central importance, the continuing vitality, and the appropriate complexity of Freud's theory of the drives and of his idea of the primacy of the body ego. It is not enough to consider man a thinking machine or a social being; his animal nature must be given a central place in psychology. The paper postulates that 'anal or sphincter defensiveness' is one of the precursors of the repression barrier. Anality has been comparatively neglected in recent psychoanalytic literature, and so has its explorer, Karl Abraham. The paper's thesis is that there is a special defensive importance to anal erogeneity and libido, and to those aspects of ego and superego that are functionally operative (as the 'sadistic-anal organization' (Freud, 1917)) during the so-called 'sadistic-anal' developmental phase. Any of the psychic danger situations can evoke regression to manifestations of 'anal narcissim'--an attempt to master overwhelming feeling by a kind of emotional sphincter action, narrowing down the world to the controllable and the predictable. The basic assumption here is Fliess's idea that the attainment of anal sphincter control functions--with, as-it-were, 'psychic resonance'--as a means to master primal (murderous, cannibalistic) affect. For optimal psychic development, a proper balance must be attained between anal control of, and anal expression of, instinctual derivatives--especially of affect laden with aggression.

  4. FISTULOTOMY VERSUS FISTULECTOMY FOR TREATMENT OF FISTULA-IN-ANO

    OpenAIRE

    Ravi Kumar; Sunil Kumar; Siddharth

    2016-01-01

    Fistula-in-ano is notorious for its frequent exacerbations, recurrences and its chronic condition. The anorectal abscess is an acute inflammatory process that often is the initial manifestation of the underlying anal fistula and is the chronic condition following inadequate drainage of the abscess. Around 90% of the cases occur due to infected anal glands. Incision and drainage of the abscess cavity will result in complete resolution of the infection in 50% of the patients, where...

  5. Protective effect of Cassia fistula fruit extract against bromobenzene-induced liver injury in mice.

    Science.gov (United States)

    Kalantari, Heibatullah; Jalali, Mohammadtaha; Jalali, Amir; Mahdavinia, Masood; Salimi, Abobakr; Juhasz, Bela; Tosaki, Arpad; Gesztelyi, Rudolf

    2011-08-01

    In the present study, hepatoprotective effect of Cassia fistula fruit extract was investigated in mice. Animals were divided into six groups receiving normal saline (1), bromobenzene (460 mg/kg) alone (2) and together with increasing doses (200, 400, 600, 800 mg/kg) of a crude hydro-alcoholic extract of Cassia fistula fruit (3-6, respectively). All administrations were carried out orally, daily, for 10 days. On the 11th day, animals were sacrificed. Serum activities of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (γGT) were determined; serum levels of direct and total bilirubin were measured; furthermore, livers were prepared for histological examination. Our results showed that bromobenzene treatment alone elicited a significant increase in activities of AST, ALT, ALP (but not γGT), and it significantly elevated the levels of direct and total bilirubin. Co-treatment with Cassia fistula fruit extract, however, significantly and dose-dependently decreased the above-mentioned enzyme activities (with exception of γGT) and bilirubin levels, producing a recovery to the naive state. The protective effect of Cassia fistula fruit extract against liver injury evoked by bromobenzene was confirmed by histological examination as well. In conclusion, the Cassia fistula fruit extract has significant hepatoprotective effect in our murine model.

  6. Identification of factors affecting the outcome of transanal advancement flap repair for high transsphincteric fistulas

    NARCIS (Netherlands)

    E. Mitalas (Evangelia)

    2009-01-01

    textabstractA fistula is defined as an abnormal communication between two epithelium lined surfaces. Perianal fistulas are abnormal communications between the anal canal and the perianal skin. Perianal fistulas have been treated since ancient times. Probably the first to describe the diagnosis and t

  7. Kirurgisk behandling af anale fistler ved Crohns sygdom

    DEFF Research Database (Denmark)

    Heyckendorff-Diebold, Tina; Maeda, Yasuko; Buntzen, Steen;

    2012-01-01

    The treatment of transsphincteric anal fistulas in Crohn's disease is a balance between the elimination of the sepsis and the functional outcome. Loose setons can be used as a preoperative drainage or chronic treatment. Fibrin glue and the anal fistula plug are methods with excellent functional...... outcomes, but the success rate varies. The endorectal advancement flap is considered to be the gold standard. Ligation of the intersphincteric fistula tract is promising. Proctectomy or proctocolectomy in combination with transposition flaps may be necessary. A success rate of 66-70% has been reported....

  8. Variation of the anal resting pressure induced by postexpiratory apnea effort in patients with constipation

    Directory of Open Access Journals (Sweden)

    Thaís Helena Benetti

    2011-03-01

    Full Text Available CONTEXT: Intestinal constipation - a common symptom among the general population - is more frequent in women. It may be secondary to an improper diet or organic or functional disturbances, such as dyskinesia of the pelvic floor. This is basically characterized by the absence of relaxation or paradoxical contraction of the pelvic floor and anal sphincter during evacuation. OBJECTIVE: To analyze, by manometric data, the anal pressure variation at rest, during evacuation effort by using the Valsalva maneuver and forced post-expiratory apnea in subjects with secondary constipation. METHODS: Twenty-one patients (19 females - 90.4% with a mean age of 47.5 years old (23-72 were studied. The diagnosis was performed using anorectal manometry, with a catheter containing eight channels disposed at the axial axis, measuring the proximal (1 and distal (2 portions of the anal orifice. The elevation of the pressure values in relation to the resting with the evacuation effort was present in all patients. The Agachan score was used for clinical evaluation of constipation. The variables studied were: mean anal pressure of the anal orifice for 20 seconds at rest, the effort of evacuation using Valsalva maneuver and the effort of evacuation during apnea after forced expiration, as well as the area under the curve of the manometric tracing at moments Valsalva and apnea. RESULTS: The analysis of the mean values of the anal pressure variation at rest evidenced difference between proximal and distal channels (P = 0.007, independent of the moment and tendency to differ during moments Valsalva and apnea (P = 0.06. The mean of values of the area under the manometric tracing curve showed differences between moments Valsalva and apnea (P = 0.0008, either at the proximal portion or at the distal portion of the anal orifice. CONCLUSION: The effort of evacuation associated with postexpiratory apnea, when compared with the effort associated with the Valsalva maneuver, provides

  9. Gunshot-Induced Aorto-Left Atrial Fistula Diagnosed by Intraoperative Transesophageal Echocardiography.

    Science.gov (United States)

    Nandate, Koichiro; Krishnamoorthy, Vijay; McIntyre, Lisa K; Verrier, Edward D; Mackensen, G Burkhard

    2016-02-01

    Aorto-left atrial fistula (AAF) is rarely encountered in clinical practice, and the early diagnosis can be very challenging. This report describes a unique case of AAF caused by a gunshot injury and the pivotal role of transesophageal echocardiography for diagnosis and assessment.

  10. Anal fissure

    Science.gov (United States)

    ... split or tear in the thin moist tissue ( mucosa ) lining the lower rectum (anus). Causes Anal fissures ... Chronic Constipation in infants and children Crohn disease Mucosa Review Date 5/24/2016 Updated by: Mary ...

  11. Endoanal ultrasound in benign anal disorders: findings and usefulness

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Tae Haeng; Shin, Hyun Joon; Cho, Young Kwon; Park, Dong Rib; Jeon, Hae Jeong; Park, Jeong Hee; Choi, Yong Chil; Park, Ung Chae; Choi, Jin Yong [Konkuk Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-09-01

    To evaluate the usefulness of endoanal ultrasonography and to determine the imaging features of patients with fecal incontinence, anal abscess or anal fistula. Twenty five patients underwent endoanal ultrasonography between October 1995 and July 1996. Ten of these were fecal incontinence cases, eight had an anal abscess, and seven, an anal fistula. The incontinence grading scale (IGS) was used for clinical grading of fecal incontinence and pudendal nerve terminal motor latency (PNTML) for pudendal nerve injury. Endoanal ultrasonographic features and operative findings were retrospectively reviewed. Endoanal ultrasonography revealed defective sphincteric muscles in all three patients with myogenic fecal incontinence, but in six of seven cases with neurogenic fecal incontinence, these muscles were not difective. Myogenic and neurogenic incontience showed different findings (p=3D0.033). In comparison with surgical findings, endoanal ultrasonography was 88% accurate in anal abscess cases and 86% accurate in those of anal fistula. Endoanal ultrasonography in conjunction with PNTML was very useful for the detection of the site and severity of sphincteric muscle defect and diagnosis of the etiology of fecal incontinence. Through analysis of the site and type of lesion, the procedure can also serve as a guide to the surgical treatment of patients with anal abscess or fistula.=20.

  12. 肛门直肠周围脓肿行一期手术治疗对术后脓肿的复发率、肛瘘发生率的影响%Influence of the recurrence and incidence of anal fistula rate of abscess after the one stage surgical in the treatment of anus and rectum abscess

    Institute of Scientific and Technical Information of China (English)

    李健

    2015-01-01

    目的:探讨肛门直肠周围脓肿行一期手术治疗对术后脓肿的复发率、肛瘘发生率的影响.方法:收治肛门直肠周围脓肿患者94例,根据手术方式将其分为观察组和对照组各47例,观察组患者给予一期手术治疗,对照组患者给予单纯切开引流术.结果:观察组术后复发、发生后遗肛瘘及术后感染控制时间均较对照组少(P<0.05).结论:对肛门直肠周围脓肿患者行一期手术治疗能有效降低术后脓肿的复发率和肛瘘发生率,明显缩短术后感染控制时间.%Objective:To investigate the influence of the recurrence and incidence of anal fistula rate of abscess after the one stage surgical in the treatment of anus and rectum abscess.Methods:94 patients with anal rectal abscess were selected,they were divided into the observation group and the control group with 47 cases in each group according to the operation mode,the observation group was treated with one stage operation,and the control group was treated with open drainage.Results:The Postoperative recurrence,occurrence of residual fistula and postoperative infection control time of the observation group were less than those of the control group(P<0.05).Conclusion:One stage surgical in the treatment of the patients with anorectal abscess,it can reduce postoperative abscess recurrence rate and incidence of anal fistula effectively,and shorten the postoperative infection control time.

  13. Arteriovenous Fistula

    Science.gov (United States)

    ... home. Accessed Feb. 23, 2015. Vascular access for hemodialysis. National Kidney and Urologic Diseases Information Clearinghouse. http:// ... www.mayoclinic.org/diseases-conditions/arteriovenous-fistula/basics/definition/CON-20034876 . Mayo Clinic Footer Legal Conditions and ...

  14. Biochemical evaluation of the hypoglycemic effects of extract and fraction of Cassia fistula linn. in alloxan-induced diabetic rats

    Directory of Open Access Journals (Sweden)

    E E Jarald

    2013-01-01

    Full Text Available Various extracts of flowers of Cassia fistula Linn (Leguminosae such as petroleum ether (60-80°, chloroform, acetone, ethanol, aqueous, and crude aqueous extracts and two fractions of ethanol extract were tested for antihyperglycemic activity in glucose-overloaded hyperglycemic rats. The effective antihyperglycemic extracts and fraction were tested for their hypoglycemic activity at two dose levels, 200 and 400 mg/kg, respectively. To confirm their utility in higher models, the effective extracts and fraction of C. fistula were subjected to antidiabetic study in an alloxan-induced diabetic model at two dose levels, 200 and 400 mg/kg, respectively. Biochemical parameters like glucose, urea, creatinine, serum cholesterol, serum triglyceride, high-density lipoprotein, low-density lipoprotein, hemoglobin, and glycosylated hemoglobin were also assessed in experimental animals. The petroleum ether and ethanol extracts of C. fistula and the water-soluble fraction of ethanol extract were found to exhibit significant antihyperglycemic activity. The extracts, at the given doses, did not produce hypoglycemia in fasted normal rats, and the fraction exhibited weak hypoglycemic effect after 2 h of the treatment. Treatment of diabetic rats with ethanol extract and water-soluble fraction of this plant restored the elevated biochemical parameters significantly (P<0.05 to the normal level. No activity was found in the petroleum ether extract of the plant. Comparatively, the water-soluble fraction of ethanol extract was found to be more effective than the ethanol extract, and the activity was comparable with that of the standard, glibenclamide (5 mg/kg.

  15. Optimizing Arteriovenous Fistula Maturation

    OpenAIRE

    2009-01-01

    Autogenous arteriovenous fistulas are the preferred vascular access in patients undergoing hemodialysis. Increasing fistula prevalence depends on increasing fistula placement, improving the maturation of fistula that fail to mature and enhancing the long-term patency of mature fistula. Percutaneous methods for optimizing arteriovenous fistula maturation will be reviewed.

  16. Hypopharyngeal fistula-induced rupture of the carotid artery 23 months after irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Masuda, Masatsugu; Kawaura, Mitsuhiro [Kawasaki, Municipal Hospital, Kanagawa (Japan); Yoshida, Akio; Yoshihara, Shigemitsu

    2001-02-01

    We report a 63-year-old man who presented with massive bleeding 23 months after irradiation for glottic cancer. He had undergone bilateral functional neck dissection without laryngectomy after irradiation. Pain in the left submandible suggested the site of bleeding. We found a hypopharyngeal fistula that communicated with the carotid artery lumen. The necrotic portion of the artery was ligated and resected with adequate replacement of blood volume: 20 units of blood. Bleeding occurred again on the 47th post-operative day and he developed a pharyngocutaneous fistula. We performed a laryngectomy with a pectoralis major myocutaneous skin flap (PMMF) following full nutritional management. Traditional ligation of the carotid artery still has an important role in the management of carotid rupture with radiation necrosis. One should not hesitate to perform laryngectomies with PMMF to avoid the risk of re-rupture, and we emphasize the need to perform early aggressive surgery with adequate nutritional management. (author)

  17. Treatment of Perianal Fistulas in Poland

    Directory of Open Access Journals (Sweden)

    Dziki Łukasz

    2015-12-01

    Full Text Available A perianal fistula is a pathological canal covered by granulation tissue connecting the anal canal and perianal area epidermis. The above-mentioned problem is the reason for the patient to visit the surgeonproctologist. Unfortunately, the disease is characterized by a high recurrence rate, even despite proper management.

  18. FISTULOTOMY VERSUS FISTULECTOMY FOR TREATMENT OF FISTULA-IN-ANO

    Directory of Open Access Journals (Sweden)

    Ravi Kumar

    2016-06-01

    Full Text Available Fistula-in-ano is notorious for its frequent exacerbations, recurrences and its chronic condition. The anorectal abscess is an acute inflammatory process that often is the initial manifestation of the underlying anal fistula and is the chronic condition following inadequate drainage of the abscess. Around 90% of the cases occur due to infected anal glands. Incision and drainage of the abscess cavity will result in complete resolution of the infection in 50% of the patients, whereas in the rest an anal fistula will develop. Most patients with an overt fistula have an antecedent history of abscess that drained spontaneously or for which surgical drainage had been performed. There are different surgeries mentioned in literature. The ultimate goal of fistula surgery is to eradicate it without disturbing or minimally disturbing the anal sphincter mechanism. MATERIALS AND METHODS A total number of 300 patients diagnosed with low fistula-in-ano were included in this clinical study. These 300 patients presented to the general surgery OPD and were admitted under the Department of General Surgery in Vydehi Institute of Medical Sciences and Research Centre during the period of April 2012 to Jan 2016. The patients were not randomized for any imaging modality or surgical procedures. Detailed history including the past history of anorectal abscess and of previous fistula surgery was taken. The mode of presentation, other comorbid conditions like diabetes, the findings on clinical examination (Digital examination and proctoscopy were recorded in the case sheet for individual patients. Complete blood count, random blood sugar, HIV, HBsAg, sono-fistulogram were done. The discharge from the external opening was sent for culture and sensitivity studies. High anal fistulas and tuberculous fistulas were excluded from the study. RESULTS 150 patients were treated with fistulotomy and 150 patients were treated with fistulectomy. More number of males had fistula

  19. Efficacy of PPH combined with fistulectomy in treatment of severe hemorrhoids complicated with anal fistula%PPH 加肛瘘切除术治疗合并肛瘘的重度痔疮临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    刘冬良; 孙刚; 庄彬武; 马允; 王苏春; 顾汝军

    2014-01-01

    目的:探讨吻合器痔上黏膜环切术加肛瘘切除术治疗重度混合痔合并肛瘘的临床疗效。方法将60例混合痔合并肛瘘患者随机分成吻合器痔上黏膜环切术加肛瘘切除术组(观察组)和外剥内扎加肛瘘切除术组(对照组),每组30例。观察和比较2组手术时间、住院时间、术中出血量、术后出血、尿潴留、肛门坠胀及水肿、术后疼痛时间、术后控便能力下降、感染、术后复发等情况。结果观察组手术时间、术中出血量、术后出血、术后疼痛时间、术后控便能力下降、肛门坠胀及水肿、住院时间优于对照组,差异有统计学意义(P值均小于0.05);2组在尿潴留、感染、肛瘘复发等方面的差异均无统计学意义( P值均大于0.05)。结论 PPH加肛瘘切除术治疗重度痔疮合并单纯性肛瘘是安全可行的术式。%Objective To explore the efficacy of the procedure for prolapse and hemorrhoids ( PPH) combined with fistu-lectomy in treatment of severe hemorrhoids complicated with anal fistula .Methods 60 patients with severe hemorrhoids com-plicated with anal fistula admitted for surgical treatment were randomly divided into a PPH plus fistulectomy group ( investiga-tion group ) and a milligan-morgan plus fistulectomy group ( control group ) ,30 cases for each .The two groups were observed and compared in terms of operating time,hospitalization time,intraoperative blood loss,postoperative bleeding,urinary reten-tion,anus belly,postoperative pain time and the ability of controlling feces ,infection,postoperative recurrence ,and so on.Re-sults There were no significant differences between the 2 groups in urinary retention ,infection,and postoperative recurrence ( P>0.05 ) .The investigation group was superior to the control group in operating time , hospitalization time , intraoperative blood loss,postoperative bleeding,anus belly,postoperative pain time and the ability of

  20. Rastreamento e seguimento dos portadores das lesões anais induzidas pelo papilomavírus humano como prevenção do carcinoma anal Screening and follow-up of patients with anal HPV induced lesions for anal carcinoma prevention

    Directory of Open Access Journals (Sweden)

    Sidney Roberto Nadal

    2009-06-01

    Full Text Available O Papilomavírus humano (HPV é o agente sexualmente transmissível mais comum na região perianal. O vírus provoca lesões clínicas e subclínicas que podem evoluir para carcinoma anal. É descrito o aumento da incidência desse tipo de tumor naqueles que praticam sexo anal; nos portadores, de ambos os sexos, de lesões genitais HPV induzidas; nas pessoas com neoplasias intraepiteliais anais de alto grau, o precursor do carcinoma, com maior incidência nos infectados pelo vírus da imunodeficiência humana (HIV, e com outras causas de supressão imunológica. Outra característica das lesões HPV induzidas é a elevada incidência de recidivas. Daí, a importância do seguimento por longo prazo e da pesquisa de meios terapêuticos para reduzir essa ocorrência. A possibilidade da detecção das lesões precursoras indica que programas padronizados de rastreamento para a prevenção do câncer anal deveriam ser instituídos. Os esfregaços anais para citologia vêm sendo realizados, com eficácia semelhante a das coletas cervicais e a colposcopia anal tem sido indicada para biópsias dirigidas quando a citologia mostrou-se alterada, embora muitos recomendam-na, também, como método de rastreamento. Nesse artigo, descrevemos a padronização da coleta de material para citologia anal e o método de realização da colposcopia anal, bem como a periodicidade com que devem ser repetidos.The human papillomavirus is the most frequent sexually transmitted agent in anorectal area. This virus provokes clinical and sub-clinical lesions that can evolve to anal carcinoma. Its incidence is increasing among those who practice anal receptive sex; in both gender patients with genital HPV induced lesions; in those with high grade anal intra-epithelial neoplasia, anal carcinoma precursor, mainly among HIV infected persons or with other causes of immunodeficiency. Another HPV induced lesions characteristic is their elevated incidence of recurrences. Therefore

  1. 一次成型手术治疗马蹄型高位复杂性肛瘘103例临床观察%Surgical treatment of clinical observation of 76 cases of horseshoe-type high complex anal fistula with one forming

    Institute of Scientific and Technical Information of China (English)

    岳滨; 曾宪东

    2013-01-01

    Use of surgical treatment of 76 cases of a forming horseshoe-type high complex anal fistula,76 cases cured,the cure rate was 100%. Healing time is 27 ~ 50 days,an average of 35.1 days. Postoperative follow-up from three months to three years,no recurrence,no incontinence and anal displacement, no deformity and other complications anus,anus and functioning properly.%采用一次成型手术治疗103例马蹄型高位复杂性肛瘘,治愈76例,治愈率100%。治愈时间27~50天,平均35.1天。术后随访三个月至三年,暂无复发,并无肛门失禁、肛门移位、肛门畸形等后遗症,肛门功能正常。

  2. Biopsy Induced Arteriovenous Fistula and Venous Stenosis in a Renal Transplant

    Directory of Open Access Journals (Sweden)

    Sridhar R. Allam

    2015-01-01

    Full Text Available Renal transplant vein stenosis is a rare cause of allograft dysfunction. Percutaneous stenting appears to be safe and effective treatment for this condition. A 56-year-old Caucasian female with end stage renal disease received a deceased donor renal transplant. After transplant, her serum creatinine improved to a nadir of 1.2 mg/dL. During the third posttransplant month, her serum creatinine increased to 2.2 mg/dL. Renal transplant biopsy showed BK nephropathy. Mycophenolate was discontinued. Over the next 2 months, her serum creatinine crept up to 6.2 mg/dL. BK viremia improved from 36464 copies/mL to 15398 copies/mL. A renal transplant ultrasound showed lower pole arteriovenous fistula and abnormal waveforms in the renal vein. Carbon dioxide (CO2 angiography demonstrated severe stenosis of the transplant renal vein. Successful coil occlusion of fistula was performed along with angioplasty and deployment of stent in the renal transplant vein. Serum creatinine improved to 1.5 mg/dL after.

  3. The nursing experience of anal ifstula%肛瘘的护理体会

    Institute of Scientific and Technical Information of China (English)

    苑爱玲; 王奂生; 郑璇

    2014-01-01

    目的:探讨肛瘘手术病人的护理。方法对98例肛瘘手术患者的护理进行分析和总结。结果98例肛瘘患者均治愈,无一例复发。结论肛瘘病人手术治疗后,通过合理的治疗和护理,取得了满意的疗效。%Objective To explore anal fistula operation nursing.Methods The nursing of 98 cases of anal fistula operation were analyzed and summarized.Results All the 98 patients with anal fistula were cured, none recrudesce.Conclusion Anal fistula patients after operation treatment, with the reasonable treatment and nursing, we has obtained the satisfactory curative effect.

  4. Perilymph Fistula

    Science.gov (United States)

    ... to the head or in some cases a "whiplash" injury. Other common causes include ear trauma, objects perforating the eardrum, or “ear block” on descent of an airplane or SCUBA diving. Fistulas may also develop after rapid increases in intracranial pressure, such as may ...

  5. Ligation of the intersphincteric fistula tract in low transsphincteric fistulae : a new technique to avoid fistulotomy

    NARCIS (Netherlands)

    van Onkelen, R. S.; Gosselink, M. P.; Schouten, W. R.

    2013-01-01

    Aim To date fistulotomy is still the treatment of choice for patients with a transsphincteric fistula passing through the lower third of the external anal sphincter, because it is a simple, effective and safe procedure with a minimal risk of incontinence. However, data suggest that the risk of impai

  6. A anorectal fistula treatment with acellular extracellular matrix: A new technique

    Institute of Scientific and Technical Information of China (English)

    Wei-Liang Song; Zhen-Jun Wang; Yi Zheng; Xin-Qing Yang; Ya-Ping Peng

    2008-01-01

    AIM:To investigate a new technique of the anorectal fistula treatment with acellular extracellular matrix (AEM).METHODS: Thirty patients with anorectal fistula were treated with AEM.All fistula tracts and primary openings were identified using conventional fistula probe.All tracts were curetted with curet and irrigated with hydrogen peroxide and metronidazole.The AEM was pulled into the fistula tract from secondary to primary opening.The material was secured at the level of the primary opening.The excess AEM was trimmed at skin level at the secondary opening.RESULTS: All of the 30 patients had successful closure of their fistula after a 7-14 d follow-up.The healing rate of anal fistula in treatment group was 100%.The ache time,healing time and anal deformation of treatment group were obviously superior to traditional surgical methods.CONCLUSION: Using AEM anal fistula plug in treatment that causes the anorectal fistula is safe and successful in 100% of patients.It can reduce pain,shorten disease course and protect anal function.

  7. Chemotherapy-induced enterocutaneous fistula after perineal hernia repair using a biological mesh

    DEFF Research Database (Denmark)

    Eriksen, Mh; Bulut, O

    2014-01-01

    This is the first reported case of an enterocutaneous fistula as a late complication to reconstruction of the pelvic floor with a Permacol™ mesh after a perineal hernia. A 70-year-old man had a reconstruction of the pelvic floor with a biological mesh because of a perineal hernia after laparoscopic...... abdominoperineal resection. Nine months after the perineal hernia operation, the patient had multiple metastases in both lungs and liver. The patient underwent chemotherapy, including bevacizumab, irinotecan, calcium folinate, and fluorouracil. Six weeks into chemotherapy, the patient developed signs of sepsis...... from the distal ileum to perineum. A resection of the small bowel with primary anastomosis was performed. The postoperative course was complicated by fluid and electrolyte disturbances, but the patient was stabilized and finally discharged to a hospice for terminal care after 28 days of hospital stay...

  8. Coronary artery fistula

    Science.gov (United States)

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... A coronary artery fistula is often congenital, meaning that it is present at birth. It generally occurs when one of the coronary arteries ...

  9. Treatment of post-prostatectomy rectourethral fistula with fibrin sealant (Quixil™) injection: a novel application.

    Science.gov (United States)

    Verriello, V; Altomare, M; Masiello, G; Curatolo, C; Balacco, G; Altomare, D F

    2010-12-01

    Rectourethral fistulas in adults is a rare but potentially devastating postoperative condition requiring complex and demanding surgery. Fibrin glue treatment has been used with some success in anal and rectovaginal fistulas, and in the case we present here this indication has been extended to a postoperative rectourethral fistula following radical prostatectomy. For the first time, to our knowledge, a fibrin sealant (Quixil) was injected into the fistula tract, and a rectal mucosal flap was used to close the internal opening. The fistula healed in few weeks, and the patient is symptom free after 1 year of follow-up.

  10. Treatment of fistula-in-ano with fistula plug – A Review under special consideration of the technique

    Directory of Open Access Journals (Sweden)

    Ferdinand eKöckerling

    2015-10-01

    Full Text Available IntroducationIn a recent Cochrane review the authors concluded that there is an urgent need for well-powered, well-conducted randomized controlled trials comparing various modes of treatment of fistula-in-ano. Ten randomized controlled trials were available for analyses: There were no significant differences in recurrence rates or incontinuence rates in any of the studied comparisons. The following article reviews all studies available for treatment of fistula-in-ano with a fistula plug.Material and MethodsPubMed, Medline, Embase and the Cochrane medical database were searched up to December 2014. 47 articles were relevant for this review.ResultsHealing rates of 50 – 60 % can be expected for treatment of complex anal fistula with a fistula plug, with a plug-extrusion rate of 10 – 20 %. Such results can be achieved not only with plugs made of porcine intestinal submucosa, but also those made of other biological mesh materials, such as acellular dermal matrix. Important technical steps in the performance of a complex anal fistula plug repair need to be followed.SummaryTreatment of a complex fistula-in-ano with a fistula plug is an option with a success rate of 50 – 60 % with low complication rate. Further improvements in technique and better studies

  11. CURRENT OPTIONS IN TREATMENT OF FISTULA-IN-ANO

    Directory of Open Access Journals (Sweden)

    Mohanlal Khadia

    2016-08-01

    Full Text Available Fistula-in-ano has long been notorious for its tendency to recur after operation. Although surgery remains the main modality of treatment, still no clear recommendations are available and its treatment is still debatable. Treating anal fistula remains a challenging issue because of the anatomical location, the potential risks of septic complications and postoperative stool incontinence. Nowadays several sphincter sparing procedures are preferred, but they carry their own risk of recurrence and some degree of incontinence. So here we will discuss current procedures used in treatment of different types of fistula-in-ano.

  12. Anal acoustic reflectometry

    DEFF Research Database (Denmark)

    Mitchell, Peter J; Klarskov, Niels; Telford, Karen J;

    2011-01-01

    Anal acoustic reflectometry is a new technique of assessing anal sphincter function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, the opening and closing elastance, and hysteresis.......Anal acoustic reflectometry is a new technique of assessing anal sphincter function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, the opening and closing elastance, and hysteresis....

  13. An Atypical Etiology of Suprasphincteric Fistula: A Forgotten Surgical Material

    Directory of Open Access Journals (Sweden)

    Melih Paksoy

    2010-01-01

    Full Text Available While the majority of fistulas in ano result from infection of the anal crypts, complex, recurrent, and/or nonhealing fistulas should always raise the suspicion of a chronic underlying condition. In this paper, we present a 30-year-old male patient with a diagnosis of a complex suprasphincteric fistula caused by a surgical thread left behind after an orthopedic hip operation performed sixteen years ago. Partial fistulectomy, extraction of the foreign material, and debridement procedures were performed. Few cases of such complex fistulas in ano due to foreign materials have been described in the literature. After careful history-taking, meticulous physical examination under general anesthesia should be done in order to deal with this rare type of fistula.

  14. The effect of lateral internal sphincterotomy on resting anal sphincter pressures

    OpenAIRE

    Peker, Kemal; YILMAZ, İsmayil; DEMİRYILMAZ, İsmail; İNAL, Abdullah; Işik, Arda

    2014-01-01

    Anal fissures are one of the most common proctologic disorders. This study aimed to investigate alterations in anal sphincteric resting pressures after lateral internal sphincterotomy, which was performed for chronic anal fissure treatment. Materials and methods: Fifty-six (68.3%) male and 26 (31.7%) female patients were included in this study. Patients complicated with fistula-in-ano, abscess, cancer, inflammatory bowel disease, dermatitis, poor general condition, allergy to any of the stan...

  15. Endoanal ultrasound in perianal fistulae and abscesses.

    Science.gov (United States)

    Visscher, Arjan Paul; Felt-Bersma, Richelle J F

    2015-06-01

    Endoanal ultrasound is a technique that provides imaging of the anal sphincters and its surrounding structures as well as the pelvic floor. However, endoanal magnetic resonance imaging (MRI) is preferred by most physicians, although costs are higher and demand easily outgrows availability. Endoanal ultrasound is an accurate imaging modality delineating anatomy of both cryptoglandular as well as Crohn perianal fistula and abscess. Endoanal ultrasound is comparable with examination under anesthesia and equally sensitive as endoanal MRI in fistula detection. When fistula tracts or abscesses are located above the puborectal muscle, an additional endoanal MRI should be performed. Preoperative imaging is advocated in recurrent cryptoglandular fistula because a more complex pattern can be expected. Endoanal ultrasound can help avoid missing tracts during surgery, lowering the chance for the fistula to persist or recur. It can easily be performed in an outpatient setting and endosonographic skills are quickly incremented. Costs are low and endoanal ultrasound has the potential to improve outcome of patients with both cryptoglandular and fistulizing Crohn disease; therefore, it values more attention.

  16. Neuromyogenic properties of the internal anal sphincter: therapeutic rationale for anal fissures.

    Science.gov (United States)

    Bhardwaj, R; Vaizey, C J; Boulos, P B; Hoyle, C H

    2000-06-01

    Lateral sphincterotomy diminishes internal anal sphincter hypertonia and thereby reduces anal canal pressure. This improves anal mucosal blood flow and promotes the healing of anal fissures. However, sphincterotomy can be associated with long term disturbances of sphincter function. The optimal treatment for an anal fissure is to induce a temporary reduction of anal canal resting pressure to allow healing of the fissure without permanently disrupting normal sphincter function. Broader understanding of the intrinsic mechanisms controlling smooth muscle contraction has allowed pharmacological manipulation of anal sphincter tone. We performed an initial Medline literature search to identify all articles concerning "internal anal sphincter" and "anal fissures". This review is based on these articles and on additional publications obtained by manual cross referencing. Internal anal smooth muscle relaxation can be inhibited by stimulation of non-adrenergic non-cholinergic enteric neurones, parasympathetic muscarinic receptors, or sympathetic beta adrenoceptors, and by inhibition of calcium entry into the cell. Sphincter contraction depends on an increase in cytoplasmic calcium and is enhanced by sympathetic adrenergic stimulation. Currently, the most commonly used pharmacological agent in the treatment of anal fissures is topical glyceryl trinitrate, a nitric oxide donor. Alternative agents that exhibit a similar effect via membrane Ca2+ channels, muscarinic receptors, and alpha or beta adrenoceptors are also likely to have a therapeutic potential in treating anal fissures.

  17. Congenital tracheobiliary fistula.

    NARCIS (Netherlands)

    Croes, F.; Nieuwaal, N.H. van; Heijst, A.F.J. van; Enk, G.J. van

    2010-01-01

    Congenital tracheobiliary fistula is a rare malformation that can present with a variety of respiratory symptoms. We present a case of a newborn patient with a tracheobiliary fistula and severe respiratory insufficiency needing extracorporal membrane oxygenation to recover.

  18. Clinical observation on self-made cuyu-prescription’s detumescence and wound healing for post-operative damp-heat low anal fistula%自拟促愈汤对湿热下注型低位肛瘘术后止痛促愈作用

    Institute of Scientific and Technical Information of China (English)

    夏泽华; 张雅明; 沈菲菲

    2016-01-01

    Objective To observe the clinical efficacy of self-made cuyu-prescription’s detumescence and wound healing for post-operative damp-heat low anal fistula. Methods Ninty-six subjects with postoperative low anal fistula of downward flow of damp-heat pattern were randomized into treatment group and control group,with 48 subjects each group. The subjects in treatment group take“self-made cuyu-prescription”and subjects in control one take“bixie Shenshi prescription”with the course of 14 days. We observe the symptoms of pain、edema,exudates,wound area re-duced rate and heal time completely at the 1 th,5 th,9 th,14 th day after operation,and evaluate the clinical efficacy after treatment. Results Postoperative complication of pain in treatment group was less than control one at at the 5 th,9 th day(P﹤0. 05),one of edema,exudates,Amount of painkillers in treatment one was less than control one at 5 th,9 th,14 th day(P﹤0. 05)after operation. wound area reduced rate in treatment group at 5 th,9 th,14 th day was superior to control one. wound cure time of treatment one(24. 04 ± 2. 12 d)was superior to control one(28. 02 ± 2. 69d)(P﹤0. 05). The total efficacy in treatment one at 30 d,35 d was was superior to control one(P﹤0. 05). Conclusion Self-made cuyu-prescription can reduce the postoperative discomfort,promote patient ’s recovery and clinical effect is better.%目的:观察自拟利湿养阴促愈汤治疗湿热下注型低位肛瘘的临床疗效。方法将符合湿热下注型低位肛瘘诊断标准的96例低位肛瘘患者随机分为治疗组和对照组,各48例,治疗组煎服自拟促愈汤,对照组煎服萆薢渗湿汤,观察2组术后第1、5、9、14天创面疼痛、水肿、渗出、创面缩小率及愈合时间。结果治疗组术后第5、9天创面疼痛评价优于对照组,第5、9、14天服用止痛药少于对照组( P﹤0.05);治疗组术后第5、9、14天创面水肿和渗出评价优于对照组( P

  19. Ureteroarterial Fistula

    Directory of Open Access Journals (Sweden)

    D. H. Kim

    2009-01-01

    Full Text Available Ureteral-iliac artery fistula (UIAF is a rare life threatening cause of hematuria. The increasing frequency is attributed to increasing use of ureteral stents. A 68-year-old female presented with gross hematuria. She had prior low anterior resection for rectal cancer and a retained ureteral stent. CT abdomen and pelvis showed a large recurrent pelvic mass and a retained stent. The patient underwent cystoscopy which showed a normal bladder. Upon removal of the stent, brisk bleeding was noted coming from the ureteral orifice. Antegrade pyelogram was done which revealed a UIAF. Angiography was done and a covered stent was placed. Multiple treatment options are available. All must consider management of the arterial and ureteral side. The arterial side may be addressed by primary open repair, embolization with extra-anatomic vascular reconstruction, or endovascular stenting. The ureter can be managed with nephroureterectomy, ureteral reconstruction, placement of a nephrostomy tube, or ureteral stenting. Being minimally invasive, we believe that endovascular stenting should be the preferred therapeutic option as it also corrects the source of bleeding while preserving distal blood flow.

  20. Clinical Observation on Promotion Effect of Wound Healing Postoperative Anal Fistula by Retention Enema of ModifiedWu-Wei Xiao-DuDecoction%五味消毒饮加味保留灌肠促进肛瘘术后创面愈合的临床观察*

    Institute of Scientific and Technical Information of China (English)

    王燕; 麻清; 丁克; 梅笑玲; 周永坤

    2015-01-01

    目的:观察五味消毒饮加味保留灌肠在减轻肛瘘术后并发症的临床疗效并探讨其作用机理。方法:在符合纳入标准的病例中选择60例病人,随机分为治疗组和对照组,各30例。两组患者均诊断为低位单纯性肛瘘,并采用低位单纯性肛瘘切开术,术后换药时分别给予五味消毒饮加味或复方黄柏液各30 mL保留灌肠,每日1次。详细观察创面渗液、色泽、肛周瘙痒情况,并评分,比较腐肉脱落时间、新生上皮出现时间、创面缩小率、创面愈合时间及术后第21天临床总疗效。结果:两组比较,创面渗液情况在术后第7天、第14天治疗组优于对照组,第21天两组无显著差异;创面色泽情况在术后第7天、第14天治疗组优于对照组;肛周瘙痒情况在术后第7天、第14天、第21天治疗组优于对照组;创面腐肉脱落时间及新生上皮出现时间,治疗组均早于对照组;术后第7天、第14天、第21天两组创面缩小率无显著差异;术后第21天两组临床总疗效以及两组创面平均愈合时间均无明显差异。结论:五味消毒饮加味可缩短炎症反应阶段、减少创面渗出、减轻瘙痒症状,可使腐肉尽早脱,促进新生上皮组织生长。%This study was aimed to observe the promotion effect of wound healing retention enema for postoperative anal fistula by modifiedWu-Wei Xiao-Du(WWXD) decoction, in order to explore its mechanism. A total of 60 patients who met the inclusion criteria were randomly divided into the treatment group and control group, with 30 cases in each group. Patients in both groups were diagnosed as simple low anal fistula and treated with low anal fistula incision. The retention enema of 30 mL modified WWXD decoction or complexHuang-Bai fluid were given once a day for postoperative dressing changes. Detailed observations and scores were made on wound exudate, color, and itching around the anus. The

  1. MRI in perianal fistulae

    Directory of Open Access Journals (Sweden)

    Khera Pushpinder

    2010-01-01

    Full Text Available MRI has become the method of choice for evaluating perianal fistulae due to its ability to display the anatomy of the sphincter muscles orthogonally, with good contrast resolution. In this article we give an outline of the classification of perianal fistulae and present a pictorial assay of sphincter anatomy and the MRI findings in perianal fistulae. This study is based on a retrospective analysis of 43 patients with a clinical diagnosis of perianal fistula. MRI revealed a total of 44 fistulae in 35 patients; eight patients had only perianal sinuses.

  2. Aortoenteric Fistula Assocaited with Acute Myocardial Infarcation

    OpenAIRE

    Fingerote, Robert J.; Alan BR Thomson

    1990-01-01

    A 64-year-old male with a prior abdominal aortic graft for lower limb ischemia presented with melena and myocardial infarction. Despite aggressive investigation, an aortoenteric fistula was not diagnosed until after massive gastrointestinal hemorrhage. The patient's myocardial infarction may have heen precipitated by hypotension induced by hemorrhage through the aortoenteric fistula. Patients with prior abdominal aortic graft surgery presenting with gastrointestinal bleeding, abdominal pain o...

  3. Arteriovenous fistulas aggravate the hemodynamic effect of vein bypass stenoses

    DEFF Research Database (Denmark)

    Nielsen, T G; Djurhuus, C; Pedersen, Erik Morre;

    1996-01-01

    PURPOSE: The purpose of this study was to assess the impact of arteriovenous fistulas combined with varying degrees of stenosis on distal bypass hemodynamics and Doppler spectral parameters. METHODS: In an in vitro flow model bypass stenoses causing 30%, 55%, and 70% diameter reduction were induced...... 10 cm upstream of a fistula with low outflow resistance. Flow and intraluminal pressure were measured proximal to the stenosis and downstream of the fistula. The waveform parameters peak systolic velocity, end-diastolic velocity, pulsatility index, and pulse rise time were determined from midstream...... Doppler spectra obtained 10 cm downstream of the fistula. All measurements were carried out with open and clamped fistula. RESULTS: At 30% diameter reducing stenosis opening of the fistula induced a 12% systolic pressure drop across the stenosis but had no adverse effect on the Doppler waveform parameters...

  4. MR imaging evaluation of perianal fistulas: spectrum of imaging features.

    Science.gov (United States)

    de Miguel Criado, Jaime; del Salto, Laura García; Rivas, Patricia Fraga; del Hoyo, Luis Felipe Aguilera; Velasco, Leticia Gutiérrez; de las Vacas, M Isabel Díez Pérez; Marco Sanz, Ana G; Paradela, Marcos Manzano; Moreno, Eduardo Fraile

    2012-01-01

    Perianal fistulization is an inflammatory condition that affects the region around the anal canal, causing significant morbidity and often requiring repeated surgical treatments due to its high tendency to recur. To adopt the best surgical strategy and avoid recurrences, it is necessary to obtain precise radiologic information about the location of the fistulous track and the affected pelvic structures. Until recently, imaging techniques played a limited role in evaluation of perianal fistulas. However, magnetic resonance (MR) imaging now provides more precise information on the anatomy of the anal canal, the anal sphincter complex, and the relationships of the fistula to the pelvic floor structures and the plane of the levator ani muscle. MR imaging allows precise definition of the fistulous track and identification of secondary fistulas or abscesses. It provides accurate information for appropriate surgical treatment, decreasing the incidence of recurrence and allowing side effects such as fecal incontinence to be avoided. Radiologists should be familiar with the anatomic and pathologic findings of perianal fistulas and classify them using the St James's University Hospital MR imaging-based grading system.

  5. Transanal approach in repairing acquired rectovestibular fistula in females

    Institute of Scientific and Technical Information of China (English)

    Ya-Jun Chen; Ting-Chong Zhang; Jin-Zhe Zhang

    2004-01-01

    AIM: To summarize the operative experience of the transanal approach in acquired rectovestibular fistula repair.METHODS: Ninety-six cases of acquired rectovestibular fistula in young females were analyzed retrospectively. The etiology and operative procedure were discussed. Operative essential points were, the patient was laid in prone frog position, with the knees and hips flexed at 90°; the perineum was elevated; and the anal opening was exposed. Four stay sutures were applied to the margin of the fistular orifice in the anal opening at points 3, 6, 9 and 12 o'clock.A circular incision of mucosa surrounding the stay sutures was made. The fistula was dissected from its anal opening to its vestibular opening. The wound of vestibule was sutured,and the rectoanal wound was then sutured transversely.RESULTS: All the 96 patients recovered uneventfully from operation with a successful rate of 93.75%.CONCLUSION: The transanal approach in the treatment of the acquired rectovestibular fistula is a simple and feasible technique.

  6. STUDY OF ENTEROCUTANEOUS FISTULA

    Directory of Open Access Journals (Sweden)

    Arti

    2015-03-01

    Full Text Available BACKGROUND: A fistula is defined as abnormal communication between two epithelial surfaces . 1 Enterocutaneous fistula is defined as abnormal communication between hollow organ and skin. They are classified as congenital or acquired. We have excluded congenital and internal fistulas. We have also excluded esophageal, urinary, p ancreatic and biliary fistulas as their management is complex and differs significantly from enterocutaneous fistulas. AIM: 1. Study of aetiology, pathophysiology and management of enterocutaneous fistula. To evaluate previously laid principles of management of enterocutaneous fistula. 2. To assess the feasibility of early intervention safety and outcome as the conservative long term treatment appears to be cost prohibitive. 3. To study morbidity and mortality related to enterocutaneous fistula. MATERIAL AND METHODS: In all, 50 cases of enterocutaneous fistula were studied during a period from June 2012 to N ovember 2014 at a Government tertiary care C entre. Both, patients referred from other centres with post - operative fistulas and fistulas developed in this institute after surgeries or spontaneously were included in the study after fulfilling the inclusion and exclusion criteria. RESULT S : The maximum numbers of cases were between 39 - 48 years of age group. Spontaneous closure was achieved in 72.7% and surgical closure in 76.7% of the patients Vacuum assisted closure was achieved in 66.66% of the patients in whom VAC was used. Of the patients in whom octreotide was used closure was achieved in 66.66% of the patients. The association between serum albumin levels and fistula healing and between fistula output and mortality were statistically significant. Overall mortality in this study was 26% with 44.44% among referred cases and 15.625% among institutional cases.

  7. Pancreaticobronchial Fistula: A Complication of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Dorota Overbeck-Zubrzycka

    2011-01-01

    Full Text Available Context Pancreaticobronchial fistula is a rare complication of severe pancreatitis. Various diagnostic methods have been described previously. Case report The presentation, diagnostic methods, management and 5-year follow-up of a 40-year-old woman with severe gallstone induced pancreatitis complicated by a pancreaticobronchial fistula were reviewed. Diagnosis was made on the endotracheal intubation when amylase rich-fluid was drained via the tube and confirmed by CT scanning. Successful management was achieved by an open pancreatic necrosectomy, during which air bubbles were seen emerging from the pancreatic collection which supported the diagnosis of the fistula. Five-year follow-up did not reveal any complications. Conclusions Pancreaticobronchial fistulas have the potential to cause severe respiratory complications and mortality. Awareness of this condition is important in the treatment of complicated cases of pancreatitis.

  8. Evaluation of Hydrogen Peroxide-Enhanced Endoanal Ultrasound in Detecting the Internal Orifice and Type of Fistula-in-Ano

    Directory of Open Access Journals (Sweden)

    M.S Fazeli

    2009-12-01

    Full Text Available   "n"n Background/Objective: Accurate delineation of the fistula tract anatomy is necessary for surgical management of anal fistulas. Among different ways to do this, endoanal ultrasound (EUS is being increasingly used to evaluate patients with anal fistula. In this study we assessed the accuracy of hydrogen peroxide-enhanced EUS in detecting the internal orifice and the type of the fistula."n"n Patients and Methods: Patients with history and physical examination compatible with fistula-in-ano underwent an injection of 1 ml hydrogen peroxide into the external orifice and then EUS with a 7.5 MHz probe was carried out prior to surgery. The location of the internal orifice, presence of the abscess and the type of the fistula were examined and the results were compared with surgical findings. Results: Thirty-two patients entered the study. The fistula type could be identified in 29 patients (90.6%. Twenty-two (75.8% of these patients had trans-sphincteric  and seven (24.2% had inter-sphincteric fistulas. In 11 (34.3% patients, an abscess was found uring EUS. The fistula type was identified surgically in 29 patients, in which 26 were trans-sphincteric (89.8%, two were inter-sphincteric (6.8%, and one was extra-sphincteric (3.4%. There was a difference between detected sites of internal orifices during EUS and surgery (p value<0.001. Hydrogen peroxide-enhanced EUS had an appropriate agreement in detecting trans-sphincteric fistulas with surgery. Conclusion: Hydrogen peroxide-enhanced EUS is a suitable method for detecting the internal orifice of anal fistulas. It can be used for detecting trans-sphincteric fistulas, which are the most common type.     "n  

  9. Pancreaticopleural Fistula: Revisited

    Directory of Open Access Journals (Sweden)

    Norman Oneil Machado

    2012-01-01

    Full Text Available Pancreaticopleural fistula is a rare complication of acute and chronic pancreatitis. This usually presents with chest symptoms due to pleural effusion, pleural pseudocyst, or mediastinal pseudocyst. Diagnosis requires a high index of clinical suspicion in patients who develop alcohol-induced pancreatitis and present with pleural effusion which is recurrent or persistent. Analysis of pleural fluid for raised amylase will confirm the diagnosis and investigations like CT. Endoscopic retrograde cholangiopancreaticography (ECRP or magnetic resonance cholangiopancreaticography (MRCP may establish the fistulous communication between the pancreas and pleural cavity. The optimal treatment strategy has traditionally been medical management with exocrine suppression with octreotide and ERCP stenting of the fistulous pancreatic duct. Operative therapy considered in the event patient fails to respond to conservative management. There is, however, a lack of clarity regarding the management, and the literature is reviewed here to assess the present view on its pathogenesis, investigations, and management.

  10. Management of colovesical fistula.

    Science.gov (United States)

    Rao, P N; Knox, R; Barnard, R J; Schofield, P F

    1987-05-01

    The clinical presentation and management of 24 patients treated for colovesical fistula were reviewed. It is concluded that an aggressive investigative approach in the management of patients with suspected colovesical fistula is rewarding. Cystoscopy and barium enema appear to be the most useful investigative tools. Once found the fistulae should be managed surgically. Radical excision of the sigmoid colon with primary anastomosis is the treatment of choice and is accompanied by no mortality and a very low complication rate.

  11. Primary aortoduodenal fistula after radiotherapy. Report of a case

    Energy Technology Data Exchange (ETDEWEB)

    Oshima, Takeshi; Inoue, Hitoshi; Oshima, Akira; Minami, Tomohito; Matsumine, Takao [Tokyo Metropolitan Fuchu Hospital (Japan)

    1999-10-01

    Aortoduodenal fistula is a rare and life-threatening cause of gastrointestinal hemorrhage. The patient was a 44-year-old woman who repeated intermittent hematemesis and melena after hysterectomy, para-aortic lymph node dissection, and subsequent radiotherapy. Angiography revealed no bleeding point. Upper gastrointestinal endoscopy showed an ulcer at the third portion of the duodenum. Emergency laparotomy revealed an aortoduodenal fistula which was inferred to be caused by radiotherapy because no recurrence of malignancy was detected. After the fistula was closed, the patient repeated hematemesis and anal bleeding. She died of acute hemorrhagic shock, in spite of three operations including axillo-femoral bypass. We propose that radiation might have played a role in the pathogenesis of the aortoduodenal fistula in our case. The new case of primary aortoduodenal fistula following radiotherapy is added to four cases previously reported in the literature. Six cases in which the lesion of the duodenum could be demonstrated by endoscopy, have been reported in Japan. Aortoduodenal fistula should be considered as a probable diagnosis in patients presenting massive gastrointestinal hemorrhage after radiotherapy. Rapid surgical treatments are needed, and operative procedures to be considered include resection of the aorta with aortic stump closure and axillo-femoral bypass. (author)

  12. Usefulness of preoperative MRI in recurrent anorectal fistula

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hwa Jin; Cho, Jae Ho; Kim, Jae Woon; Park, Bok Hwan; Hwang, Mi Soo; Sim, Min Chul; Byun, Woo Mok [Yeungnam Univ. School of Medicine, Daegu (Korea, Republic of)

    1997-04-01

    To evaluate the usefulness of preoperative MRI in the patient with recurrent anorectal fistula. Fourteen patients with recurrent anorectal fistula underwent non-contrast MRI. In eight patients, T1-, T2- and proton-weighted images were taken in the axial, coronal and sagittal planes, and T1- and T2-weighted images taken in the axial and coronal planes were obtained from the other six. Fourteen cases of anorectal fistula and eight cases in which there was a combined abscess were detected. Preoperative MRI clearly showed the exact anatomical relationship with the anal sphincter, levator ani and surrounding soft tissue. In two cases in which there was fibrous scarring of the fistula tract, low signal intensities were seen on all MRI sequences. Preoperative information in the group in which only axial and coronal T1- and T2-weighted images were obtained was sufficient. Preoperative MRI in patients with recurrent anorectal fistula or suspected multiple fistulous tracts provide objective information concerning the anatomical location and extension of a fistula and combined abscess and could thus reduce the reoperation rate. An understanding of pathologic state through MRI signal intensity can help decide the most appropriate course of treatment.

  13. Transperineal ultrasonography for evaluation of the perianal fistula and abscess in pediatric Crohn disease: preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Jae Yeon [Dept. of Radiology, Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of); Yoon, Hye Kyung; Kim, Wee Kyung; Cho, Young Ah; Lee, Jin Seong; Yoon, Chong Hyun [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Lee, Yeoun Joo [Dept. of Pediatrics, Pusan National University Children' s Hospital, Yangsan (Korea, Republic of); Kim, Kyung Mo [Dept. of Pediatrics, Asan Medical Center Children' s Hospital, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2014-10-15

    To assess the feasibility and effectiveness of transperineal ultrasonography (TPUS) for the evaluation of perianal Crohn disease (PCD) in pediatric patients. Between September 2010 and August 2013, 64 TPUS examinations were performed in 43 patients (34 males and 9 females; mean age±standard deviation, 13.3±2.4 years; age range, 6 to 17 years) to evaluate PCD. The pain severity, location, and activity of perianal fistula, the presence of an abscess, and anal canal hyperemia were retrospectively evaluated. Spearman rank correlation analysis was performed to assess the relationship between the severity of the pain and the fistula activity, the presence of an abscess, and anal canal hyperemia. All examinations were successfully performed. Thirty-nine examinations (60.9%) were performed without any pain experienced by the patient, 19 examinations (29.7%) with mild pain, five examinations (7.8%) with moderate pain, and one examination (1.6%) with severe pain. The pain severity was correlated with the fistula activity (P<0.01). An anterior fistula location was more common than a posterior location. Active fistulas and abscesses were identified during 30 examinations (46.9%) and 12 examinations (18.8%), respectively. Anal canal hyperemia was identified in 31 examinations (48.4%). TPUS with a color Doppler study is useful for visualizing a perianal fistula or abscess and for assessing its inflammatory activity in pediatric Crohn patients.

  14. Historical Perspectives in the Care of Patients with Enterocutaneous Fistula

    Science.gov (United States)

    2010-09-01

    KEYWORDS: Enterocutaneous fistulas, historical review Objectives: On completion of this article the reader should understand the evolution of care of the...and proton-pump inhibitors can decrease fistula effluent, prevent stress- induced gastritis , and reduce electrolyte losses, but have not been

  15. Vesicouterine fistula: MRI diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, J.M.; Lomas, D.J. [Dept. of Radiology, Addenbrooke' s Hospital and University of Cambridge, Cambridge (United Kingdom); Lee, G.; Doble, A. [Dept. of Urology, Addenbrooke' s Hospital and University of Cambridge (United Kingdom); Sharma, S.D. [Dept. of Urology, Peterborough NHS Trust Hospital (United Kingdom)

    1999-07-01

    A case of vesicouterine fistula in a young woman following caesarean section is presented. The diagnosis was established successfully using heavily T2-weighted MRI which clearly demonstrated fluid within the fistula, obviating the need for conventional radiographic contrast examination. (orig.)

  16. Spontaneous aortocaval fistula.

    Directory of Open Access Journals (Sweden)

    Rajmohan B

    2002-07-01

    Full Text Available Spontaneous aortocaval fistula is rare, occurring only in 4% of all ruptured abdominal aortic aneurysms. The physical signs can be missed but the presence of low back pain, palpable abdominal aortic aneurysm, machinery abdominal murmur and high-output cardiac failure unresponsive to medical treatment should raise the suspicion. Pre-operative diagnosis is crucial, as adequate preparation has to be made for the massive bleeding expected at operation. Successful treatment depends on management of perioperative haemodynamics, control of bleeding from the fistula and prevention of deep vein thrombosis and pulmonary embolism. Surgical repair of an aortocaval fistula is now standardised--repair of the fistula from within the aneurysm (endoaneurysmorraphy followed by prosthetic graft replacement of the aneurysm. A case report of a 77-year-old woman, initially suspected to have unstable angina but subsequently diagnosed to have an aortocaval fistula and surgically treated successfully, is presented along with a review of literature.

  17. Dosimetric Predictors of Radiation-Induced Vaginal Stenosis After Pelvic Radiation Therapy for Rectal and Anal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Son, Christina H.; Law, Ethel [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Oh, Jung Hun; Apte, Aditya P. [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Yang, T. Jonathan [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Riedel, Elyn [Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Wu, Abraham J. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Deasy, Joseph O. [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Goodman, Karyn A., E-mail: goodmank@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2015-07-01

    Purpose: Although vaginal stenosis (VS) is a recognized toxicity in women who receive pelvic radiation therapy (RT), the relationship between RT dose and the volume and extent of toxicity has not been analyzed. We modeled this relationship to identify predictors of VS. Methods and Materials: We evaluated 54 women, aged 29 to 78 years, who underwent pelvic RT for rectal or anal cancer during 2008 to 2011 and were enrolled in a prospective study evaluating vaginal dilator use. Maximum dilator size was measured before RT (baseline) and 1 month and 12 months after RT. Dilator use was initiated at 1 month. The difference (D) in dilator size before and after RT was recorded. Those with D ≤−1 were classified as having VS (n=35); those with D ≥0 were classified as having no VS (n=19 at 1 month). Dose-volume parameters were extracted, and the generalized equivalent uniform dose (gEUD) was used to build a predictive model. Results: The mean vaginal doses were 50.0 Gy and 36.8 Gy for anal and rectal cancer patients, respectively. One month after RT, a gEUD model using a wide range of a values suggests that sparing of vaginal volume to a low dose may be important. When gEUD (a = −1) was <35 Gy and the mean vaginal dose was <43 Gy, severe VS was reduced (P=.02). A 1-year analysis suggests increasingly negative D values with increasing mean dose. However, patients with compliance <40% were more likely to have toxicity. Conclusions: Vaginal stenosis is influenced by multiple RT dose-volume characteristics. Mean dose and gEUD constraints together may reduce the risk of severe VS. Patients receiving higher mean vaginal doses should have greater compliance with dilator therapy to minimize risk of toxicity. Further validation with independent datasets is needed.

  18. [Management of complications in anal and transanal tumor surgery].

    Science.gov (United States)

    Sailer, M; Eisoldt, S; Möllmann, C

    2015-08-01

    Anal and transanal tumor operations are safe and are associated with a very low morbidity. Perianal and anal lesions as well as low rectal tumors can be excised by direct exposure using an anal retractor. For lesions situated in the middle or upper third of the rectum, special instrumentation, such as transanal endoscopic microsurgery (TEM) and transanal endoscopic operation (TEO) should be used to avoid unnecessary R1 resections. Fatal complications are extremely rare and most complications, such as urinary retention or temporary subfebrile temperatures, are minor. Suture line dehiscences are usually clinically unremarkable. Major complications comprise significant hemorrhage and opening of the peritoneal cavity. The latter must be recognized intraoperatively and can usually be managed by primary suturing. Infections, abscess formation, rectovaginal fistula, injury of the prostate or even urethra are extremely rare complications.

  19. CLINICAL STUDY OF FISTULA IN ANO

    Directory of Open Access Journals (Sweden)

    Raj

    2015-10-01

    Full Text Available Fistula in Ano is a benign treatable lesion of the rectum and the anal canal. Cryptoglandular infection accounts for about 90% of these cases. Majority of the infections are Acute and a minority contributed by chronic low grade infection hence pointing to varying etiologies. The pathogenesis has been attributed to the bursting open of an acute or inadequately treated Anorectal abscess into the peri anal skin. Diagnosis of the condition can be made easily with a good source of light, a proctoscope and a meticulous digital examination. Establishing a cure in this condition is difficult owing to two reasons. Firstly, the site of the infection makes the patient reluctant to subject themselves to examination. Secondly, a significant percent of these diseases persist or recur when appropriate surgery is not done or when the post op care is inadequate. Mostly it affects the young and the middle age group thus affecting productive man hours and quality of life. MATERIALS AND METHODS: All cases of clinically diagnosed Fistulae-in-ano above the age of 12 years, admitted in various surgical units in K.R. Hospital (attached to Government Medical College, Mysore during the study period December 1, 2008 to May 31, 2010. REUSLTS: Age Incidence, Sex Incidence, Socio Economic Status, Modes of Presentation, No. of External Openings, Situation of External Openings, Level of Fistulae, Type of surgical treatment, Associated with Fissure in Ano, Postoperative complication and Results were studied. CONCLUSION: Commonest age of presentation in our series is 30-40 years – 40%. Males are more commonly affected. Ratio Male: Female::3:1, Disease is more commonly seen in people with lower socio economic status group. 80% High socio economic class 20%. Discharging sinus is the commonest mode of presentation 72% and pain 72% and 84% pass history of perianal abscess was the presenting symptoms.

  20. Sensibilidade e especificidade da citologia anal com escova no diagnóstico das lesões clínicas provocadas pelo papilomavírus humano, comparando uma com duas coletas Sensibility and specifity of anal cytology with cytobrush in the HPV induced clinical lesions diagnosis, comparing one to two smears

    Directory of Open Access Journals (Sweden)

    Sidney Roberto Nadal

    2009-09-01

    Full Text Available OBJETIVO: comparar os resultados da coleta única com duas amostras para avaliar se haverá melhora da sensibilidade e especificidade do exame. MÉTODO: Foram 112 doentes masculinos HIV-positivo com doença anal pregressa ou atual pelo Papilomavírus humano (HPV. As lesões HPV induzidas foram observadas em 58 deles. Colhemos material do canal anal utilizando duas escovas (cytobrush Comparamos estatisticamente os resultados da primeira amostra com a soma das duas coletas. RESULTADOS: dos 58 doentes com lesões clínicas, a primeira amostra confirmou a doença em 40 (69% e a soma das duas coletas revelou lesões em 51 (88%. Os resultados mostraram sensibilidade de 69% com a primeira coleta e 88% quando somadas as duas amostras. Essa diferença foi confirmada estatisticamente. A especificidade foi menor para as duas amostras, porém sem diferença estatística. CONCLUSÃO: Concluímos que a sensibilidade foi maior e a especificidade foi semelhante quando os resultados foram obtidos com a somação das duas amostras da citologia anal.OBJECTIVE: The aim of this study was to know if two smears may have better sensibility and specificity than a unique smear for anal cytology. METHOD: There were 112 patients, males, HIV-positive, with current or previous anal HPV-induced lesions. Proctological examination revealed clinical disease in the anal canal of 58 of them. Smears were collect with cytobrushes. We compared results of the first smear to a sum of this with a second one. RESULTS: First smear was positive in 40 patients (69%, and with both smears this incidence reached 88%. Results showed sensibility of 69% to the unique smear, and 88% when both were summed. Statistics revealed significant difference. Specificity was higher when both smears were summed, but statistics showed no difference. CONCLUSION: We concluded sensibility of anal cytology was better and specificity was similar when results were obtained with a sum of two smears.

  1. Anal cancer; Cancer du canal anal

    Energy Technology Data Exchange (ETDEWEB)

    Fesneau, M.; Champeaux-Orange, E. [Service de radiotherapie, Centre regional universitaire de cancerologie Henry-S.-Kaplan CHU de Tours, Hopital Bretonneau, 37 - Tours (France); Champeaux-Orange, E. [Service d' oncologie-radiotherapie, Centre hospitalier regional d' Orleans, 45 - Orleans (France); Hennequin, C. [Service de cancerologie-radiotherapie, hopital Saint-Louis, 75 - Paris (France)

    2010-07-01

    Anal canal epidermoid carcinomas represent 1.2% of digestive cancers and 6% of ano-rectal cancers. For localized diseases, the treatment is based on radiotherapy with or without chemotherapy (5-FU and cisplatin or mitomycin), according to tumour and nodal extension. The recommended treatment dose is 45 Gy in the anal canal, the mesorectum, para-rectal lymph nodes, and inguinal lymph nodes. An additional dose of 15 to 20 Gy is delivered in the initial tumour for good responders. Salvage surgery is necessary in case of poor response. The organs at risk to be considered are bladder, femur heads, small intestine and vulva. The objective of this work is to summarize the epidemiological and radio-anatomic and prognostic characteristics of this tumour. The conformal radiotherapy technique is illustrated by a case report. (authors)

  2. Pancreaticopleural fistula : CT demonstration

    Energy Technology Data Exchange (ETDEWEB)

    Hahm, Jin Kyeung [Chuncheon Medical Center, ChunChon (Korea, Republic of)

    1997-03-01

    In patients with chronic pancreatitis, the pancreaticopleural fistula is known to cause recurrent exudative or hemorrhagic pleural effusions. These are often large in volume and require treatment, unlike the effusions in acute pancreatitis. Diagnosis can be made either by the finding of elevated pleural fluid amylase level or, using imaging studies, by the direct demonstration of the fistulous tract. We report two cases of pancreaticopleural fistula demonstrated by computed tomography.

  3. Pancreatic Pseudocyst Pleural Fistula in Gallstone Pancreatitis

    Directory of Open Access Journals (Sweden)

    Sala Abdalla

    2016-01-01

    Full Text Available Extra-abdominal complications of pancreatitis such as pancreaticopleural fistulae are rare. A pancreaticopleural fistula occurs when inflammation of the pancreas and pancreatic ductal disruption lead to leakage of secretions through a fistulous tract into the thorax. The underlying aetiology in the majority of cases is alcohol-induced chronic pancreatitis. The diagnosis is often delayed given that the majority of patients present with pulmonary symptoms and frequently have large, persistent pleural effusions. The diagnosis is confirmed through imaging and the detection of significantly elevated amylase levels in the pleural exudate. Treatment options include somatostatin analogues, thoracocentesis, endoscopic retrograde cholangiopancreatography (ERCP with pancreatic duct stenting, and surgery. The authors present a case of pancreatic pseudocyst pleural fistula in a woman with gallstone pancreatitis presenting with recurrent pneumonias and bilateral pleural effusions.

  4. HIV-associated anal cancer

    OpenAIRE

    Newsom-Davis, Thomas; Bower, Mark

    2010-01-01

    HIV-associated anal carcinoma, a non-AIDS-defining cancer, is a human papillomavirus-associated malignancy with a spectrum of preinvasive changes. The standardized incidence ratio for anal cancer in patients with HIV/AIDS is 20-50. Algorithms for anal cancer screening include anal cytology followed by high-resolution anoscopy for those with abnormal findings. Outpatient topical treatments for anal intraepithelial neoplasia include infrared coagulation therapy, trichloroacetic acid, and imiqui...

  5. Recurrent Fistula between Ileal Pouch and Vagina—Successful Treatment with a Gracilis Muscle Flap

    Directory of Open Access Journals (Sweden)

    Feride Aydin

    2009-01-01

    Full Text Available Fistulae between an ileal pouch and the vagina are an uncommon complication of ileal pouch-anal anastomosis following proctocolectomy and mucosectomy in patients with familial adenomatous polyposis coli. Several reports describe the successful use of muscle flaps to close recurrent pouch-vaginal-fistulae (PVF. However, series only contain small numbers and an optimal management has not yet been determined. We report the case of a 26-year old woman with a third recurrence of a PVF after proctocolectomy for treatment of familial adenomatous polyposis in October 2005. Because local approaches failed, definitive closure of the fistula was achieved by interposition of a gracilis muscle flap between the pouch-anal anastomosis and the vagina. The postoperative course was uneventful; the patient was discharged 7 days after surgery and remained free of recurrence and symptomatic complaints for 22 months now. The gracilis muscle flap proved to be an effective method in the treatment of recurrent PVF.

  6. Trans-Fistula Anorectoplasty (TFARP: Our Experience in the Management of Anorectovestibular Fistula in Neonates

    Directory of Open Access Journals (Sweden)

    Ashrarur Rahman Mitul

    2012-07-01

    Full Text Available Aim: The purpose of the study was to observe the outcome of trans-fistula anorectoplasty (TFARP in treating female neonates with anorectovestibular fistula (ARVF. Methods: A prospective study was carried out on female neonates with vestibular fistula, admitted into the surgical department of a tertiary level children hospital during the period from January 2009 to June 2011. TFARP without a covering colostomy was performed for definitive correction in the neonatal period in all. Data regarding demographics, clinical presentation, associated anomalies, preoperative findings, preoperative preparations, operative technique, difficulties faced during surgery, duration of surgery, postoperative course including complications, hospital stay, bowel habits and continence was prospectively compiled and analyzed. Anorectal function was measured by the modified Wingspread scoring as, “excellent”, “good”, “fair” and “poor”. Results: Thirty-nine neonates with vestibular fistula underwent single stage TFARP. Mean operation time was 81 minutes and mean hospital stay was 6 days. Three (7.7% patients suffered vaginal tear during separation from the rectal wall. Two patients (5.1% developed wound infection at neoanal site that resulted in anal stenosis. Eight (20.51% children in the series are more than 3 years of age and are continent; all have attained “excellent” fecal continence score. None had constipation or soiling. Other 31 (79.5% children less than 3 years of age have satisfactory anocutaneous reflex and anal grip on per rectal digital examination, though occasional soiling was observed in 4 patients. Conclusion: Primary repair of ARVF in female neonates by TFARP without dividing the perineum is a feasible procedure with good cosmetic appearance and good anal continence. Separation of the rectum from the posterior wall of vagina is the most delicate step of the operation, takes place under direct vision. It is very important to keep

  7. Fistula Vesiko Vaginalis

    Directory of Open Access Journals (Sweden)

    Luki Ertandri

    2016-08-01

    Full Text Available Abstrak          Latar belakang : fistula vesiko vaginalis merupakan bagian dari fistula vesiko urogenital merupakansuatu keadaan ditandai fistel antara kandung kemih dengan vagina yang menyebabkan rembesan urin keluar melalui vagina.           Kasus : wanita P3A0H3, 44 tahun, datang dengan keluhan terasa rembesan buang air kecil dari kemaluan sejak 3 bulan yang lalu. Keluhan muncul 7 hari setelah menajalani operasi histerektomi 3 bulan yang lalu. Histerektomi dilakukan atas indikasi mioma uteri dilakukan di Rumah Sakit Swasta. Tanda vital dalam batas normal. Pada pemeriksaan inspekulo tampak cairan urin menumpuk di fornix posterior. Dilakukan prosedur tes methylene blue didapatkan hasil positif di puncak vagina anterior 1 fistel dengan ukuran 1-1,5 cm. Pada pasien dilakukan fistulorraphy vesikovagina dengan teknik repair latzko dalam spinal anasthesi.           Pembahasan : Kasus fistula vesiko vaginalis biasa muncul di negara berkembang. Diantara faktor predisposisi adalah disebabkan operasi histerektomi, selain itu trauma persalinan dan komplikasi operasi daerah pelvik. Pemeriksaan Fisik dan pemeriksaan tambahan secara konvensional atau minimal invasif seperti sistoskopi, sistografi menggunakan zat kontras bisa membantu menegakan diagnosa, menentukan lokasi, ukuran dan jumlah fistel. Pembedahan adalah terapi andalan untuk fistula urogenital melalui transvagina atau trans abdomen. Pendekatan terapi tergantung ilmu, pengalaman dan kolaborasi dengan ahli lain bila dibutuhkan.Kata kunci: fistula vesiko vaginalis, histerektomi, latzkoAbstractBackground : Vesica vagina fistula is a part of urogenital fistula wich condition that present fistula between bladder and vagina and make urine mold through vagina.Case Report: Woman P3A0H3, 44 years old, admitted with complaining mold of urine from vagina since three months ago after seven days having surgery procedure. Complaint appeared seven days after histerctomi procedure. The

  8. Obstetric anal sphincter injuries

    Directory of Open Access Journals (Sweden)

    Remon Keriakos

    2015-10-01

    Full Text Available Obstetric anal sphincter injuries can be associated with significant short and long term consequences causing devastating impacts on the quality of lives of young, otherwise healthy women. The major consequence is anal incontinence which may be short or long term and vary in severity. The other consequences include pain, infection, dyspareunia and sexual dysfunction. This may in turn result in considerable economic burden to health care providers and patients. It also has an implication on future deliveries. Although it can never be eliminated, it can be reduced by improving practice, training and provision of high quality multidisciplinary care in order to reduce long-term morbidity. Obstetric anal sphincter injuries are also a source of litigation which can be distressing to both patients and clinicians. The aim of this review article is to explore the available evidence on epidemiology, strategies for preventions, prognosis and also how to deal with governance issues.

  9. Obstetric anal sphincter injuries

    Institute of Scientific and Technical Information of China (English)

    Remon Keriakos; Deepa Gopinath

    2015-01-01

    Obstetric anal sphincter injuries can be associated with significant short and long term consequences causing devastating impacts on the quality of lives of young, otherwise healthy women. The major consequence is anal incontinence which may be short or long term and vary in severity. The other consequences include pain, infection, dyspareunia and sexual dysfunction. This may in turn result in considerable economic burden to health care providers and patients. It also has an implication on future deliveries. Although it can never be eliminated, it can be reduced by improving practice, training and provision of high quality multidisciplinary care in order to reduce long-term morbidity. Obstetric anal sphincter injuries are also a source of litigation which can be distressing to both patients and clinicians. The aim of this review article is to explore the available evidence on epidemiology, strategies for preventions, prognosis and also how to deal with governance issues.

  10. [Tuberculous prostato-rectal fistula].

    Science.gov (United States)

    Rabii, Redouane; Fekak, Hamid; el Manni, Ahmed; Joual, Abdenbi; Benjelloun, Saad; el Mrini, Mohammed

    2002-09-01

    In a 60-year-old man admitted for right epididymo-orchitis with scrotal fistula and urine leak via the rectum, the diagnosis of tuberculosis was based on histological examination of a tissue sample of the scrotal fistula. The fistula was successfully treated with tuberculostatic drugs and cystostomy.

  11. Congenital parotid fistula

    Directory of Open Access Journals (Sweden)

    Shiggaon Natasha

    2014-01-01

    Full Text Available Parotid fistula is a cause of great distress and embarrassment to the patient. Parotid fistula is most commonly a post-traumatic situation. Congenital parotid salivary fistulas are unusual entities that can arise from accessory parotid glands or even more infrequently, from normal parotid glands through an aberrant Stensen′s duct. The treatment of fistulous tract is usually surgical and can be successfully excised after making a skin incision along the skin tension line around the fistula opening. This report describes a case of right accessory parotid gland fistula of a 4-year-old boy with discharge of pus from right cheek. Computed tomography (CT fistulography and CT sialography demonstrated fistulous tract arising from accessory parotid gland. Both CT fistulography and CT sialography are very helpful in the diagnosis and surgical planning. In this case, superficial parotidectomy is the treatment of choice. A detailed history, clinical and functional examination, proper salivary gland investigations facilitates in correct diagnosis followed by immediate surgical intervention helps us to restore physical, psychological health of the child patient.

  12. Fistulas complicating diverticulitis.

    Science.gov (United States)

    Vasilevsky, C A; Belliveau, P; Trudel, J L; Stein, B L; Gordon, P H

    1998-01-01

    This study was undertaken to assess the appropriate management of patients with diverticulitis complicated by fistula formation. A retrospective chart review was conducted on patients with symptoms of a fistula who presented between 1975 to 1995. There were 42 patients (32 women, 76%; 10 men, 24%) who ranged in age from 46 to 89 years (mean 69.8 +/- 9.8). Six patients had multiple fistulas. The types of fistulas included colovesical (48%), colovaginal (44%), colocutaneous (4%), colotubal (2%), and coloenteric (2%). Operative procedures consisted of resection and primary anastomosis in 38 patients and a Hartmann's operation in one. Three patients were managed conservatively with antibiotics (two due to poor performance status, the third due to resolution of symptoms). There were no operative deaths. The postoperative course was uncomplicated in 69%, while 12 patients (31%) experienced 19 complications (40%). These consisted of urinary tract infection (9.5%), atelectasis (7.1%), prolonged ileus (4.8%), arrhythmias (4.8%) and renal failure, myocardial infarction, pseudomembranous colitis, peroneal nerve palsy, unexplained fever, pulmonary edema (2.4% each). There were no anastomotic leaks and no deaths. Hospital stay ranged from 6 to 31 days (mean 12.3 +/- 7.6). Fistulas due to diverticulitis were safely managed by resection and primary anastomosis without mortality and with acceptable morbidity in this series. Patients deemed to be poor operative risks can be managed with a course of nonoperative treatment.

  13. MRI for the detection of anorectal fistulas; MRT in der Diagnostik anorektaler Fisteln

    Energy Technology Data Exchange (ETDEWEB)

    Schaefer, A.O.; Baumann, T.; Langer, M. [Abt. Roentgendiagnostik, Universitaetsklinikum Freiburg (Germany)

    2006-11-15

    MRI is accepted as one of the major diagnostic tools for the detection of anorectal fistulas and abscesses. Noninvasiveness and high accuracy are advantageous hallmarks of this technique. In general, the purpose of imaging anal fistulas is to reduce the risk of recurrence, incontinence and non-healing. To achieve these goals, the applied method must provide the proctologist with detailed information. In this context, MRI acts as a guide for surgeons to accurately plan fistula operations. Another aspect is the follow-up of conservatively treated patients with fistulizing Crohn's disease. In 2000, subtraction MR fistulography was introduced as new imaging technique. This review provides an overview of the entire spectrum of diagnostic modalities for anorectal fistulas with emphasis on subtraction MR fistulography. (orig.)

  14. Laparoscopic treatment of genitourinary fistulae.

    Science.gov (United States)

    Garza Cortés, Roberto; Clavijo, Rafael; Sotelo, Rene

    2012-09-01

    We present the laparoscopic management of genitourinary fistulae, mainly five types of fistulae, vesicovaginal, ureterovaginal, vesicouterine, rectourethral and rectovesical fistula. Vesicovaginal fistula (VVF) is mostly secondary to urogynecologic procedures in developed countries, abdominal hysterectomy being the main cause of this condition; they represent 84.9% of the genitourinary fistulae (1).Management has been described for this type of fistula, where low success rate (7-12%) has been reported. Ureterovaginal fistulas may occur following pelvic surgery, particularly gynecological procedures, or as a result of vaginal foreign bodies or stone fragments after shock wave lithotripsy, patients typically present with global and persistent urine leakage through the vagina, this causes patient discomfort, distress, and typically protection is used to stay dry, the initial management is often conservative but typically fails. Vesicouterine fistula is a rare condition that only occurs in 1 to 4% of genitourinary fistulas, the primary cause is low segment cesareansection, and clinically presents in three different forms, which will be described. Treatment of this type of fistulae has been conservative,with hormone therapy and surgery, depending on the presenting symptoms. Recto-urinary (rectovesical and rectourethral) fistulae (RUF) are uncommon and can be difficult to manage clinically. Although they may develop in patients with inflammatory bowel disease and perirectal abscesses, rectourethral fistula frequently result as an iatrogenic complication of extirpative or ablative prostate procedures. Rectovesical fistula usually develops following radical prostatectomy, and occurs along the vesicourethral anastomotic line or along the suture line of a posterior "racquet-handle" closure of the bladder. Conservative management consisting of urinary diversion, broad-spectrum antibiotics and parenteral nutrition is often initially attempted but these measures often fail

  15. Stable gastric pentadecapeptide BPC 157 heals rat colovesical fistula.

    Science.gov (United States)

    Grgic, Tihomir; Grgic, Dora; Drmic, Domagoj; Sever, Anita Zenko; Petrovic, Igor; Sucic, Mario; Kokot, Antonio; Klicek, Robert; Sever, Marko; Seiwerth, Sven; Sikiric, Predrag

    2016-06-05

    To establish the effects of BPC 157 on the healing of rat colovesical fistulas, Wistar Albino male rats were randomly assigned to different groups. BPC 157, a stable gastric pentadecapeptide, has been used in clinical applications-specifically, in ulcerative colitis-and was successful in treating both external and internal fistulas. BPC 157 was provided daily, perorally, in drinking water (10µg/kg, 12ml/rat/day) until sacrifice or, alternatively, 10µg/kg or 10ng/kg intraperitoneally, with the first application at 30min after surgery and the last at 24h before sacrifice. Controls simultaneously received an equivolume of saline (5.0ml/kg ip) or water only (12ml/rat/day). Assessment (i.e., colon and vesical defects, fistula leaking, fecaluria and defecation through the fistula, adhesions and intestinal obstruction as healing processes) took place on days 7, 14 and 28. Control colovesical fistulas regularly exhibited poor healing, with both of the defects persisting; continuous fistula leakage; fecaluria and defecation through the fistula; advanced adhesion formation; and intestinal obstruction. By contrast, BPC 157 given perorally or intraperitoneally and in µg- and ng-regimens rapidly improved the whole presentation, with both colon and vesical defects simultaneously ameliorated and eventually healed. The maximal instilled volume was continuously raised until it reached the values of healthy rats, there were no signs of fecaluria and no defecation through the fistula, there was counteraction of advanced adhesion formation or there was an intestinal obstruction. In conclusion, BPC 157 effects appear to be suited to inducing full healing of colocutaneous fistulas in rats.

  16. Differential radiodiagnosis of draining pararectal cysts and rectal fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Mushnikova, V.N.; Savvateeva, N.Yu.; Arablinskij, V.M.

    Proceeding from an analysis of multimodality examination and treatment of patients with difficulties in differential diagnosis, it has been established that proctography and fistulography play the most important role in radiodiagnosis. The presence of a multichamber cavity with clear even contours at the level of the medium- or lower ampullar region of the rectum is characteristic of draining pararectal cysts. The fustulous passage is single and unramified. Usually there is no connection between the cavity and fistula with the rectum. In rectal fistulas as a result of chronic periproctites the cavity is single, of uneven shape with unclear irregular contours at the level of the anal canal or lower ampullar region of the rectum. The fustulous passage is ramified, frequently connected with the rectal lumen.

  17. Management of an extrasphincteric fistula in an HIV-positive patient by using fibrin glue: a case report with tips and tricks

    Directory of Open Access Journals (Sweden)

    Sapalidis Konstantinos

    2010-02-01

    Full Text Available Abstract Background Individuals with impaired immunity are at higher risk of perianal diseases. Concerning complex anal fistulas impaired healing and complication rates are also higher. Definitive treatment of a fistula aims controlling the purulent discharge and prevents its recurrence. It depends mainly on the trajectory of the fistula and the underlying disease. We present a case of a HIV-positive patient with a complex extrasphincteric anal fistula who was treated successfully with fibrin glue application. We further, discuss tips and tricks when applying fibrin glue as plugging material in complex anal fistulas. Case presentation A sixty-one-year-old HIV-positive male referred to us for warts and extrasphincteric fistula. Because of the patients' immunological status, we opted against surgery and recommended fibrin glue plugging. The patient was discharged the same day. A follow-up examination was performed 5 days after the initial fibrin glue application showing that the fistula canal was obstructed. Three months and a year post-intervention the fistula tract remains closed. Conclusion The best treatment for a disease gives at least the same result with the other treatments with minimised risk for the life of the patient and minimal application effort. Conservative closure of fistula with fibrin plugging is simple, safe and with less morbidity than surgery. Our patient was successfully treated without endangering his life despite his precarious medical state. Not everybody believes in the effectiveness of fibrin glue application, however we consider this solution in cases of complex fistulas at least as primary procedure in special populations such as the immunosupressed.

  18. Anterior sagittal anorectoplasty: An alternative to posterior approach in management of congenital vestibular fistula

    Directory of Open Access Journals (Sweden)

    Man Mohan Harjai

    2013-01-01

    Full Text Available Background: Better exposure, possibility of extension if needed and precise placement of the anal canal within the external sphincter complex have made the posterior and anterior sagittal approaches more popular and established for the correction of anovestibular fistula. The mini posterior sagittal anorectoplasty (PSARP was the procedure of choice for female ARM at our center till date. As an alternative surgical option, we performed anterior sagittal anorectoplasty (ASARP in 15 cases of anovestibular fistula and compared them with 12 cases of vestibular fistula operated by PSARP technique. Patients and Methods: Fifteen female infants with vestibular fistula who had anterior sagittal anorectoplasty (ASARP procedure were reviewed. The procedure and its outcome were evaluated. Results : The manoeuvering during anesthesia and operative access were quite easier in ASARP compared to PSARP. Delineation of plane in ASARP between rectum and vagina was easier and clearer in comparison to PSARP. Rent occurred in the posterior vaginal wall in three cases of ASARP and two cases of PSARP. There were two cases of wound infection in each group. Three cases of PSARP group developed anal stenosis and constipation while one in the ASARP group developed constipation. Conclusion : Anesthesia and access in ASARP makes it an easier alternative option to PSARP in the management of anovestibular fistula in girls.

  19. Anal squamous intraepithelial neoplasia.

    Science.gov (United States)

    Bejarano, Pablo A; Boutros, Marylise; Berho, Mariana

    2013-12-01

    Diagnosis, follow up, and treatment of anal intraepithelial neoplasia are complex and not standardized. This may be partly caused by poor communication of biopsy and cytology findings between pathologists and clinicians as a result of a disparate and confusing terminology used to classify these lesions. This article focuses on general aspects of epidemiology and on clarifying the current terminology of intraepithelial squamous neoplasia, its relationship with human papilloma virus infection, and the current methods that exist to diagnose and treat this condition.

  20. Necrotizing fasciitis caused by a primary appendicocutaneous fistula.

    Science.gov (United States)

    Takeda, Makoto; Higashi, Yukihiro; Shoji, Tuyoshi; Hiraide, Takanori; Maruo, Hirotoshi

    2012-08-01

    We report a case of necrotizing fasciitis in the loin of a 76-year old man with several coexisting or past health issues, including diabetes mellitus, hypertension, alcohol-related liver cirrhosis, gastrectomy for gastric cancer, subarachnoid hemorrhage, normal pressure hydrocephalus, and cerebral infarction. Incision of the necrotizing fasciitis was successful, but it revealed an appendicocutaneous fistula; thus, we performed appendectomy and fistulectomy. We think that the necrotizing fasciitis was caused by appendicitis perforation involving the retroperitoneum, inducing the formation of an appendicocutaneous fistula. Necrotizing fasciitis and appendicocutaneous fistulae are rare complications of appendicitis. Moreover, to our knowledge, this is the first report of fluoroscopic examination demonstrating that a primary appendicocutaneous fistula had caused necrotizing fasciitis. Our search of the literature found 12 cases of necrotizing fasciitis caused by preoperative appendicitis. We discuss the characteristics and findings of these cases.

  1. [Laparoscopic operation for colovesical fistula].

    Science.gov (United States)

    Tvedskov, Tove H Filtenborg; Ovesen, Henrik; Seiersen, Michael

    2008-01-14

    Since 2005 the surgical department of Roskilde County Hospital has treated selected patients with colovesical fistulas laparoscopically. We describe two patients with symptoms of pneumaturia and urinary tract infections. CT scanning, cystoscopy and sigmoideoscopy showed colovesical fistula and laparoscopic operation was performed. The operating times were 280 and 285 minutes and the length of their hospital stays was four and three days without complications. We suggest that laparoscopic operation for colovesical fistula can be a good alternative to open operation on selected patients.

  2. Surgery for fistula-in-ano in a specialist colorectal unit: a critical appraisal

    Directory of Open Access Journals (Sweden)

    Sileri Pierpaolo

    2011-11-01

    Full Text Available Abstract Background Several techniques have been described for the management of fistula-in-ano, but all carry their own risks of recurrence and incontinence. We conducted a prospective study to assess type of presentation, treatment strategy and outcome over a 5-year period. Methods Between 1st January 2005 and 31st March 2011 247 patients presenting with anal fistulas were treated at the University Hospital Tor Vergata and were included in the present prospective study. Mean age was 47 years (range 16-76 years; minimum follow-up period was 6 months (mean 40, range 6-74 months. Patients were treated using 4 operative approaches: fistulotomy, fistulectomy, seton placement and rectal advancement flap. Data analyzed included: age, gender, type of fistula, operative intervention, healing rate, postoperative complications, reinterventions and recurrence. Results Etiologies of fistulas were cryptoglandular (n = 218, Crohn's disease (n = 26 and Ulcerative Colitis (n = 3. Fistulae were classified as simple -intersphincteric 57 (23%, low transphincteric 28 (11% and complex -high transphicteric 122 (49%, suprasphincteric 2 (0.8%, extrasphinteric 2 (0.8%, recto-vaginal 7 (2.8% Crohn 26 (10% and UC 3 (1.2%. The most common surgical procedure was the placement of seton (62%, usually applied in case of complex fistulae and Crohn's patients. Eighty-five patients (34% underwent fistulotomy, mainly for intersphincteric and mid/low transphincteric tracts. Crohn's patients were submitted to placement of one or more loose setons. The main treatment successfully eradicated the primary fistula tract in 151/247 patients (61%. Three cases of major incontinence (1.3% were detected during the follow-up period; Furthermore, three patients complained minor incontinence that was successfully treated by biofeedback and permacol injection into the internal anal sphincter. Conclusions This prospective audit demonstrates an high proportion of complex anal fistulae treated by

  3. MRI IN ISOLATED TRAN S - SPHINCTERIC FISTULA IN ANO OPENING NEAR SCROTUM - A VERY RARE ENTITY: 2 CASE REPORTS

    Directory of Open Access Journals (Sweden)

    Bhimarao

    2015-04-01

    Full Text Available Fistula in ano is an inflammatory condition affecting perianal re gion and adjacent structures. It is a cause of significant morbidity, requiring repeated surgical treatments due to its high recurrence rate. Most perianal fistulous disease have external openings located within 2.5 cm of the anal verge. It is rare for an anal fistula to involve the scrotum. Such involvement can occur frequently in patients with inflammatory bowel disease, especially Crohn’s disease and rarely in ulcerative colitis. Isolated involvement of scrotal region is quite rare without concomitant inflammatory bowel disease. This has been rarely reported in the literature. We present 2 isolated cases of trans sphincteric fistula in ano with external opening in the vicinity of scrotum. Both our cases did not reveal any signs of inflammatory bowel disease.

  4. Secondary aortoduodenal fistula

    Institute of Scientific and Technical Information of China (English)

    Girolamo Geraci; Franco Pisello; Francesco Li Volsi; Tiziana Facella; Lina Platia; Giuseppe Modica; Carmelo Sciumè

    2008-01-01

    Aorto-duodenal fistulae (ADF) are the most frequent aorto-enteric fistulae (80%), presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication (0.3%-2%) of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.

  5. Anal anatomy and normal histology.

    Science.gov (United States)

    Pandey, Priti

    2012-12-01

    The focus of this article is the anatomy and histology of the anal canal, and its clinical relevance to anal cancers. The article also highlights the recent histological and anatomical changes to the traditional terminology of the anal canal. The terminology has been adopted by the American Joint Committee on Cancer, separating the anal region into the anal canal, the perianal region and the skin. This paper describes the gross anatomy of the anal canal, along with its associated blood supply, venous and lymphatic drainage, and nerve supply. The new terminology referred to in this article may assist clinicians and health care providers to identify lesions more precisely through naked eye observation and without the need for instrumentation. Knowledge of the regional anatomy of the anus will also assist in management decisions.

  6. Pathophysiology of fistula formation in Crohn’s disease

    Institute of Scientific and Technical Information of China (English)

    Michael; Scharl; Gerhard; Rogler

    2014-01-01

    Fistulae represent an important complication in patient suffering from Crohn’s disease(CD). Cumulative incidence of fistula formation in CD patients is 17%-50% and about one third of patients suffer from recurring fistulae formation. Medical treatment options often fail and also surgery frequently is not successful. Available data indicate that CD-associated fistulae originate from an epithelial defect that may be caused by ongoing inflammation. Having undergone epithelial to mesenchymal transition(EMT), intestinal epithelial cells(IEC) penetrate into deeper layers of the mucosa and the gut wall causing localized tissue damage formation of a tube like structure and finally a connection to other organs or the body surface. EMT of IEC may be initially aimed toimprove wound repair mechanisms since "conventional" wound healing mechanisms, such as migration of fibroblasts, are impaired in CD patients. EMT also enhances activation of matrix remodelling enzymes such as matrix metalloproteinase(MMP)-3 and MMP-9 causing further tissue damage and inflammation. Finally, soluble mediators like TNF and interleukin-13 further induce their own expression in an autocrine manner and enhance expression of molecules associated with cell invasiveness aggravating the process. Additionally, pathogen-associated molecular patterns also seem to play a role for induction of EMT and fistula development. Though current knowledge suggests a number of therapeutic options, new and more effective therapeutic approaches are urgently needed for patients suffering from CD-associated fistulae. A better understanding of the pathophysiology of fistula formation, however, is a prerequisite for the development of more efficacious medical anti-fistula treatments.

  7. Congenital bronchoesophageal fistula in adults

    Institute of Scientific and Technical Information of China (English)

    Bao-Shi Zhang; Nai-Kang Zhou; Chang-Hai Yu

    2011-01-01

    AIM: To study the clinical characteristics, diagnosis and surgical treatment of congenital bronchoesophageal fistulae in adults. METHODS: Eleven adult cases of congenital bronchoesophageal fistula diagnosed and treated in our hospital between May 1990 and August 2010 were reviewed. Its clinical presentations, diagnostic methods, anatomic type, treatment, and follow-up were recorded. RESULTS: Of the chief clinical presentations, nonspecific cough and sputum were found in 10 (90.9%), recurrent bouts of cough after drinking liquid food in 6 (54.6%), hemoptysis in 6 (54.6%), low fever in 4 (36.4%), and chest pain in 3 (27.3%) of the 11 cases, respectively. The duration of symptoms before diagnosis ranged 5-36.5 years. The diagnosis of congenital bronchoesophageal fistulae was established in 9 patients by barium esophagography, in 1 patient by esophagoscopy and in 1 patient by bronchoscopy, respectively. The congenital bronchoesophageal fistulae communicated with a segmental bronchus, a main bronchus, and an intermediate bronchus in 8, 2 and 1 patients, respectively. The treatment of congenital bronchoesophageal fistulae involved excision of the fistula in 10 patients or division and suturing in 1 patient. The associated lung lesion was removed in all patients. No long-term sequelae were found during the postoperative follow-up except in 1 patient with bronchial fistula who accepted reoperation before recovery. CONCLUSION: Congenital bronchoesophageal fistula is rare in adults. Its most useful diagnostic method is esophagography. It must be treated surgically as soon as the diagnosis is established.

  8. Hypertrophied anal papillae and fibrous anal polyps, should they be removed during anal fissure surgery?

    Institute of Scientific and Technical Information of China (English)

    Pravin J. Gupta

    2004-01-01

    AIM: Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice.They are mostly ignored being considered as normal structures. The present study was aimed to demonstrate that hypertrophied anal papillae and fibrous anal polyps could cause symptoms to the patients and that they should be removed in treatment of patients with chronic fissure in anus.METHODS: Two groups of patients were studied. A hundred patients were studied in group A in which the associated fibrous polyp or papillae were removed by radio frequency surgical device after a lateral subcutaneous sphincterotomy for relieving the sphincter spasm. Another group of a hundred patients who also had papillae or fibrous polyps, were treated by lateral sphincterotomy alone. They were followed up for one year.RESULTS: Eighty-nine percent patients from group A expressed their satisfaction with the treatment in comparison to only 64% from group B who underwent sphincterotomy alone with the papillae or anal polyps left untreated. Group A patients showed a marked reduction with regard to pain and irritation during defecation (P= 0.0011),pricking or foreign body sensation in the anus (P = 0.0006)and pruritus or wetness around the anal verge (P = 0.0008).CONCLUSION: Hypertrophied anal papillae and fibrous anal polyps should be removed during treatment of chronic anal fissure. This would add to effectiveness and completeness of the procedure.

  9. An open prospective study evaluating efficacy and safety of a new medical device for rectal application of activated carbon in the treatment of chronic, uncomplicated perianal fistulas

    DEFF Research Database (Denmark)

    Zawadzki, Antoni; Johnson, Louis Banka; Bohe, Måns;

    2017-01-01

    PURPOSE: It has been proposed that biological/chemical substances in the intestine might play a role in the occurrence and deterioration of perianal fistulas. Elimination of such unidentified factors from the lower gastrointestinal tract might offer a new strategy for the management of anal...... fistulas. The aim of this study was to evaluate the clinical effects on non-Crohn's disease perianal fistula healing, and the safety and tolerability of a new medical device that applies high-purity, high-activity granular activated carbon locally into the rectum twice daily of patients with perianal...... fistulas without any concomitant medication. METHODS: An open, single-arm, prospective study with active treatment for 8 weeks and an optional follow-up until week 24 ( ClinicalTrial.gov identifier NCT01462747) among patients with chronic, uncomplicated perianal fistulas scheduled for surgery was conducted...

  10. The proposed use of radiofrequency ablation for the treatment of fistula-in-ano.

    Science.gov (United States)

    Keogh, Kenneth M; Smart, Neil J

    2016-01-01

    Fistula in ano is a very common presentation to colorectal clinic. Embarrassment due to the symptoms makes accurate estimations of incidence difficult. It is estimated that up to 40% of peri-anal abscess will be accompanied by or preceded by a fistula. Fistulae can be classified into simple fistulae that involve no or minimal sphincter muscle and complex, which involve significant amounts of the anal sphincter muscle, possibly with multiple tracts. For complex fistulae a seton suture is usually placed through the tract and out through the anus to form a loop allowing pockets of sepsis to drain internally and externally and a mature tract of fibrous tissue to develop. Following this period definitive fistula treatment is considered. This can involve a number of procedures that have tremendously varied success rates in the literature. The first stage of surgical treatment is often a core fistulectomy, which entails surgical removal of the tract. This may be followed by insertion of fibrin glue, a collagen plug or formation of a rotation skin flap from surrounding tissue in order to close the resultant tissue defect. All current treatments have a significant failure rate. If this wound breaks down the surgery can leave a large painful peri-anal wound that can lead to ongoing fistulation. Should this occur resiting of the seton will be required with the patient only getting back to square one after months of healing around the seton. In addition removing cores of fibrous tissue passing through the sphincter can threaten the sphincter function resulting in impaired continence. Having seen radiofrequency ablation used to close varicose veins the authors propose that one could use similar techniques to close a fibrous tract matured with a seton in order to close a fistula. The authors propose that a short length radiofrequency catheter could be used to treat fistula in ano. This would in theory be less painful with less tissue destruction. In addition there would be no

  11. Comparing Ksharasutra (Ayurvedic Seton) and open fistulotomy in the management of fistula-in-ano

    OpenAIRE

    2015-01-01

    Background: Most commonly practiced surgical “lay open” technique to treat fistula-in-ano (a common anorectal pathology) has high rate of recurrence and anal incontinence. Alternatively, a nonsurgical cost efficient treatment with Ksharasutra (cotton Seton coated with Ayurvedic medicines) has minimal complications. In our study, we have tried to compare these two techniques. Materials and Methods: A prospective randomized control study was designed involving patients referred to the Departmen...

  12. Anorectal abscess and fistula-in-ano: evidence-based management.

    Science.gov (United States)

    Rizzo, Julie A; Naig, Anna L; Johnson, Eric K

    2010-02-01

    The management of anorectal abscess and anal fistula has changed markedly with time. Invasive methods with high resulting rates of incontinence have given way to sphincter-sparing methods that have a much lower associated morbidity. There has been an increase in reports in the medical literature describing the success rates of the varying methods of dealing with this condition. This article reviews the various methods of treatment and evidence supporting their use and explores advances that may lead to new therapies.

  13. Perianal fistula: retrospective study of surgical treatment of 241 cases

    Directory of Open Access Journals (Sweden)

    Drager Luciano Ferreira

    1998-01-01

    Full Text Available Perianal fistula, usually has a criptoglandular etiology, developing from a perianal abscess and communicating the anal mucosa with the perianal skin. The aim of this paper is to study retrospectively 241 cases of perianal fistula (172 men and 69 women; 2,5:1 aging from 7 and 80 years old (average: 37,4 years, operated on at the Hospital da Clínicas - UFMG, from 1977 to 1996. The surgical techniques and post-operative outcome have been analysed. Perianal abscesses with spontaneous drainage were the predominant etiology (132 patients; 54,8%. Eighty percent were submitted to fistulectomy as the first surgical treatment. Among early complications (78; 32,4%, local pain was the most frequent (60; 24,9%. Among the late complications (136; 56,4% fistula recurrence (101; 41,9% was the most frequent. There were 141 reoperations in 80 patients. Fistulectomy was the predominant surgical technique employed for the treatment (101; 71,6%. The average hospitalization time was 6,3 days until 1990 and 1,5 day from 1991 to 1996, after the advent of day-surgery beds in HC-UFMG. The surgical treatment of perianal fístula has a significant rate of post-operative complications and a high recurrence rate, in spite of the short stay in hospital.

  14. Internal fistulas in diverticular disease.

    Science.gov (United States)

    Woods, R J; Lavery, I C; Fazio, V W; Jagelman, D G; Weakley, F L

    1988-08-01

    Internal fistulas in diverticular disease are uncommon and have a reputation of being difficult to treat. Eighty four patients treated from 1960 to April 1986, representing 20.4 percent (84 of 412) of the surgically treated diverticular disease patients, were reviewed. Eight patients had multiple fistulas. Sixty-five percent (60 to 92) of fistulas were colovesical, 25 percent (23 of 92) colovaginal, 6.5 percent (6 of 92) coloenteric, and 3 percent (3 of 92) colouterine fistulas. There were 66 percent (35 of 53) males and 34 percent (18 of 53) females with colovesical fistulas only. Hysterectomies had been performed in 50 percent (12 of 24) and 83 percent (19 of 23) of females with colovesical and colovaginal fistulas, respectively. Operative management included: resection anastomosis, resection with anastomosis and diversion, Hartmann procedure, and three-stage procedure. In the latter half of the series there was a significant decrease in staging procedures with no significant statistical difference in complications. There were three deaths (3.5 percent) in the series. Other complications included: wound infection, 21 percent (18 of 84), enterocutaneous fistula, 1 percent (4 of 84), and anastomotic dehiscence, 5 percent (4 of 84). Primary anastomosis can be performed with acceptable morbidity and mortality and today is the procedure of choice, leaving staging procedures to selected patients.

  15. USE OF TRANSPERINEAL ULTRASONOGRAPHY TO STUDY THE EFFECT OF DELIVERY AND EPISIOTOMY ON ANAL SPHINCTER IN WOMEN

    Directory of Open Access Journals (Sweden)

    Rooplekha

    2014-06-01

    Full Text Available Parturition has profound effect on the pelvic floor muscles and is associated with mechanical or neurological injuries. In most women, this effect is transitory, however in a few, permanent damage occurs in the form of urinary or fecal incontinence, fistulae, and sexual problems. often very little attention is paid on to these problems postnataly and few women volunteer to inform about these. Therefore, the true incidence of the problem is unknown. We conducted a study to correlate the various risk factors with the degree of perianal injury caused by the mode of delivery and episiotomy on the anal sphincter. Until recently, defects of external anal sphincter (EAS were detected by electromyography and internal anal sphincter (IAS by measurement of low resting anal pressure. This study uses the transperineal ultrasonography (TPUS. TPUS assesses the anal sphincter under more physiological condition with no intra anal probe like anal endosonography so also demonstrate the internal anal cushion (mucosa & submucosa of the resting canal. TPUS gives accurate images of both sphincter muscles, leading to recognition of unsuspected defects of external & internal sphincter.

  16. PERFACT procedure to treat supralevator fistula-in-ano: A novel single stage sphincter sparing procedure

    Institute of Scientific and Technical Information of China (English)

    Pankaj Garg

    2016-01-01

    AIM: To prospectively perform the PERFACT procedure in supralevator anal fistula/abscess.METHODS: Magnetic resonance imaging was done preoperatively in all the patients. Proximal cauterization around the internal opening, emptying regularly of fistula tracts and curettage of tracts(PERFACT) was done in all patients with supralevator fistula or abscess. All types of anal fistula and/or abscess with supralevator extension, whether intersphincteric or transsphincteric, were included in the study. The internal opening along with the adjacent mucosa was electrocauterized. The resulting wound was left open to heal by secondary intention so as to heal(close) the internal opening by granulation tissue. The supralevator tract/abscess was drained and thoroughly curetted. It was regularly cleaned and kept empty in the postoperative period. The primary outcome parameter was complete fistula healing. The secondary outcome parameters were return to work and change in incontinence scores(Vaizey objective scoring system) assessed preoperatively and at 3 mo after surgery.RESULTS: Seventeen patients were prospectively enrolled and followed for a median of 13 mo(range 5-21 mo). Mean age was 41.1 ± 13.4 years, M:F-15:2. Fourteen(82.4%) had a recurrent fistula, 8(47.1%) had an associated abscess, 14(82.4%) had multiple tracts and 5(29.4%) had horseshoe fistulae. Infralevator part of fistula was intersphincteric in 4 and transsphincteric in 13 patients. Two patients were excluded. Eleven out of fifteen(73.3%) were cured and 26.7%(4/15) had a recurrence. Two patients with recurrence were reoperated on with the same procedure and one was cured. Thus, the overall healing rate was 80%(12/15). All the patients could resume normal work within 48 h of surgery. There was no deterioration in incontinence scores(Vaizey objective scoring system). This is the largest series of supralevator fistula-in-ano(SLF) published to date. CONCLUSION: PERFACT procedure is an effective single step sphincter

  17. Endoscopic closure instead of surgery to close an ileal pouch fistula with the over-the-scope clip system

    Science.gov (United States)

    Wei, Yao; Gong, Jian-Feng; Zhu, Wei-Ming

    2017-01-01

    An ileal pouch fistula is an uncommon complication after an ileal pouch anal anastomosis. Most patients who suffer from an ileal pouch fistula will need surgical intervention. However, the surgery can be invasive and has a high risk compared to endoscopic treatment. The over-the-scope clip (OTSC) system was initially developed for hemostasis and leakage closure in the gastrointestinal tract during flexible endoscopy. There have been many successes in using this approach to apply perforations to the upper gastrointestinal tract. However, this approach has not been used for ileal pouch fistulas until currently. In this report, we describe one patient who suffered a leak from the tip of the “J” pouch and was successfully treated with endoscopic closure via the OTSC system. A 26-year-old male patient had an intestinal fistula at the tip of the “J” pouch after an ileal pouch anal anastomosis procedure. He received endoscopic treatment via OTSC under intravenous anesthesia, and the leak was closed successfully. Endoscopic closure of a pouch fistula could be a simpler alternative to surgery and could help avoid surgery-related complications. PMID:28250903

  18. Colovesical fistula presenting with epididymitis.

    Science.gov (United States)

    Arneill, Matthew; Hennessey, Derek Barry; McKay, Damian

    2013-04-23

    This article reports a case of colovesical fistula presenting with epididymitis. A 75-year-old man with a recent conservatively managed localised diverticular perforation presented to hospital with acute pain and swelling of his left testicle and epididymis. On further questioning, the patient reported passing air in his urine. Urine cultures grew Enterococcus faecalis. Ultrasound scan confirmed a diagnosis of bacterial epididymitis and the patient was treated with intravenous antibiotics. Subsequent CT imaging revealed air in the bladder and a colovesical fistula. The patient went on to have Hartmann's procedure with repair of the bladder defect. This case highlights that: (1) Colovesical fistulae may rarely present with epididymitis. (2) Colovesical fistulae are the most common cause of pneumaturia.

  19. Colovesical fistula presenting with epididymitis

    Science.gov (United States)

    Arneill, Matthew; Hennessey, Derek Barry; McKay, Damian

    2013-01-01

    This article reports a case of colovesical fistula presenting with epididymitis. A 75-year-old man with a recent conservatively managed localised diverticular perforation presented to hospital with acute pain and swelling of his left testicle and epididymis. On further questioning, the patient reported passing air in his urine. Urine cultures grew Enterococcus faecalis. Ultrasound scan confirmed a diagnosis of bacterial epididymitis and the patient was treated with intravenous antibiotics. Subsequent CT imaging revealed air in the bladder and a colovesical fistula. The patient went on to have Hartmann's procedure with repair of the bladder defect. This case highlights that: (1) Colovesical fistulae may rarely present with epididymitis. (2) Colovesical fistulae are the most common cause of pneumaturia. PMID:23616326

  20. Esophagogastric fistula complicating Nissen fundoplication

    OpenAIRE

    Marcel Tafen; Nader Tehrani; Afshin A. Anoushiravani; Avinash Bhakta; Timothy G. Canty; Christine Whyte

    2016-01-01

    Esophagogastric fistula or double-lumen esophagus is a rare condition. There have been fewer than 15 reported cases in adults and only one reported case in the pediatric population. Esophagogastric fistulas typically develop in patients with preexisting gastrointestinal reflux, esophagogastric surgery, esophageal ulcers, or carcinoma. Our case involves a 5-year old girl presenting with odynophagia and nocturnal cough who had a prior Nissen fundoplication. She was found to have an esophagogast...

  1. Ureteroarterial fistula: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Sun; Kim, Ji Chang [Daejeon St Mary' s Hospital, Daejeon (Korea, Republic of)

    2007-01-15

    Ureteroarterial fistula is an extremely rare complication, but is associated with a high mortality rate. Previous pelvic surgery, long standing ureteral catheter insertion, radiation therapy, vascular surgery and vascular pathology contribute the development of this uncommon entity. Herein, a case of ureteroarterial fistula in a 69-year-old female patient, who presented with a massive hematuria, proven in a second attempt at angiography, is reported.

  2. Cholecystic fistula with atypical symptoms

    DEFF Research Database (Denmark)

    Bang, U.C.; Hasbak, P.; From, G.

    2008-01-01

    We report a patient with spontaneous cholecystocolonis fistula secondary to cholelithiasis. A 93 year-old woman was admitted because of weight loss, diarrhoea and upper abdominal pain. Ultrasound examination revealed air in the biliary tract and cholescientigraphy revealed a fistula between the g...... the gallbladder and right colon. Using endoscopic retrograde cholangiopancreatography a calculus was extracted from the bile duct and the symptoms disappeared Udgivelsesdato: 2008/1/14...

  3. Direct radionuclide cystography imaging in colovesical fistula due to inguinal hernia operation complication.

    Science.gov (United States)

    Tamam, Muge; Yavuz, Hatice Sümeyye; Hacimahmutoğlu, Serafettin; Mülazimoğlu, Mehmet; Kacar, Tulay; Ozpacaci, Tevfik

    2009-09-01

    Colovesical fistula is an abnormal connection between the enteric and urinary systems, usually sigmoid colon, caused by various conditions. One cause of colovesical fistula is iatrogenic injury, such as induced by inguinal hernia surgery. We present a case of colovesical fistula. A 57-year-old male was admitted to a local hospital with complaints of dysuria and pneumaturia. He had a past history of total extraperitoneal laparoscopic inguinal hernia repair operation 7 years previously for bilateral inguinal hernia. The case was assessed with radiologic and scintigraphic techniques. Radiologic techniques (plain abdominal radiography, intravenous pyelogram, ultrasound examination, double-contrast barium enema, CT, MRI) were inadequate to determine the colovesical fistula. The colovesical fistula was visualized with direct radionuclide voiding cystography as an alternative scintigraphic method.

  4. Spontaneous nephrocutaneous fistula

    Directory of Open Access Journals (Sweden)

    Alberto A. Antunes

    2004-08-01

    Full Text Available Spontaneous renal fistula to the skin is rare. The majority of cases develop in patients with antecedents of previous renal surgery, renal trauma, renal tumors, and chronic urinary tract infection with abscess formation. We report the case of a 62-year old woman, who complained of urine leakage through the skin in the lumbar region for 2 years. She underwent a fistulography that revealed drainage of contrast agent to the collecting system and images suggesting renal lithiasis on this side. The patient underwent simple nephrectomy on this side and evolved without intercurrences in the post-operative period. Currently, the occurrence of spontaneous renal and perirenal abscesses is extremely rare, except in patients with diabetes, neoplasias and immunodepression in general.

  5. Chronic kidney disease aggravates arteriovenous fistula damage in rats.

    Science.gov (United States)

    Langer, Stephan; Kokozidou, Maria; Heiss, Christian; Kranz, Jennifer; Kessler, Tina; Paulus, Niklas; Krüger, Thilo; Jacobs, Michael J; Lente, Christina; Koeppel, Thomas A

    2010-12-01

    Neointimal hyperplasia (NIH) and impaired dilatation are important contributors to arteriovenous fistula (AVF) failure. It is unclear whether chronic kidney disease (CKD) itself causes adverse remodeling in arterialized veins. Here we determined if CKD specifically triggers adverse effects on vascular remodeling and assessed whether these changes affect the function of AVFs. For this purpose, we used rats on a normal diet or on an adenine-rich diet to induce CKD and created a fistula between the right femoral artery and vein. Fistula maturation was followed noninvasively by high-resolution ultrasound (US), and groups of rats were killed on 42 and 84 days after surgery for histological and immunohistochemical analyses of the AVFs and contralateral femoral vessels. In vivo US and ex vivo morphometric analyses confirmed a significant increase in NIH in the AVFs of both groups with CKD compared to those receiving a normal diet. Furthermore, we found using histological evaluation of the fistula veins in the rats with CKD that the media shrank and their calcification increased significantly. Afferent artery dilatation was significantly impaired in CKD and the downstream fistula vein had delayed dilation after surgery. These changes were accompanied by significantly increased peak systolic velocity at the site of the anastomosis, implying stenosis. Thus, CKD triggers adverse effects on vascular remodeling in AVFs, all of which contribute to anatomical and/or functional stenosis.

  6. [Endoscopic management of postoperative biliary fistulas].

    Science.gov (United States)

    Farca, A; Moreno, M; Mundo, F; Rodríguez, G

    1991-01-01

    Biliary fistulas have been managed by surgical correction with no good results. From 1986 to 1990, endoscopic therapy was attempted in 24 patients with postoperative persistent biliary-cutaneous fistulas. Endoscopic retrograde cholangiography demonstrated residual biliary stones in 19 patients (79%). The mean fistula drainage was 540 ml/day, and in 75% the site of the fistula was near the cistic duct stump. Sphincterotomy with or without biliary stent placement resulted in rapid resolution of the fistula in 23 patients (95.8%). In those patients treated with biliary stents the fistula healed spectacularly in 24-72 hrs.

  7. Non-VACTERL-type anomalies are frequent in patients with esophageal atresia/tracheo-esophageal fistula and full or partial VACTERL association.

    NARCIS (Netherlands)

    Jong, E.M. de; Felix, J.F.; Deurloo, J.A.; Dooren, M.F. van; Aronson, D.C.; Torfs, C.P.; Heij, H.A.; Tibboel, D.

    2008-01-01

    BACKGROUND: The VACTERL association is the nonrandom co-occurrence of Vertebral anomalies, Anal atresia, Cardiovascular malformations, Tracheo-esophageal fistula (TEF) and/or Esophageal atresia (EA), Renal anomalies, and/or Limb-anomalies. The full phenotype of patients with EA/TEF and other anomali

  8. Cross sectional study of MR fistulography in the evaluation of perianal fistulae and its surgical correlation

    Directory of Open Access Journals (Sweden)

    Sameeha Khan

    2015-10-01

    Full Text Available Aims and objectives: To evaluate the diagnostic accuracy of Magnetic Resonance Fistulography in the assessment of the perianal fistulae. Background: The success of the surgical approach for perianal fistulae treatmentis closely associated with the preoperative assessment. MR imaging plays a key role in describing the fistulae in relation to the anatomy of the perianal region. This has been categorised according to the involvement of the fistulous tract in relation to the sphincters and its extension of the disease into five imaging based grades. This helps in selecting the appropriate surgery in order to reduce the load of recurrences. Materials and methods: Over a period of 6 months, a cross sectional study was conducted among 18 patients who were admitted with the features of perianal fistulae at Al-Ameen Medical College Hospital , Vijayapura. The average age of patients was 44.5 years, ranging from 33 to 72 years, with the number of females 22.2% (n = 4 and males 77.8% (n = 14. The pre-operative MR imaging assessment was studied and correlated with intra operative surgical findings. Results: The accuracy of MR Fistulography was consistent with 17 out of 18 surgical findings, except for one case, which was falsely over diagnosed. Conclusion: To conclude, MR Fistulography is an essential investigation of choice in the evaluation of perianal fistulae. It helps in accurate identification of the type of perianal fistula in relation to the anal sphincters and adjacent anatomical structures. Hence this investigation should be recommended routinely in preoperative work up for precise surgical management of perianal fistulae.

  9. Comparative study of anal acoustic reflectometry and anal manometry in the assessment of faecal incontinence

    DEFF Research Database (Denmark)

    Hornung, B R; Mitchell, P J; Carlson, G L;

    2012-01-01

    Anal acoustic reflectometry (AAR) is a reproducible technique providing a novel physiological assessment of anal sphincter function. It may have advantages over conventional anal manometry. The aims of this study were to determine the ability of AAR and anal manometry to identify changes in anal...

  10. Dapsone-induced agranulocytosis leading to perianal abscess and death: a case report

    Directory of Open Access Journals (Sweden)

    Kitamura Nobuya

    2011-03-01

    Full Text Available Abstract Introduction Dapsone (diaminodiphenylsulfone is used for the treatment of intractable skin diseases such as pemphigus and leprosy. The side effects of Dapsone are anemia, leukopenia, and liver dysfunction. Here, we present a case of agranulocytosis-induced septic shock, which was a side effect of Dapsone. Case presentation An 82-year-old Japanese woman was transferred to our hospital with fever, leucopenia, and respiratory arrest. At the previous hospital, she had been administered Dapsone for linear IgA bullous dermatosis. At the time of admission, she presented with methemoglobinemia and septic shock, which was due to immunosuppression caused by the normal dose of Dapsone. Although her overall health initially improved, her condition deteriorated because of septic shock caused by an anal fistula. She died of sepsis on hospital day 80. Conclusion One of the side effects of Dapsone is agranulocytosis. Patients with agranulocytosis may be in danger of developing anal fistula. Therefore, care must be taken if a patient with agranulocytosis develops a decubitus ulcer in the sacral region, since it could develop into a fistula-in-ano.

  11. [APPLICATION OF FISTULA PLUG WITH THE FIBRIN ADHESIVE IN TREATMENT OF RECTAL FISTULAS].

    Science.gov (United States)

    Aydinova, P R; Aliyev, E A

    2015-05-01

    Results of surgical treatment of 21 patients, suffering high transsphincteric and extrasphincteric rectal fistulas, were studied. In patients of Group I the fistula passage was closed, using fistula plug obturator; and in patients of Group II--by the same, but preprocessed by fibrin adhesive. The fistula aperture germeticity, prophylaxis of rude cicatrices development in operative wound zone, promotion of better fixation of bioplastic material were guaranteed, using fistula plug obturator with preprocessing, using fibrin adhesive.

  12. Sex-linked differences in the course of chronic kidney disease and congestive heart failure: a study in 5/6 nephrectomized Ren-2 transgenic hypertensive rats with volume overload induced using aorto-caval fistula.

    Science.gov (United States)

    Červenka, Luděk; Škaroupková, Petra; Kompanowska-Jezierska, Elzbieta; Sadowski, Janusz

    2016-10-01

    The role of hypertension and the renin-angiotensin system (RAS) in sex-related differences in the course of chronic kidney disease (CKD) and congestive heart failure (CHF) remain unclear, especially when the two diseases are combined. In male and female Ren-2 transgenic rats (TGR), a model of hypertension with activation of endogenous RAS, CKD was induced by 5/6 renal mass reduction (5/6 NX) and CHF was elicited by volume overload achieved by creation of an aorto-caval fistula (ACF). The primary aim of the study was to examine long-term CKD- and CHF-related mortality, especially in animals with CKD and CHF combined, with particular interest in the potential sex-related differences. The follow-up period was 23 weeks after the first intervention (5/6 NX). We found, first, that TGR did not exhibit sexual dimorphism in the course of 5/6 NX-induced CKD. Second, in contrast, TGR exhibited important sex-related differences in the course of ACF-induced CHF-related mortality: intact female TGR showed higher survival rate than male TGR. This situation is reversed in the course of combined 5/6 NX-induced CKD and ACF-induced CHF-related mortality: intact female TGR exhibited poorer survival than male TGR. Third, the survival rate in animals with combined 5/6 NX-induced CKD and ACF-induced CHF was significantly worsened as compared with rat groups that were exposed to 'single organ disease'. Collectively, our present results clearly show that CKD aggravates long-term mortality of animals with CHF. In addition, TGR exhibit remarkable sexual dimorphism with respect to CKD- and CHF-related mortality, especially in animals with combined CKD and CHF.

  13. Optimizing management of pancreaticopleural fistulas

    Institute of Scientific and Technical Information of China (English)

    Marek Wronski; Maciej Slodkowski; Wlodzimierz Cebulski; Daniel Moronczyk; Ireneusz W Krasnodebski

    2011-01-01

    AIM: To evaluate the management of pancreaticopleu ral fistulas involving early endoscopic instrumentation of the pancreatic duct.METHODS: Eight patients with a spontaneous pancre aticopleural fistula underwent endoscopic retrograde cholangiopancreatography (ERCP) with an intention to stent the site of a ductal disruption as the primary treatment. Imaging features and management were evaluated retrospectively and compared with outcome.RESULTS: In one case, the stent bridged the site of a ductal disruption. The fistula in this patient closed within 3 wk. The main pancreatic duct in this case appeared normal, except for a leak located in the body of the pancreas. In another patient, the papilla of Vater could not be found and cannulation of the pancreatic duct failed. This patient underwent surgical treatment. In the remaining 6 cases, it was impossible to insert a stent into the main pancreatic duct properly so as to cover the site of leakage or traverse a stenosis situated down stream to the fistula. The placement of the stent failedbecause intraductal stones (n = 2) and ductal strictures (n = 2) precluded its passage or the stent was too short to reach the fistula located in the distal part of the pan creas (n = 2). In 3 out of these 6 patients, the pancre aticopleural fistula closed on further medical treatment. In these cases, the main pancreatic duct was normal or only mildly dilated, and there was a leakage at the body/tail of the pancreas. In one of these 3 patients, additional percutaneous drainage of the peripancreatic fluid collections allowed better control of the leakage and facilitated resolution of the fistula. The remaining 3 patients had a tight stenosis of the main pancreatic duct resistible to dilatation and the stent could not be inserted across the stenosis. Subsequent conservative treatment proved unsuccessful in these patients. After a failed therapeutic ERCP, 3 patients in our series devel oped super infection of the pleural or peripancreatic

  14. Gastrocolic Fistula: A Shortcut through the Gut

    Directory of Open Access Journals (Sweden)

    Nauzer Forbes

    2016-01-01

    Full Text Available Gastrocolic fistulas are observed in association with several conditions. Traditionally, peptic ulcer disease was commonly implicated in the formation of gastrocolic fistulas; however, this is now a rare etiology. Here, we present a case of gastrocolic fistula secondary to peptic ulcer disease alone, in addition to reviewing the literature and providing options for diagnosis and treatment.

  15. Posterior cranial fossa arteriovenous fistula with presenting as caroticocavernous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Liu, H.M.; Shih, H.C.; Huang, Y.C.; Wang, Y.H. [Dept. of Medical Imaging, National Taiwan University Hospital, Taipei (Taiwan)

    2001-05-01

    We report cases of posterior cranial fossa arteriovenous fistula (AVF) with presenting with exophthalmos, chemosis and tinnitus in 26- and 66-year-old men. The final diagnoses was vertebral artery AVF and AVF of the marginal sinus, respectively. The dominant venous drainage was the cause of the unusual presentation: both drained from the jugular bulb or marginal sinus, via the inferior petrosal and cavernous sinuses and superior ophthalmic vein. We used endovascular techniques, with coils and liquid adhesives to occlude the fistulae, with resolution of the symptoms and signs. (orig.)

  16. Laparoscopic repair of vesicovaginal fistula

    Directory of Open Access Journals (Sweden)

    Miłosz Wilczyński

    2011-06-01

    Full Text Available A vesicovaginal fistula is one of the complications that a gynaecologist is bound to face after oncological operations, especially in postmenopausal women. Over the years there have been introduced many techniques of surgical treatment of this entity, including transabdominal and transvaginal approaches.We present a case of a 46-year-old patient who suffered from urinary leakage via the vagina due to the presence of a vesicovaginal fistula that developed after radical abdominal hysterectomy and subsequent radiotherapy. The decision was made to repair it laparoscopically due to retracted, fibrous and scarred tissue in the vaginal apex that precluded a transvaginal approach. A small cystotomy followed by an excision of fistula borders was performed. After six-month follow-up no recurrence of the disease has been noted.We conclude that laparoscopy is an interesting alternative to traditional approaches that provides comparable results.

  17. Fistulas secondary to gynecological and obstetrical operations

    Directory of Open Access Journals (Sweden)

    Jakovljević Branislava N.

    2003-01-01

    Full Text Available The authors present urogenital and rectogenital fistulas treated at the Department of Obstetrics and Gynecology in Novi Sad in the period from 1976 to 1999. The study comprised 28 cases of fistula out of which 17 were vesicovaginal, 3 ureterovaginal, 1 vesicorecto vaginal and 7 recto vaginal. During the investigated period there were 182 Wertheim operations, 3864 total abdominal hysterectomies, 1160 vaginal hysterectomies and 7111 cesarean sections. The vesicovaginal fistulas were most frequent with the incidence of 0.33%, whereas the tocogenic fistulas did not occur. Urogenital fistulas secondary to radical hysterectomy are extremely rare thanks to the administered measures of prevention during the surgical procedure.

  18. MRI of congenital urethroperineal fistula

    Energy Technology Data Exchange (ETDEWEB)

    Ghadimi-Mahani, Maryam; Dillman, Jonathan R.; Pai, Deepa; DiPietro, Michael [C. S. Mott Children' s Hospital, Department of Radiology, Section of Pediatric Radiology, University of Michigan Health System, Ann Arbor, MI (United States); Park, John [C. S. Mott Children' s Hospital, Department of Pediatric Urology, University of Michigan Health System, Ann Arbor, MI (United States)

    2010-12-15

    We present the MRI features of a congenital urethroperineal fistula diagnosed in a 12-year-old boy being evaluated after a single urinary tract infection. This diagnosis was initially suggested by voiding cystourethrogram and confirmed by MRI. Imaging revealed an abnormal fluid-filled tract arising from the posterior urethra and tracking to the perineal skin surface that increased in size during micturition. Surgical resection and histopathological evaluation of the abnormal tract confirmed the diagnosis of congenital urethroperineal fistula. MRI played important roles in confirming the diagnosis and assisting surgical planning. (orig.)

  19. Enigma of primary aortoduodenal fistula

    Institute of Scientific and Technical Information of China (English)

    Miklosh Bala; Jacob Sosna; Liat Appelbaum; Eran Israeli; Avraham I Rivkind

    2009-01-01

    A diagnosis of primary aortoenteric fistula is difficult to make despite a high level of clinical suspicion. It should be considered in any elderly patient who presents with upper gastrointestinal bleeding in the context of a known abdominal aortic aneurysm. We present the case of young man with no history of abdominal aortic aneurysm who presented with massive upper gastrointestinal bleeding. Initial misdiagnosis led to a delay in treatment and the patient succumbing to the illness. This case is unique in that the fistula formed as a result of complex atherosclerotic disease of the abdominal aorta, and not from an aneurysm.

  20. Case report of an anal adenocarcinoma arising from a perineal lump

    Directory of Open Access Journals (Sweden)

    Dedrick Kok-Hong Chan

    2016-03-01

    Full Text Available Anal adenocarcinoma is a rare condition and can arise in chronic inflammatory states such as in Crohn's disease, or in a chronic fistula-in-ano. We report our diagnosis and management of a patient who presented with a large perineal lump with a long-standing history of perianal fistulous disease. This was initially evaluated with a Magnetic Resonance Imaging, and the diagnosis was confirmed with biopsy. Multimodality treatment with chemoradiotherapy and surgery should be offered to achieve the best outcomes.

  1. TUBERCULOUS SIALO-CUTANEOUS FISTULA

    Directory of Open Access Journals (Sweden)

    Bapi Lal

    2013-04-01

    Full Text Available ABSTRACT: Tuberculosis of the parotid gland is a rare clinica l entity. We present a case of parotid gland tuberculosis that presented with a sial o-cutaneous fistula. This case was successfully treated with antituberculous drugs onl y without any surgical excision.

  2. Gastropulmonary Fistula after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Maya Doumit

    2009-01-01

    Full Text Available The Roux-en-Y gastric bypass is one of the most common operations for morbid obesity. Although rare, gastropulmonary fistulas are an important complication of this procedure. There is only one recently reported case of this complication. The present report describes the serious nature of this complication in a patient after an uneventful laparoscopic gastric bypass surgery.

  3. Relapsing Urinary Tract Infection Due to Rectourethral Fistula in a Renal Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Ayşegül ORUÇ KOÇ

    2015-12-01

    Full Text Available Objectives: Urinary tract infection (UTI is the most common cause of bacterial infection in renal transplant recipients. It occurs frequently in the early period because of the high-dose immunosuppressive agents and urethral catheterizations. Relapsing UTI may lead to graft dysfunction and further evaluations have to be performed for predisposing factors. We report the case of a renal transplant recipient who presented with relapsing bacterial UTI due to a rectourethral fistula. Case: A 24-year-old male patient underwent a successful renal transplantation from a living donor on May 2008. He had a history of surgical intervention for anal atresia and rectourethral fistula. He was hospitalized five times because of relapsing bacterial UTI after transplantation. We investigated the presence of an anatomical abnormality and found a rectourethral fistula. After the surgical repair of the fistula the UTI did not relapse. Conclusion: Relapsing infections are not uncommon and anatomical abnormalities can lead to relapsing UTI in transplant recipients. Further investigations must be performed regarding the factors that might contribute to the development of UTIs in the presence of relapsing UTI.

  4. A CLINICAL STUDY ON PERI ANAL TUBERCULOSIS IN S.V.R.R.G.G. HOSPITAL TIRUPATI

    Directory of Open Access Journals (Sweden)

    Sobha Rani

    2015-09-01

    Full Text Available Tuberculosis around the anus is a rare form of extra pulmonary tuberculosis It is necessary to recognize it due to a specific treatment. (1 Perianal tuberculosis is an uncommon condition; it may not be easily distinguishable from the other inflammatory anal diseases. Undiagnosed cases are associated with high recurrence rates. Perianal tuberculosis can have varied presentation, frequently mimicking other common as well as rare diseases. Ano pe rianal tuberculosis may be associated with abdominal tuberculosis either as an extension of the original lesion or due to its spread via the lymphatics. AIMS & OBJECTIVES OF STUDY : To study the prevalence of ano - perianal tuberculosis in patients attending surgery OPD, SVRR Government General Hospital, Tirupati. To prevent recurrence and morbidity due to peri anal tuberculosis by early detection and intervention with anti tuberculous drugs . MATERIALS AND METHODS : STUDY DESIGN : Prospective study . STUDY SETTING : The present study was conducted at Department of General Surgery, SVRR Government General Hospital, and Tirupati. After getting institutional approval, written and informed consent was taken from each patient. PERIOD OF STUDY : 12 months . SAMPLE SI ZE : 142 patients who attended Surgery OP and were admitted in General Surgery ward, SVRR Government General Hospital, Tirupati with anal and perianal lesions like anal fistulae, perianal suppurations, growths, ulcers during the study period. INCLUSION CRIT ERIA : Age more than 15 years , Both men and women are included , Both sputum positive and negative for AFB , Both HIV positive and negative patients , All Anal and perianal (more than 3cm and within 3cm of anal verge lesions are included , Willingness of the p atient to participate in the study . EXCLUSION CRITERIA : Age less than 15 years , Patients who are not willing to participate in the study . CONCLUSION : Tuberculosis was responsible for 11% cases in recurrent fistula - in - ano

  5. Management of Postpneumonectomy Bronchopleural Fistulae

    Directory of Open Access Journals (Sweden)

    Kemal Karapinar

    2016-04-01

    Full Text Available Aim: Postpneumonectomy bronchopleural fistula (PPBPF is a hard-to-treat complication that may develop after pneumonectomy. It follows a persistent course. Although there is no commonly adopted method, closure of the fistula with flaps is the general principle. The use of the omental flap may provide higher success rates in the treatment. Material and Method: PPBPF developed in 12 out of 162 pneumonectomies performed at the department of thoracic surgery between 2011 and 2014. The demographic characteristics, fistula management strategies, morbidity, and mortalities were retrospectively studied by analysis of operative reports and a digital database. Results: The rate of PPBPF was 7.4%. The bronchopleural fistulae could be closed by various treatments in 10 patients; omentopexy constituted the basis of treatment in 8 of them. In the other patients with successful results, resuturing with staplers and vacuum assisted closure were performed during the early period. One of the patients who failed treatment died due to ARDS; therefore, it was not possible to apply all the treatment alternatives. In the other patient, despite the use of all treatment alternatives (eloesser flap, tracheal stent, omentopexy, thoracomyoplasty, vacuum assisted closure, the treatment failed. Discussion: PPBPF is one of the most significant causes of morbidity and mortality in thoracic surgery units. Because its treatment may be long, a good plan and its execution by experienced units are necessary. The omental flap is increasingly popular due to good perfusion. We believe that omentopexy and j type tracheal stent performed by experienced teams will provide successful results in fistula treatment.

  6. ENTEROCUTANEOUS FISTULAS, OUR EXPERIENCE IN MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Anantha Ramani Pratha

    2016-06-01

    Full Text Available Enterocutaneous fistulas are a surgeon’s nightmare, more so if they occur after one’s own surgery. They are a challenge, testing the surgeon’s patience and expertise. Their management remains a team work. The success depends on the wellbeing of the patient during this great ordeal of management. In this article, we are reviewing and presenting the experience gained by us while managing 58 cases of enterocutaneous fistulas. We have studied the causes, the time of occurrence, the duration of conservative treatment, the methods of investigations and definitive treatment and ultimate outcome of our management of 58 cases of postoperative enterocutaneous fistulas, in a period of 5 years. Total 58 cases, postoperative enterocutaneous fistulas were the most common type (75%, 4 lost for followup. All fistulas were initially managed conservatively. Patients were maintained on total parenteral nutrition, evaluated for the cause and site of leak. High output fistulas were made as controlled fistula by diverting the loop to exterior following stabilisation, to minimise spillage and sepsis. Low output fistulas explored and definitive treatment carried out if there is persistent leak after 8 weeks. 8 ileal fistulas healed spontaneously (13.7%. 3 malignant rectal fistulas sent for radiotherapy. Initial damage control surgery was done in 15 cases (ileal+sigmoid+rectum (25.86%. Definitive surgery was done in 39 cases (67%. Out of 54 cases, 15 expired-(27.7%

  7. Enterovesical fistulae: aetiology, imaging, and management.

    Science.gov (United States)

    Golabek, Tomasz; Szymanska, Anna; Szopinski, Tomasz; Bukowczan, Jakub; Furmanek, Mariusz; Powroznik, Jan; Chlosta, Piotr

    2013-01-01

    Background and Study Objectives. Enterovesical fistula (EVF) is a devastating complication of a variety of inflammatory and neoplastic diseases. Radiological imaging plays a vital role in the diagnosis of EVF and is indispensable to gastroenterologists and surgeons for choosing the correct therapeutic option. This paper provides an overview of the diagnosis of enterovesical fistulae. The treatment of fistulae is also briefly discussed. Material and Methods. We performed a literature review by searching the Medline database for articles published from its inception until September 2013 based on clinical relevance. Electronic searches were limited to the keywords: "enterovesical fistula," "colovesical fistula" (CVF), "pelvic fistula", and "urinary fistula". Results. EVF is a rare pathology. Diverticulitis is the commonest aetiology. Over two-thirds of affected patients describe pathognomonic features of pneumaturia, fecaluria, and recurrent urinary tract infections. Computed tomography is the modality of choice for the diagnosis of enterovesical fistulae as not only does it detect a fistula, but it also provides information about the surrounding anatomical structures. Conclusions. In the vast majority of cases, this condition is diagnosed because of unremitting urinary symptoms after gastroenterologist follow-up procedures for a diverticulitis or bowel inflammatory disease. Computed tomography is the most sensitive test for enterovesical fistula.

  8. Case report: misdiagnosis of tailgut cyst presenting as recurrent perianal fistula with pelvic abscess.

    Science.gov (United States)

    Johnson, Kevin N; Young-Fadok, Tonia M; Carpentieri, David; Acosta, Juan M; Notrica, David M

    2013-02-01

    Tailgut cysts are uncommon lesions that usually occur within the presacral space. The relative rarity and nonspecific complaints associated with these lesions often lead to misdiagnosis or unnecessary procedures before the correct diagnosis is made. We describe a case of a 16-year-old female who presented with pelvic pain. She had previously undergone several procedures at an outside institution for recurrent perianal fistula and perirectal abscess. Subsequent evaluation under anesthesia revealed a presacral cystic mass with a well-developed tract within the anorectal ring in the posterior midline. This mass was surgically removed using a combined transanal and posterior sagittal excision technique and was found to be a tailgut cyst upon pathologic evaluation. Tailgut cysts and other presacral masses should be included in the differential for patients with recurrent abscess in the presacral space or fistula within the anal canal. A variety of surgical approaches are available depending on the anatomy of the lesion.

  9. Unusual Presentation of a Rectovestibular Fistula as Gastrointestinal Hemorrhage in a Postmenopausal Woman

    Directory of Open Access Journals (Sweden)

    Olga Grechukhina

    2014-01-01

    Full Text Available Background. Anorectal malformations (ARMs are extremely rare and are usually identified neonatally. It is unusual for these cases to present in the postmenopausal period. This case report describes a postmenopausal patient with ARM and rectovaginal hemorrhage. Case. An 86-year-old, gravida 11, para 9, presented to the emergency department complaining of profuse postmenopausal vaginal bleeding. Her gynecologic history was significant only for an unclear history of an anal abnormality that was noted at birth. Speculum examination revealed profuse rectal bleeding from a rectovestibular fistula exterior to her hymenal ring. Colonoscopic examination revealed severe diverticular disease. Conclusion. This patient was born with an imperforate anus which resolved as rectovestibular fistula and ectopic anus. This case presents a rare clinical circumstance which integrates the fields of obstetrics, gynecology, gastroenterology, and embryology alike.

  10. Urethral Fistula and Scrotal Abscess Associated with Colovesical Fistula Due to the Sigmoid Colon Cancer

    OpenAIRE

    2015-01-01

    We report here a rare case of urethral fistula and scrotal abscess associated with colovesical fistula due to sigmoid colon cancer. An 84-year-old male was referred to our hospital complaining of macrohematuria, fecaluria, pneumaturia and micturitional pain. Computed tomography (CT) showed colovesical fistula. Other examinations, including colonoscopy and cystoscopy, did not reveal a clear cause for the colovesical fistula. Only an elevated serum level of the tumor marker CA19-9 suggested the...

  11. Bronchopleural fistula following laparoscopic liver resection.

    Science.gov (United States)

    Bhardwaj, Neil; Kundra, Amritpal; Garcea, Giuseppe

    2014-10-09

    A rare case is presented of a 58-year-old woman who developed a bronchopleural fistula following a laparoscopic liver resection for a colorectal metastasis. The bronchopleural fistula was finally diagnosed when after repeated admissions for chest infections, the patient coughed up surgical clips. We propose a management plan based on our experience and hope this case report will add to the scarce reports of postoperative bronchopleural fistula cases in the literature.

  12. Enterovesical Fistulae: Aetiology, Imaging, and Management

    OpenAIRE

    2013-01-01

    Background and Study Objectives. Enterovesical fistula (EVF) is a devastating complication of a variety of inflammatory and neoplastic diseases. Radiological imaging plays a vital role in the diagnosis of EVF and is indispensable to gastroenterologists and surgeons for choosing the correct therapeutic option. This paper provides an overview of the diagnosis of enterovesical fistulae. The treatment of fistulae is also briefly discussed. Material and Methods. We performed a literature revie...

  13. Lacrimal gland fistula after upper eyelid blepharoplasty

    Directory of Open Access Journals (Sweden)

    Mohsen Bahmani Kashkouli

    2011-01-01

    Full Text Available To report the first case of lacrimal gland fistula after upper eyelid blepharoplasty for blepharochalasis. Standard upper blepharoplasty and the hooding excision were performed in a female with blepharochalasis. The patient developed a fistulous tract with tearing from the incision few days after hooding excision. Fistula excision and lacrimal gland repositioning were performed. There were no complications after the repositioning procedure (6 months follow up. Prolapsed lacrimal gland and fistula formation can occur after upper blepharoplasty hooding excision.

  14. Pancreaticoatmospheric fistula following severe acute necrotising pancreatitis.

    Science.gov (United States)

    Simoneau, Eve; Chughtai, Talat; Razek, Tarek; Deckelbaum, Dan L

    2014-12-17

    Severe acute necrotising pancreatitis is associated with numerous local and systemic complications. Abdominal compartment syndrome requiring urgent decompressive laparotomy is a potential complication of this disease process and is associated with increased morbidity and mortality. We describe the case of a pancreaticoatmospheric fistula following decompressive laparotomy in a patient with severe acute necrotising pancreatitis. While this fistula was managed successfully using the current standard of care for pancreatic fistulas, the wound care for in this patient with drainage of the fistula through an open abdomen, is a significant challenge.

  15. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

    Leonhardt, H.; Mellander, S.; Snygg, J.

    2008-01-01

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed...... arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered. Patients with cancer may only need treatment for the acute bleeding episode, and an endovascular approach has the advantage...

  16. Colovesical fistulae in the sigmoid diverticulitis.

    Science.gov (United States)

    Cirocchi, R; La Mura, F; Farinella, E; Napolitano, V; Milani, D; Di Patrizi, M S; Trastulli, S; Covarelli, P; Sciannameo, F

    2009-01-01

    In most cases Colovesical fistulae are complications of diverticular disease and representing the most common kind of colodigestive fistula; less common are colovaginal, colocutaneous, coloenteric and colouterine fistula. In this article we review the literature concerning colovesical fistulae in colorectal surgery for sigmoid diverticulitis and report on two cases that required a surgical treatment, one elective and the other in emergency. In both cases we performed a sigmoid resection with a primary anastomosis and small vesical window-ectomy placing a Foley catheter for about 10 days.

  17. Emphysematous prostatic abscess with rectoprostatic fistula

    Directory of Open Access Journals (Sweden)

    Po-Cheng Chen

    2014-12-01

    Full Text Available Emphysematous prostatic abscess is a rare but relatively serious infectious disease, and its association with rectoprostatic fistula is extremely unusual. The reported risk factors for this condition include diabetes mellitus, immunosuppression, and prostate surgery. We report a rare case of emphysematous prostatic abscess successfully treated by transurethral drainage. Nonetheless, a rectoprostatic fistula was found postoperatively. The fistula healed spontaneously without fasting or fecal diversion after suprapubic cystostomy and placement of a urethral catheter. This case highlights the importance of surgical drainage for the treatment of an emphysematous prostatic abscess and that conservative treatment can be a safe and effective approach for an associated rectoprostatic fistula.

  18. Report of a complete second branchial fistula.

    LENUS (Irish Health Repository)

    Khan, Mohammad Habibullah

    2010-08-01

    We report a case of complete congenital branchial fistula with an internal opening near the tonsillar fossa. Cysts, fistulas, and sinuses of the second branchial cleft are the most common developmental anomalies arising from the branchial apparatus. In our case, a 43-year-old man presented with a several-year history of a discharging sinus from the right side of his neck, consistent with a branchial fistula. He underwent various investigations and finally was treated with a one-stage complete surgical excision of the fistula tract. We describe the general clinical presentation, investigations, and surgical outcome of this case.

  19. Colovesical fistula presenting with epididymitis

    OpenAIRE

    2013-01-01

    This article reports a case of colovesical fistula presenting with epididymitis. A 75-year-old man with a recent conservatively managed localised diverticular perforation presented to hospital with acute pain and swelling of his left testicle and epididymis. On further questioning, the patient reported passing air in his urine. Urine cultures grew Enterococcus faecalis. Ultrasound scan confirmed a diagnosis of bacterial epididymitis and the patient was treated with intravenous antibiotics. Su...

  20. Choledochoduodenal fistula of ulcer etiology

    Directory of Open Access Journals (Sweden)

    Čolović Radoje

    2010-01-01

    Full Text Available Introduction Choledochoduodenal fistulas are very rare and in most cases are caused by a long-lasting and poorly treated chronic duodenal ulcer. They may be asymptomatic or followed by symptoms of ulcer disease, by attacks of cholangitis or bleeding or vomiting in cases of ductoduodenal stenosis. The diagnosis is simple and safe, however treatment is still controversial. If surgery is the choice of treatment, local findings should be taken into consideration. As a rule, intervention involving closure of fistula is not recommended. Case Outline The authors present a 60-year-old woman with a long history of ulcer disease who developed attacks of cholangitis over the last three years. Ultrasonography and CT showed masive pneumobilia due to a choledochoduodenal fistula. . As there was no duodenal stenosis or bleeding, at operation the common bile duct was transected and end-to-side choledochojejunostomy was performed using a Roux-en Y jejunal limb. From the common bile duct, multiple foreign bodies of herbal origin causing biliary obstruction and cholangitis were removed. After uneventful recovery the patient stayed symptom free for four years now. Conclusion The performed operation was a simple and good surgical solution which resulted in complication-free and rapid recovery with a long-term good outcome. .

  1. Carotid cavernous fistula: Ophthalmological implications

    Directory of Open Access Journals (Sweden)

    Chaudhry Imtiaz

    2009-01-01

    Full Text Available Carotid cavernous fistula (CCF is an abnormal communication between the cavernous sinus and the carotid arterial system. A CCF can be due to a direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus, or a communication between the cavernous sinus, and one or more meningeal branches of the internal carotid artery, external carotid artery or both. These fistulas may be divided into spontaneous or traumatic in relation to cause and direct or dural in relation to angiographic findings. The dural fistulas usually have low rates of arterial blood flow and may be difficult to diagnose without angiography. Patients with CCF may initially present to an ophthalmologist with decreased vision, conjunctival chemosis, external ophthalmoplegia and proptosis. Patients with CCF may have predisposing causes, which need to be elicited. Radiological features may be helpful in confirming the diagnosis and determining possible intervention. Patients with any associated visual impairment or ocular conditions, such as glaucoma, need to be identified and treated. Based on patient′s signs and symptoms, timely intervention is mandatory to prevent morbidity or mortality. The conventional treatments include carotid ligation and embolization, with minimal significant morbidity or mortality. Ophthalmologist may be the first physician to encounter a patient with clinical manifestations of CCF, and this review article should help in understanding the clinical features of CCF, current diagnostic approach, usefulness of the available imaging modalities, possible modes of treatment and expected outcome.

  2. The Patency Rate of Arteriovenous Fistulas

    Directory of Open Access Journals (Sweden)

    Aşkın Ender Topal

    2004-01-01

    Full Text Available The purpose of this investigation is to determine the patency of thearteriovenous (A-V fistulas, created in patients with chronic renal failure, inthe early and late periods according to sex.The A-V fistulas created for hemodialisis were investigated retrospectively.Of 238 patients, there were 130 male.269 operations were made to 238 patients. Of these, 198 (73.6 % wereradiochephalic, 56 (20.8 % were brachiochephalic, 8 (3 % were brachiobasilicA-V fistulas. In 3 (1.1 % patients loop graft between brachial artery and vein,in 1 (0.37 % patient graft between radial artery and brachial vein, in 1 patientgraft between brachial artery and basilic vein, in 1 patient graft betweensuperficial femoral artery and saphenous vein were placed. Of 198radiochephalic A-V fistulas 24 (12.1 % in early period and 3 (1.5 % in lateperiod became inactive. Of 56 brachiochephalic A-V fistulas 4 (7.1 % and of 8brachiobasilic A-V fistulas 2 (25 % became unsuccessful in early period. 1 of 6A-V fistulas with prosthetic graft failed in late period because of thrombosis. Inradial level patency rate of A-V fistulas in females were lower than in males(82.3 %-89.8 %.The patency rate of A-V fistulas in radial and brachial levels were similar,but in radial level rate of successful of A-V fistulas decreased in femalesaccording to males. Use of graft in A-V fistula didn’t give superiority to A-Vfistulas without graft.

  3. Anal incontinence in women with recurrent obstetric anal sphincter rupture

    DEFF Research Database (Denmark)

    Bøgeskov, Reneé; Nickelsen, Carsten Nahne Amtoft; Secher, Niels Jørgen

    2015-01-01

    UNLABELLED: Abstract Objectives: To determine the risk of recurrent anal sphincter rupture (ASR), and compare the risk of anal incontinence (AI) after recurrent ASR, with that seen in women with previous ASR who deliver by caesarean section or vaginally without sustaining a recurrent ASR. METHODS...... uncomplicated vaginal delivery or caesarean section. RESULTS: There were 93 437 vaginal deliveries. ASR occurred in 5.5% (n = 2851) of the nulliparous and 1.5% (n = 608) of the multiparous women. Recurrent ASR occurred in 8% (n = 49) of whom 50% reported symptoms of AI. We found no difference in the occurrence...... of AI between women with recurrent ASR, and those who delivered vaginally without repeat ASR (p = 0.37; OR = 2.0) or by caesarean section (p = 0.77; OR = 1.3). CONCLUSION: Women with a past history of ASR have an 8% risk of recurrence. AI affects half of the women with recurrent ASR. Larger studies...

  4. The role for dickkopf-homolog-1 in the pathogenesis of Crohn's disease-associated fistulae.

    Directory of Open Access Journals (Sweden)

    Sandra Michaela Frei

    Full Text Available BACKGROUND: One of the most challenging conditions in Crohn's disease (CD patients is the treatment of perianal fistulae. We have recently shown that epithelial-to-mesenchymal transition (EMT plays a crucial role during CD-fistulae development. Dickkopf-homolog 1 (DKK-1 is known to play a key role during EMT. Here, we investigated a role for DKK-1 in the pathogenesis of CD-associated fistulae. METHODS: Dkk-1 protein expression in CD-fistula specimens were investigated by immunohistochemistry. Colonic lamina propria fibroblasts (CLPF were obtained from either non-IBD control patients or patients with fistulizing CD. HT-29 intestinal epithelial cells (IEC were either grown as monolayers or spheroids. Cells were treated with either TNF-α, TGF-β or IL-13. Knock-down of DKK-1 or β-Catenin was induced in HT-29-IEC by siRNA technique. mRNA expression was determined by real-time-PCR. RESULTS: Dkk-1 protein was specifically expressed in transitional cells lining the fistula tracts. TGF-β induced DKK-1 mRNA expression in HT-29-IEC, but decreased it in fistula CLPF. On a functional level, DKK-1 knock-down prevented TGF-β-induced IL-13 mRNA expression in HT-29-IEC. Further, loss of β-Catenin was accompanied by reduced levels of DKK-1 and, again, IL-13 in IEC in response to TGF-β. In turn, treatment of HT-29-IEC as well as fistula CLPF with IL-13 resulted in decreased levels of DKK-1 mRNA. Treatment with TNF-α or the bacterial wall component, muramyl-dipeptide, decreased DKK-1 mRNA levels in HT-29-IEC, but enhanced it in fistula CLPF. DISCUSSION: We demonstrate that DKK-1 is strongly expressed in cells lining the CD-fistula tracts and regulates factors involved in EMT initiation. These data provide evidence for a role of DKK-1 in the pathogenesis of CD-associated perianal fistulae.

  5. Acute abscess with fistula: long-term results justify drainage and fistulotomy.

    Science.gov (United States)

    Benjelloun, E B; Jarrar, A; El Rhazi, K; Souiki, T; Ousadden, A; Ait Taleb, K

    2013-09-01

    Conventional treatment of anal abscess by a simple drainage continues to be routine in many centers despite retrospective and randomized data showing that primary fistulotomy at the time of abscess drainage is safe and efficient. The purpose of this study is to report the long-term results of fistulotomy in the treatment of anal abscesses. This is a prospective nonrandomized study of 165 consecutive patients treated for anal abscess in University Hospital Hassan II, Fez, Morocco, between January 2005 and December 2010. Altogether 102 patients were eligible to be included in the study. Among them, 52 were treated by a simple drainage and 50 by drainage with fistulotomy. The results were analyzed in terms of recurrence and incontinence after a median follow-up of 3.2 years (range 2-6 years). The groups were comparable in terms of age, gender distribution, type and size of abscess. The recurrence rate after surgery was significantly higher in the group treated by drainage alone (88 %) compared to other group treated by drainage and fistulotomy (4, 8 %) (p anal abscess with good long-term results. An exception is a high fistula, where fistulotomy may be associated with a risk of recurrence and incontinence.

  6. Cholecystoduodenal fistula in a porcelain gallbladder

    Energy Technology Data Exchange (ETDEWEB)

    Delpierre, I.; Tack, D.; Delcour, C. [Department of Radiology, CHU-Hopital Civil de Charleroi, 92 Boulevard Janson, 6000 Charleroi (Belgium); Moisse, R. [Department of Gastroenterology, CHU-Hopital Civil de Charleroi, 92 Boulevard Janson, 6000 Charleroi (Belgium); Boudaka, W. [Department of Surgery, CHU-Hopital Civil de Charleroi, 92 Boulevard Janson, 6000 Charleroi (Belgium)

    2002-09-01

    Calcification of the gallbladder wall (porcelain gallbladder) is rare. Its appearance is quite characteristic on plain films, ultrasonography and computed tomography. Sporadic cases of cholecystitis have been described in porcelain gallbladders. Enterobiliary fistula may complicate acute or chronic cholecystitis in non-calcified gallbladder. We report a unusual case of acute cholecystitis with cholecystoduodenal fistula in a porcelain gallbladder. (orig.)

  7. Computed tomography demonstration of cholecystogastric fistula

    Directory of Open Access Journals (Sweden)

    Chung Kuao Chou, MD, MPH

    2016-06-01

    Full Text Available Cholecystogastric fistula is a rare complication of chronic cholecystitis or long-standing cholelithiasis. It results from the gradual erosion of the approximated, chronically inflamed wall of the gall bladder and stomach with fistulous tract formation. The present case describes the direct visualization of a cholecystogastric fistula by computed tomography in a patient without prior biliary system complaints.

  8. Spontaneous Resolution of Direct Carotid Cavernous Fistula

    NARCIS (Netherlands)

    Ishaq, Mazhar; Arain, Muhammad Aamir; Ahmed, Saadullah; Niazi, Muhammad Khizar; Khan, Muhammad Dawood; Iqbal, Zamir

    2010-01-01

    Proptosis due to carotid cavernous fistula is rare sequelae of head injury. We report a case of post-traumatic, direct high flow carotid cavernous fistula that resolved spontaneously 06 weeks after carotid angiography. It however, resulted in loss of vision due to delay in early treatment. In the ca

  9. Diagnosis and treatment of inflammatory intestinovesical fistulas.

    Science.gov (United States)

    Szentgyörgyi, E; Kondás, J; Szöke, D; Balogh, A; Orbán, L

    1989-01-01

    The histories of 3 patients operated for inflammatory intestinovesical fistulas are reviewed. Two of them were treated for colovesical, one for ileovesical fistula. The questions concerning the development, diagnostics and surgical management are discussed in detail. The importance of cystoscopy in diagnosis is emphasized. In all three patients one-session operations were performed with good results.

  10. Urethral diverticulo-rectal fistula in AIDS.

    Science.gov (United States)

    Lee, W H; Yang, W J; Rha, K H; Chang, K H; Kim, J M; Lee, M S

    2001-10-01

    A 41-year-old heterosexual African man was evaluated for persistent urethral discharge, pneumaturia and watery diarrhea. Radiographic and endoscopic procedures established the diagnosis of a rectourethral fistula. The differential diagnosis of an acquired rectourethral fistula and the significance of AIDS are discussed.

  11. Vector Volume Flow in Arteriovenous Fistulas

    DEFF Research Database (Denmark)

    Hansen, Peter Møller; Heerwagen, Søren; Pedersen, Mads Møller;

    2013-01-01

    , but is very challenging due to the angle dependency of the Doppler technique and the anatomy of the fistula. The angle independent vector ultrasound technique Transverse Oscillation provides a new and more intuitive way to measure volume flow in an arteriovenous fistula. In this paper the Transverse...

  12. Rapid tumor progression in a patient with HPV type 16 associated anal squamous cell carcinoma suffering from long-standing Crohn's disease: A case report

    Directory of Open Access Journals (Sweden)

    Fischer AK

    2016-10-01

    Full Text Available Background and aim: Squamous cell carcinoma (SCC is the most common cancer of the anal region, typically associated with high-risk (hr HPV infection. Furthermore, there is evidence that Crohn's disease predisposes to adenocarcinoma in patients with perianal disease. Materials and methods: A 57-year old patient presenting with long history of Crohn's disease since the age of mid-twenties, went through several surgeries including ileocolectomy and anal fistula resection, combined with immunosuppressive therapy additionally periodically since 2008. One year before death (in 2015 a painful fistula was diagnosed with extensive high grade anal intraepithelial neoplasia (AIN-HG and evidence of invasive growth as non-keratinizing SCC. Tissue samples from several previous and current resection specimens were re-evaluated and extensively investigated for Crohn´s type inflammation, dysplasia and HPV both by immunohistochemistry (p16/Ki67 and molecular subtyping of HPV. Results: AIN-HG and invasive anal squamous cell carcinoma turned out to be strongly positive for p16/Ki67 staining and molecular analysis disclosed a HPV-16 subtype. In contrast, HPV-analysis was negative in all available previous tissue samples including one anal fistula resected five years before (in 2009 which was lined by non-keratinized squamous epithelium without any evidence of dysplasia. Thus, the patient was diagnosed as Crohn's disease with hr-HPV infection that rapidly (< 5ys progressed to AIN-HG and anal SCC. Finally, osseous metastases occurred and the patient died shortly after. Conclusions: This case of a patient diagnosed with SCC of the anal canal in combination with Crohn's disease as well as HPV Type 16 infection, points to the pathomechanism leading to dysplasia and finally cancer. We assume that immunosuppressive therapy in Crohn's disease may predispose to both persistent HPV infection and HPV related invasive anal carcinoma. The accelerated progression of HPV

  13. Milk Fistula: Diagnosis, Prevention, and Treatment.

    Science.gov (United States)

    Larson, Kelsey E; Valente, Stephanie A

    2016-01-01

    Milk fistula is an uncommon condition which occurs when there is an abnormal connection that forms between the skin surface and the duct in the breast of a lactating woman, resulting in spontaneous and often constant drainage of milk from this path of least resistance. A milk fistula is usually a complication that results from a needle biopsy or surgical intervention in a lactating patient. Here, the authors present an unusual case of a spontaneous milk fistula which developed from an abscess in the breast of a lactating woman. The patient initially presented to the office with a large open wound on her breast, formed from skin breakdown, within which milk was pooling. She was treated with local wound care and cessation of breastfeeding, with appropriate healing of the wound and closure of the fistula with 6 weeks. Diagnosis, prevention, and treatment of milk fistula were reviewed.

  14. Physiologic assessment of coronary artery fistula

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, N.C.; Beauvais, J. (Creighton Univ., Omaha, NE (USA))

    1991-01-01

    Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery.

  15. Recto-vestibular disruption defect resulted from the malpractice in the treatment of the acquired recto-vestibular fistula in infants

    Institute of Scientific and Technical Information of China (English)

    Ting-Chong Zhang; Wen-Bo Pang; Ya-Jun Chen; Jin-Zhe Zhang

    2007-01-01

    AIM: To explore the pathogenesis of the rectovestibular disruption (RVD) defect and to recommend a successful repair, and prevention of it.METHODS: Clinical records of 15 girls, age ranged from 3 to 15 (median, 7.5) years, with acquired rectovestibular fistula (RVF) mistreated before were retrospectively reviewed. All of them presented an abnormal appearance of perineum and were suffering from some degree of fecal incontinence, and those were graded Ⅲ to Ⅳ by Li Zheng's Score. Repair of anal sphincters and reconstruction of perineum body and skin by anterior perineal rectoanoplasty were performed in all cases.RESULTS: Operation in all cases was successful. The perineum looked practically normal and fecal continence score rose up to Ⅵ by Li Zheng's Score.CONCLUSION: The conventional treatment for anal fistula, lay-open or string-treatment, should beconsidered as malpractice of RVF, and certainly leads to the RVD defect, and the anterior perineal rectoanoplasty could cure it satisfactorily.

  16. Fistulotomy and drainage of deep postanal space abscess in the treatment of posterior horseshoe fistula

    Directory of Open Access Journals (Sweden)

    Gencosmanoglu Rasim

    2003-11-01

    Full Text Available Abstract Background Posterior horseshoe fistula with deep postanal space abscess is a complex disease. Most patients have a history of anorectal abscess drainage or surgery for fistula-in-ano. Methods Twenty-five patients who underwent surgery for posterior horseshoe fistula with deep postanal space abscess were analyzed retrospectively with respect to age, gender, previous surgery for fistula-in-ano, number of external openings, diagnostic studies, concordance between preoperative studies and operative findings for the extent of disease, operating time, healing time, complications, and recurrence. Results There were 22 (88% men and 3 (12% women with a median age of 37 (range, 25–58 years. The median duration of disease was 13 (range, 3–96 months. There was one external opening in 12 (48% patients, 2 in 8 (32%, 3 in 4 (16%, and 4 in 1 (4%. Preoperative diagnosis of horseshoe fistula was made by contrast fistulography in 4 (16% patients, by ultrasound in 3 (12%, by magnetic resonance imaging in 6 (24%, and by physical examination only in the remainder (48%. The mean ± SD operating time was 47 ± 10 min. The mean ± SD healing time was 12 ± 3 weeks. Three of the 25 patients (12% had diabetes mellitus type II. Nineteen (76% patients had undergone previous surgery for fistula-in-ano, while five (20% had only perianal abscess drainage. Neither morbidity nor mortality developed. All patients were followed up for a median of 35 (range, 6–78 months and no recurrence was observed. Conclusions Fistulotomy of the tracts along the arms of horseshoe fistula and drainage of the deep postanal space abscess with posterior midline incision that severs both the lower edge of the internal sphincter and the subcutaneous external sphincter and divides the superficial external sphincter into halves gives excellent results with no recurrence. When it is necessary, severing the halves of the superficial external sphincter unilaterally or even bilaterally in the

  17. Aortoesophageal fistula in a child

    Directory of Open Access Journals (Sweden)

    Shasanka Shekhar Panda

    2013-01-01

    Full Text Available Aortoesophageal fistulae (AEF are rare and are associated with very high mortality. Foreign body ingestions remain the commonest cause of AEF seen in children. However in a clinical setting of tuberculosis and massive upper GI bleed, an AEF secondary to tuberculosis should be kept in mind. An early strong clinical suspicion with good quality imaging and endoscopic evaluation and timely aggressive surgical intervention helps offer the best possible management for this life threatening disorder. Our case is a 10-year-old boy who presented to the pediatric emergency with massive bouts of haemetemesis and was investigated and managed by multidisciplinary team effort in the emergency setting.

  18. A tiny dural arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    ZHANG Peng 张 鹏; ZHU Fengshui 朱风水; LING Feng 凌 锋; Christophe COGNARD

    2003-01-01

    @@ Pulsatile tinnitus is commonly encountered in approximately 10% of a given population.1 Since causes of the disease vary, selecting appropriate protocols of imaging strategies is quite challenging.2 Vascular anormalies or diseases including anormalies of the carotid arteries and jugular veins, intracranial arteriovenous malformation and dural arteriovenous fistula (DAVF) are major causative factors of the disease. Before imaging studies, history inquiry and physical examination are important for detect the possible causes of pulsatile tinnitus. Different imaging examinations are depended on histories and clinical signs of different patients.

  19. Radiologic recognition of bronchopleural fistula.

    Science.gov (United States)

    Friedman, P J; Hellekant, C A

    1977-08-01

    Examination of more than 30 cases of bronchopleural fistula (BPF), of diverse causes, including 6 following resectional surgery, revealed a distinctive configuration of air/fluid collections in the pleural space. Maler in 1940 independently observed that loculated BPF pockets conform in shape to the adjacent chest wall. With the most common posterior costophrenic angle location, there is a wide air-fluid level in the frontal view, but on lateral films the anteroposterior diameter is narrow. In contrast, abscess cavities tend to be spherical and farther from the ribs. Use of these plain film criteria permits earlier and more confident diagnosis.

  20. Neuronal hyperplasia in the anal canal

    DEFF Research Database (Denmark)

    Fenger, C; Schrøder, H D

    1990-01-01

    In a consecutive series of minor surgical specimens from the anal canal, neuronal hyperplasia was found in nine of 56 haemorrhoidectomy specimens and in four of 23 fibrous polyps. In an additional series of 14 resections of the anal canal, neuronal hyperplasia was present in six cases, of which...

  1. Anal intraepithelial neoplasia in HIV+ men

    NARCIS (Netherlands)

    Richel, O.

    2014-01-01

    In this thesis we investigated several aspects of anal intraepithelial neoplasia (AIN) in HIV+ men who have sex with men (MSM). This condition has gained clinical interest because of the impressive increase of the anal cancer incidence in HIV+ MSM since the introduction of combination antiretroviral

  2. Nocturnal faecal soiling and anal masturbation.

    OpenAIRE

    Clark, A. F.; Tayler, P J; Bhate, S R

    1990-01-01

    Two cases of late onset faecal soiling as a result of anal masturbation in children who were neither mentally handicapped nor psychotic were studied. The role of soiling in aiding the young person and his family to avoid separating and maturing is highlighted. We suggest that the association of anal masturbation and resistant nocturnal soiling may be unrecognised.

  3. 肛瘘护理体会%Nursing Experience of Anal Fistula

    Institute of Scientific and Technical Information of China (English)

    吴岚

    2011-01-01

    @@ 肛管或直肠腔与肛门外皮肤相通的一种异常管道称为肛管直肠瘘,简称肛瘘.中医学认为,凡窍内生瘘,脓血淋漓不止者,称为瘘,又称为痔漏.本病可由感染湿热余毒,蕴结不散,气滞血郁而成毒,化热成腐所致.或因肺、脾、肾三阴亏损.或因肛裂损伤,邪毒内生,构成直肠周围痈疽溃破后,由于正气不足,无以驱邪外出,久不收口,形成本病.

  4. O Proceso analítico

    OpenAIRE

    Yebra Biurrun, María del Carmen

    2013-01-01

    Esta unidade didáctica enfócase de maneira que permita proporcionar unha visión global da Química Analítica e a súa terminoloxía básica, mostrando a importancia da Química Analítica para a resolución de problemas de diversos ámbitos. Este enfoque faise sobre o esquema do proceso analítico como medio de resolución dunha determinada problemática analítica real. Deste xeito, partindo dun esquema sinxelo, explícase o obxectivo e as distintas etapas do proceso analítico: definición do problema...

  5. Synchronous rectal adenocarcinoma and anal canal adenocarcinoma

    Institute of Scientific and Technical Information of China (English)

    GU Jin; LI Jiyou; YAO Yunfeng; LU Aiping; WANG Hongyi

    2007-01-01

    It is difficult to distinguish a tectal carcinoma with anal metastases from coexistent synchronous anorectal carcinomas.The therapeutic strategy for rectal and anal carcinoma is so different that it should be clearly identified.Here,we report on the case of a 63-year-old man who presented with an upper-third rectal adenocarcinoma.Five months after resection,he developed an adenocarcinoma in the anal canal.The histological slides of both tumors were reviewed and immunohistochemical studies for cytokeratins(CKs)7 and 20 were performed.The index tumor demonstrated CK 7-/CK 20+and the second showed CK7+/CK20+.For this reason,we believe the present case had synchronous adenocarcinomas arising from anal canal and the rectum separately.It is very important to difierentiate the anorectal lesions pathologically because of the impact on the therapeutic options available,especially for the lesion arising in the anal canal.

  6. Enterovesical Fistulae: Aetiology, Imaging, and Management

    Directory of Open Access Journals (Sweden)

    Tomasz Golabek

    2013-01-01

    Full Text Available Background and Study Objectives. Enterovesical fistula (EVF is a devastating complication of a variety of inflammatory and neoplastic diseases. Radiological imaging plays a vital role in the diagnosis of EVF and is indispensable to gastroenterologists and surgeons for choosing the correct therapeutic option. This paper provides an overview of the diagnosis of enterovesical fistulae. The treatment of fistulae is also briefly discussed. Material and Methods. We performed a literature review by searching the Medline database for articles published from its inception until September 2013 based on clinical relevance. Electronic searches were limited to the keywords: “enterovesical fistula,” “colovesical fistula” (CVF, “pelvic fistula”, and “urinary fistula”. Results. EVF is a rare pathology. Diverticulitis is the commonest aetiology. Over two-thirds of affected patients describe pathognomonic features of pneumaturia, fecaluria, and recurrent urinary tract infections. Computed tomography is the modality of choice for the diagnosis of enterovesical fistulae as not only does it detect a fistula, but it also provides information about the surrounding anatomical structures. Conclusions. In the vast majority of cases, this condition is diagnosed because of unremitting urinary symptoms after gastroenterologist follow-up procedures for a diverticulitis or bowel inflammatory disease. Computed tomography is the most sensitive test for enterovesical fistula.

  7. Enterovesical Fistulae: Aetiology, Imaging, and Management

    Science.gov (United States)

    Golabek, Tomasz; Szymanska, Anna; Szopinski, Tomasz; Bukowczan, Jakub; Furmanek, Mariusz; Powroznik, Jan; Chlosta, Piotr

    2013-01-01

    Background and Study Objectives. Enterovesical fistula (EVF) is a devastating complication of a variety of inflammatory and neoplastic diseases. Radiological imaging plays a vital role in the diagnosis of EVF and is indispensable to gastroenterologists and surgeons for choosing the correct therapeutic option. This paper provides an overview of the diagnosis of enterovesical fistulae. The treatment of fistulae is also briefly discussed. Material and Methods. We performed a literature review by searching the Medline database for articles published from its inception until September 2013 based on clinical relevance. Electronic searches were limited to the keywords: “enterovesical fistula,” “colovesical fistula” (CVF), “pelvic fistula”, and “urinary fistula”. Results. EVF is a rare pathology. Diverticulitis is the commonest aetiology. Over two-thirds of affected patients describe pathognomonic features of pneumaturia, fecaluria, and recurrent urinary tract infections. Computed tomography is the modality of choice for the diagnosis of enterovesical fistulae as not only does it detect a fistula, but it also provides information about the surrounding anatomical structures. Conclusions. In the vast majority of cases, this condition is diagnosed because of unremitting urinary symptoms after gastroenterologist follow-up procedures for a diverticulitis or bowel inflammatory disease. Computed tomography is the most sensitive test for enterovesical fistula. PMID:24348538

  8. 脱细胞真皮基质治疗伴高位盲瘘的复杂性肛瘘疗效观察(附39例报告)%Acellular Dermal Matrix treatment of high blind fistula of 39 Cases

    Institute of Scientific and Technical Information of China (English)

    田颖; 于洪顺; 秦澎湃; 王彦芳; 田磊; 葛强; 刘智永

    2012-01-01

    目的 探讨高位盲瘘的微创治疗方法,研究脱细胞真皮基质在高位盲瘘治疗中的应用价值.方法 39例高位盲瘘患者,手术分2期进行,经括约肌或括约肌间肛瘘合并高位盲瘘Ⅰ期齿线下瘘管切开、内口挂线并高位盲瘘旷置引流,括约肌上肛瘘切开内口并高位盲瘘旷置引流;Ⅱ期高位盲瘘脱细胞真皮基质填塞治疗.观察Ⅱ期手术时间、术中出血、术后疼痛、住院总天数、住院总费用及复发率等临床及相关指标.结果 39例患者中有26例获得Ⅰ期治愈,13例患者治疗失败,改行肛瘘切开挂线术后痊愈.高位盲瘘脱细胞真皮填塞术手术治愈率66.7%.括约肌上并发高位盲瘘治愈2例,治愈率100%,经括约肌并发高位盲瘘治愈6例,治愈率50%,括约肌间并发高位盲瘘治愈18例,治愈率72%.结论 应用脱细胞真皮基质材料治疗高位盲瘘具有损伤小、愈合时间短、肛门失禁率低、外形保留好等优势,值得进一步推广.%Objective To investigate the minimally invasive treatment of high blind fistula, acellular dermal matrix in the high blind fistula treatment value. Methods high blind fistula two cases: 39 cases of patients with high blind fistula, anal sphincter, sphincter anal fistula complicated by high blind fistula of 12 cases, anal sphincter between concurrent high blind fistula of 25 cases. Operation in two, fistulotomy anal sphincter or sphincter merge high blind fistula I of the dentate line, inside the mouth hung high blind fistula exclusion drainage, anal sphincter incision inside the mouth and the high blind fistula exclusion fistula drainage; II high blind acellular dermal matrix filling treatment observation period II surgery time, blood loss, postoperative pain, total hospital days, hospital clinical and related indicators of the total cost and the relapse rate. Results 39 patients, 26 cases of a cure, 13 cases of treatment failure in patients diverted a-nal incision

  9. [Secondary aorto-enteric fistula].

    Science.gov (United States)

    Giordanengo, F; Boneschi, M; Miani, S; Erba, M; Beretta, L

    1998-01-01

    Aortic graft fistula is a rare and life-threatening complication after aortic reconstruction. The incidence ranges from 0.5 to 4%, and even if the diagnosis and treatment is appropriate, the results of surgery are poor: mortality rate ranges from 14 to 70%. The optimal method of treatment is still controversial; prosthetic removal and extra-anatomic bypass has been advocated as the standard method, but more recently, because the high mortality rate associated with this procedure, some have prompted to recommend in situ aortic graft replacement as a more successful treatment. Personal experience with incidence (0.7%) outcome and mortality (57%) in 7 patients treated over a period of 6 years (1990-1996) is reported. Results from this group are compared with another group (6 patients) previously treated (1975-1982) for the same pathology. Our results after 10 years, show the same incidence (0.7 vs 0.6%) and an elevated and unchanged mortality (57 vs 66%). Better results in the management of aorto-enteric fistulas could be achieved with the removal of infected infrarenal aortic prosthetic grafts and in situ homografts replacement.

  10. Increased anal basal pressure in chronic anal fissures may be caused by overreaction of the anal-external sphincter continence reflex

    NARCIS (Netherlands)

    van Meegdenburg, Maxime M.; Trzpis, Monika; Heineman, Erik; Broens, Paul M. A.

    2016-01-01

    Chronic anal fissure is a painful disorder caused by linear ulcers in the distal anal mucosa. Even though it counts as one of the most common benign anorectal disorders, its precise etiology and pathophysiology remains unclear. Current thinking is that anal fissures are caused by anal trauma and pai

  11. Viscoelastic assessment of anal canal function using acoustic reflectometry

    DEFF Research Database (Denmark)

    Mitchell, Peter J; Klarskov, Niels; Telford, Karen J;

    2012-01-01

    Anal acoustic reflectometry is a new reproducible technique that allows a viscoelastic assessment of anal canal function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, opening and closing elastance, and hysteresis.......Anal acoustic reflectometry is a new reproducible technique that allows a viscoelastic assessment of anal canal function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, opening and closing elastance, and hysteresis....

  12. Post-traumatic recto-spinal fistula

    Energy Technology Data Exchange (ETDEWEB)

    Lantsberg, L.; Greenberg, G. [Department of Surgery A, Soroka University Medical Center, Beer-Sheva (Israel); Laufer, L.; Hertzanu, Y. [Department of Diagnostic Radiology, Soroka University Medical Center, Beer-Sheva (Israel)

    2000-01-01

    Acquired recto-spinal fistula has been described elsewhere as a rare complication of colorectal malignancy and Crohn's enterocolitis. We treated a young man who developed a recto-spinal fistula as a result of a high fall injury. The patient presented with meningeal signs, sepsis and perianal laceration. Computerized axial tomography revealed air in the supersellar cistern. Gastrografin enema showed that contrast material was leaking from the rectum into the spinal canal. Surgical management included a diverting sigmoid colostomy, sacral bone curettage and wide presacral drainage. To the best of our knowledge, rectospinal fistula of traumatic origin has not been previously reported in the English literature. (orig.)

  13. Diagnosis and management of colovesical fistulas.

    Science.gov (United States)

    Shatila, A H; Ackerman, N B

    1976-07-01

    Diagnosis and management may present difficult problems in patients with colovesical fistulas. Symptoms in the urinary tract are most common, and cystoscopy, and cystography are the most valuable diagnostic procedures. It may not always be possible to demonstrate the fistula by diagnostic tests, and a high index of suspicion should be maintained in patients with inflammatory or neoplastic disease of the rectosigmoid area or bladder with recurrent cystitis. Definitive treatment should include resection of the fistula and diseased segment of the intestine. Both one stage and multistage procedures have their place in the treatment of this condition. There are specific criteria for success for a one stage procedure.

  14. Vesicoovarian Fistula on an Endometriosis Abscessed Cyst

    Directory of Open Access Journals (Sweden)

    C. Tran

    2014-01-01

    Full Text Available We report the case of a patient who developed a vesicoovarian fistula on an endometriosis abscessed cyst. The patient presented with an advanced endometriosis stage IV complicated with a right ovarian abscessed cyst of 10 cm. A first coelioscopy with cystectomy was realized. After surgery, a voiding cystography highlighted a fistula between the ovarian abscess and the bladder. A second surgery by median laparotomy was realized with the resection of the right ovarian abscess and the resection of vesical fistula.

  15. Anal cancer and intraepithelial neoplasia screening: Areview

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    This review focuses on the early diagnosis of anal cancer and its precursor lesions through routine screening. Anumber of risk-stratification strategies as well as screeningtechniques have been suggested, and currently littleconsensus exists among national societies. Much ofthe current clinical rationale for the prevention of analcancer derives from the similar tumor biology of cervicalcancer and the successful use of routine screening toidentify cervical cancer and its precursors early in thedisease process. It is thought that such a strategy ofidentifying early anal intraepithelial neoplasia will reducethe incidence of invasive anal cancer. The low prevalenceof anal cancer in the general population prevents theuse of routine screening. However, routine screeningof selected populations has been shown to be a morepromising strategy. Potential screening modalities includedigital anorectal exam, anal Papanicolaou testing, humanpapilloma virus co-testing, and high-resolution anoscopy.Additional research associating high-grade dysplasiatreatment with anal cancer prevention as well as directcomparisons of screening regimens is necessary todevelop further anal cancer screening recommendations.

  16. Anal erogeneity: the goose and the rat.

    Science.gov (United States)

    Shengold, L

    1982-01-01

    A case is presented in which the patient's traumatically derived intense anal erogeneity (associated with traumatic anxiety as well as with castration anxiety) inhibited his phallic sensations and potency and also his power to sustain productive thought. His passive cravings were disguised and reacted against in his compulsive-exhibitionistically phallic role of a Don Juan. He described at least two levels of anal feelings: a dangerous but exciting, tolerable or even pleasurable tension associated with the imago of the goose; and an unbearable, terrifying overcharged level embodied in the imago of the rat. (He had read of, and had felt himself identified with, Freud's Rat Man.) Contrasts are presented with François Rabelais' account of the instinctual development and anal training of Gargantua, in which the connotations of the goose lead to a happy anal, phallic and intellectual control. Generalizations are ventured about the crucial attainment of command over the anal sphincter for the taming of 'primal affect'(Fliess). With early psychopathology there is a defensive overcathexis of anal control (and of anal mechanisms and character traits) to try to contain over-stimulation. In contrast true anal mastery contributes to the acquisition of optimal genital feelings and functioning and to the capacity for sustaining integrative thinking so necessary for 'owning' one's affects and impulses, and therefore for a feeling of identity. Finally, some remarks of Freud on Rabelais are reviewed in relation to levels of urethral erogeneity, seen as developmental way stations between the anal and the phallic, and partaking of both.

  17. Colovesical Fistula After Renal Transplantation: Case Report.

    Science.gov (United States)

    Imafuku, A; Tanaka, K; Marui, Y; Sawa, N; Ubara, Y; Takaichi, K; Ishii, Y; Tomikawa, S

    2015-09-01

    Colovesical fistula is a relatively rare condition that is primarily related to diverticular disease. There are few reports of colovesical fistula after renal transplantation. We report of a 53-year-old man who was diagnosed with colovesical fistula after recurrent urinary tract infection, 5 months after undergoing cadaveric renal transplantation. Laparoscopic partial resection of the sigmoid colon with the use of the Hartmann procedure was performed. Six months after that surgery, there was no evidence of recurrent urinary tract infection and the patient's renal graft function was preserved. Physicians should keep colovesical fistula in mind as a cause of recurrent urinary tract infection in renal transplant recipients, especially in those with a history of diverticular disease.

  18. Tratamento dos datos analíticos

    OpenAIRE

    Yebra Biurrun, María del Carmen

    2008-01-01

    Esta unidade didáctica é a primeira toma de contacto do alumnado co estudo do tratamento dos datos analíticos e a comprobación da súa calidade. Este estudo poderase completar máis adiante dentro do programa desta materia cando se presente o resto dos parámetros de calidade dos métodos analíticos. A importancia deste tema radica en que unha vez obtidos os datos analíticos, o primeiro aspecto que se ten que considerar é a verificación da calidade dos mesmos en termos de exactitude e precisió...

  19. Doenças anais concomitantes à doença hemorroidária: revisão de 1.122 pacientes Anal diseases associated to hemorrhoids: review of 1.122 patients

    Directory of Open Access Journals (Sweden)

    Geraldo Magela Gomes da Cruz

    2006-12-01

    main cause of the symptoms presented was achieved in 9,289 patients (27.3% being hemorrhoid associated with several anorectal diseases in 1,122 patients (12.1%. 2,417 patients of the patients underwent hemorrhoidectomy (26.0% and 729 of theese patients were operated on for associated anal diseases at the same time (65.0%. The most frequently diagnosed associated anal diseases were anal fissures (541 cases, 5.8% and hyperthrofied anal papila (312 cases, 3.4% folowed by anal fistulae (117 cases, 1.3%, partial fecal incontinence (112 cases, 1.2%, anal condyloma (37 cases, 0,4% and anal tumors (3 cases, 0,03%. The same order of incidence was verified in relation to the 1,122 cases of associated anal diseases: anal fissures (48.2%, hyperthrofied anal papila (27.8%, anal fistulae (10.4%, partial fecal incontinence (10.0%, anal condyloma (3.3% and anal tumors (0,3%. As far as associated anal diseases are concerned (1,122 cases, the incidence of surgery was 65.5% (729 patients in this order: fissurectomy (317 cases, 28.3%, anal papilectomy (267 cases, 23.8%, anal fistulectomy (89 cases, 7.9%, partial fecal incontinence (31 cases, 2.8%, resection of anal condylomata (22 cases, 1.9%, resection of anal tumors (3 cases, 0.3%. And as far as each associated anal disease is concerned the incidence of surgery was the following: resection of anal tumors (100,0%, papilectomy (85.6%, fistulectomy (76.0%, resection of anal condylomata (59.6%, fissurectomy (58.6% and partial fecal incontinence (25.8%. Associated anal diseases with the highest proportion of confirmation of proctologic diagnosis by the histopathologic examination were anal fistula (100.0% of 89 operated patients, anal condyloma (100.0% of 22 operated patients, hyperthrophied anal papilla (79.0% - 211 - of 267 operated patients, anal fissure (68.5% - 217 - of 317 operated patients and anal cancer (66.7% - 2 of 3 operated patients.

  20. Bronchobiliary Fistula Evaluated with Magnetic Resonance Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Ragozzino, A.; Rosa, R. De; Galdiero, R.; Maio, A.; Manes, G. [Aorn Cardarelli Napoli (Italy). Dept. di Gastroenterologia

    2005-08-01

    Bronchobiliary fistula (BBF) is a rare disorder consisting of a passageway between the biliary ducts and the bronchial tree. Many conditions may give rise to this development. Management of these fistulas is often difficult and can be associated with high morbidity and mortality rates. We present a case of BBF developing after hemihepatectomy in a 74-year-old man treated with endoscopic biliary drainage and illustrate MRCP findings.

  1. Vesicoovarian Fistula on an Endometriosis Abscessed Cyst

    OpenAIRE

    2014-01-01

    We report the case of a patient who developed a vesicoovarian fistula on an endometriosis abscessed cyst. The patient presented with an advanced endometriosis stage IV complicated with a right ovarian abscessed cyst of 10 cm. A first coelioscopy with cystectomy was realized. After surgery, a voiding cystography highlighted a fistula between the ovarian abscess and the bladder. A second surgery by median laparotomy was realized with the resection of the right ovarian abscess and the resection ...

  2. Locality-dependent descending reflex motor activity in the anal canal-cholinergic and nitrergic contributions in the rat model

    Institute of Scientific and Technical Information of China (English)

    Radomir RADOMIROV; Christina IVANCHEVA; Dimitar ITZEV; Polina PETKOVA-KIROVA

    2009-01-01

    Aim: Since the distal part of the intestine is targeted by a wide range of pathogens, the motility of the recto-anal region has been the object of many experimental and clinical observations. In this study, we investigated descending motor responses in the anal canal as a measure of the activation of autonomic reflex pathways underlying evacuatory recto-anal activity. Methods: The partitioned organ bath method was used to register motor responses of the anal canal as induced by balloon distension of the rectum in isolated rat recto-anal preparations. Results: Distension-induced descending responses of the anal canal comprised contractions (with distension at a distance of 15 mm), initial contractions and secondary relaxations (at 10 mm) and short contractions followed by deep relaxations (at 3-5 mm). Decreas-ing the distance between the distension stimulus and the anal canal resulted in a decreased contraction response and increased relaxation. Tetrodotoxin (0.1 μmol/L) inhibited these responses. Atropine (0.3 μmol/L) decreased contraction and did not change the relaxation response. N~G-nitro-L-arginine (0.5 mmol/L) enhanced contraction in both the absence and presence of atropine. L-arginine (0.5 mmol/L) inhibited contraction and extended relaxation in atropine-pretreated preparations. The actions of N~G-nitro-L-arginine and L-arginine were more pronounced in the aboral direction. ChAT-positive nerve fibers were observed in myenteric ganglia of the rectum and the anal canal. The density of NADPH-diaphorase-positive neurons was higher in the anal canal region. Conclusion: Our results suggest that locality-dependent activation of the descending reflex neuromuscular communications underlie evacuatory activity in the recto-anal region. This activation response involves long excitatory cholinergic and non-cholinergic pathways along the rectum and short inhibitory nitrergic pathways located predominantly in the anal canal region.

  3. Tracheoesophageal fistula associated with paracoccidioidomicosis

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nogueira

    2011-09-01

    Full Text Available Paracoccidioidomycosis is a systemic fungal disease caused byParacoccidioides brasiliensis, agent geographically distributed to certainareas of Central and South America. The infection by P. brasiliensis hasbeen reported from north Mexico to south Argentina. Paracoccidioidomycosispresents similar clinical findings of many other diseases whatever in acute or chronic scenarios. Chronic pulmonary paracoccidioidomycosis is frequentlymisdiagnosed as malignancy or tuberculosis. The authors present a caseof a 57 year-old man admitted to the hospital due to a chronic consumptivesyndrome. He underwent anti-tuberculous treatment with rifampin, isoniazid andpyrazinamide 1 year ago without resolution of the simptoms. During the clinicalinvestigation, pulmonary paracoccidioidomycosis with tracheoesophagealfistula was diagnosed. The systemic infection was treated with deoxicolate Bamphotericin followed by sulfametoxazole and trimetoprin due to acute renalfunction impairment. The fistula was endoscopically treated; inittialy with theprotection of left main bronchus with a tracheal prosthesis followed by theesophageal fistula’s ostium clipping.

  4. Novalis Stereotactic Radiosurgery for Spinal Dural Arteriovenous Fistula.

    Science.gov (United States)

    Sung, Kyoung-Su; Song, Young-Jin; Kim, Ki-Uk

    2016-07-01

    The spinal dural arteriovenous fistula (SDAVF) is rare, presenting with progressive, insidious symptoms, and inducing spinal cord ischemia and myelopathy, resulting in severe neurological deficits. If physicians have accurate and enough information about vascular anatomy and hemodynamics, they achieve the good results though the surgery or endovascular embolization. However, when selective spinal angiography is unsuccessful due to neurological deficits, surgery and endovascular embolization might be failed because of inadequate information. We describe a patient with a history of vasospasm during spinal angiography, who was successfully treated by spinal stereotactic radiosurgery using Novalis system.

  5. Anal Cancer: What Happens After Treatment?

    Science.gov (United States)

    ... see the section Understanding Recurrence . For patients with colostomies Most people treated for anal cancer don’t ... APR, you will need to have a permanent colostomy. If you have a colostomy, follow-up is ...

  6. Fractal dimension and image statistics of anal intraepithelial neoplasia

    Energy Technology Data Exchange (ETDEWEB)

    Ahammer, H., E-mail: helmut.ahammer@medunigraz.a [Institute of Biophysics, Center of Physiological Medicine, Medical University of Graz, Harrachgasse 21, A-8010 Graz (Austria); Kroepfl, J.M. [Human Performance Research Graz (HPR Graz), Karl-Franzens and Medical University of Graz, Max-Mell Allee 11, A-8010 Graz (Austria); Hackl, Ch. [Research Group of Applied Theoretical Pathology, Department of Pathology, Country Medical Centre St.Poelten, Propst Fuehrer Strasse 4, A-3100 St.Poelten (Austria); Sedivy, R. [Research Group of Applied Theoretical Pathology, Department of Pathology, Country Medical Centre St.Poelten, Propst Fuehrer Strasse 4, A-3100 St.Poelten (Austria); Department of Pathology, Country Medical Centre St.Poelten, Propst Fuehrer Strasse 4, A-3100 St.Poelten (Austria)

    2011-01-15

    Research Highlights: Human papillomaviruses cause anal intraepithelial neoplasia (AIN). Digital image processing was carried out to classify the grades of AIN quantitatively. The fractal dimension as well as grey value statistics was calculated. Higher grades of AIN yielded higher values of the fractal dimension. An automatic detection system is feasible. - Abstract: It is well known that human papillomaviruses (HPV) induce a variety of tumorous lesions of the skin. HPV-subtypes also cause premalignant lesions which are termed anal intraepithelial neoplasia (AIN). The clinical classification of AIN is of growing interest in clinical practice, due to increasing HPV infection rates throughout human population. The common classification approach is based on subjective inspections of histological slices of anal tissues with all the drawbacks of depending on the status and individual variances of the trained pathologists. Therefore, a nonlinear quantitative classification method including the calculation of the fractal dimension and first order as well as second order image statistical parameters was developed. The absolute values of these quantitative parameters reflected the distinct grades of AIN very well. The quantitative approach has the potential to decrease classification errors significantly and it could be used as a widely applied screening technique.

  7. Radiologic evaluation of the continent (S-pouch) ileal reservoir with anal anastomosis

    Energy Technology Data Exchange (ETDEWEB)

    Hennild, V.; Kjaergaard, H.; Kuld Hansen, L.

    A radiologic investigation was performed in 26 patients subjected to colectomy, mucosal proctectomy and endorectal ileo-anal anastomosis after the creation of an ileal reservoir. The patients had suffered from ulcerative colitis or familial polyposis. The reservoir and its efferent leg was best demonstrated by contrast enema. The size and position of the reservoir and the efferent leg was demonstrated, and stenoses, abscesses and fistulae could be identified. Examination of the small bowel with a contrast medium showed slight dilatation of the ileum orally to the reservoir in all instances and one patient had a stenosis at the junction of the afferent leg of the reservoir. Erect and supine projections of the abdomen showed gas in the intestine and fluid levels in the reservoir. These radiographic findings should not be confused with ileus or pelvic abscess. Radiology was of great value in disclosing postoperative complications.

  8. Late results of mucosal proctectomy and colo-anal sleeve anastomosis for chronic irradiation rectal injury

    Energy Technology Data Exchange (ETDEWEB)

    Browning, G.G.P.; Varma, J.S.; Smith, A.N.; Small, W.P.; Duncan, W.

    1987-01-01

    Ten patients with severe chronic irradiation injury to the rectum were treated by mucosal proctectomy and colo-anal sleeve anastomosis. The indications were: recurrent rectal bleeding (five), stricture (three), fistula (one) and intractable pain (one). Overall follow-up has ranged from 8 to 77 months (mean 40 months). In the present survivors (n=7) the follow-up ranges from 18 to 77 months (mean 52 months). Six patients have been followed up for more than 3 years and four for more than 5 years. There was no operative mortality. Three anastomotic strictures occurred but the protecting stoma could be closed in all but one patient. Continence was acceptable although urgency and frequency of defaecation were troublesome symptoms. The operation is recommended for life-threatening, haemorrhagic chronic irradiation injury to the rectum.

  9. Kryptorkisme hos drenge med anal atresi

    DEFF Research Database (Denmark)

    Cortes, Dina; Thorup, J M; Nielsen, Ole Henrik;

    1996-01-01

    was the incidence of cryptorchidism. The incidence of renal and ureteric malformations and dysplasias showed a parallel tendency. The incidence of vertebral malformations and dysplasias in the T10-S5 area was low among patients with a covered anus or a perineal fistula. Cryptorchidism was found to be associated...

  10. German S3-Guideline: Rectovaginal fistula [Deutsche S3-Leitlinie: Rektovaginale Fistel

    Directory of Open Access Journals (Sweden)

    Ommer, Andreas

    2012-10-01

    Full Text Available [english] Background: Rectovaginal fistulas are rare, and the majority is of traumatic origin. The most common causes are obstetric trauma, local infection, and rectal surgery. This guideline does not cover rectovaginal fistulas that are caused by chronic inflammatory bowel disease.Methods: A systematic review of the literature was undertaken. Results: Rectovaginal fistula is diagnosed on the basis of the patient history and the clinical examination. Other pathologies should be ruled out by endoscopy, endosonography or tomography. The assessment of sphincter function is valuable for surgical planning (potential simultaneous sphincter reconstruction.Persistent rectovaginal fistulas generally require surgical treatment. Various surgical procedures have been described. The most common procedure involves a transrectal approach with endorectal suture. The transperineal approach is primarily used in case of simultaneous sphincter reconstruction. In recurrent fistulas. Closure can be achieved by the interposition of autologous tissue (Martius flap, gracilis muscle or biologically degradable materials. In higher fistulas, abdominal approaches are used as well. Stoma creation is more frequently required in rectovaginal fistulas than in anal fistulas. The decision regarding stoma creation should be primarily based on the extent of the local defect and the resulting burden on the patient.Conclusion: In this clinical S3-Guideline, instructions for diagnosis and treatment of rectovaginal fistulas are described for the first time in Germany. Given the low evidence level, this guideline is to be considered of descriptive character only. Recommendations for diagnostics and treatment are primarily based the clinical experience of the guideline group and cannot be fully supported by the literature.[german] Hintergrund: Rektovaginale Fisteln stellen eine seltene Erkrankung dar. Die Mehrzahl der rektovaginalen Fisteln ist traumatischer Genese. Die wichtigsten

  11. Report of 2 cases of misdiagnosed vesicouterine fistula.

    Science.gov (United States)

    Petrikovets, Andrey; Lespinasse, Pierre F

    2014-01-01

    Vesicouterine fistula is a rare complication that may occur after multiple cesarean deliveries. The following reports describe cases where vesicouterine fistula was misdiagnosed; one was initially treated for urge incontinence, and the other was treated for stress urinary incontinence.

  12. Imaging diagnosis of dural and direct cavernous carotid fistulae

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Daniela dos; Monsignore, Lucas Moretti; Nakiri, Guilherme Seizem; Cruz, Antonio Augusto Velasco e; Colli, Benedicto Oscar; Abud, Daniel Giansante, E-mail: danisantos2404@gmail.com [Universidade de Sao Paulo (HCFMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

    2014-07-15

    Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. They are classified into dural cavernous sinus fistulae or direct carotid-cavernous fistulae. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid-cavernous fistulae, but it is possible to differentiate one type from the other. Amongst the available imaging methods (Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography), angiography is considered the gold standard for the diagnosis and classification of cavernous sinus arteriovenous fistulae. The present essay is aimed at didactically presenting the classification and imaging findings of cavernous sinus arteriovenous fistulae. (author)

  13. Gangrenous cystitis: a rare cause of colovesical fistula

    OpenAIRE

    1999-01-01

    A case of gangrenous cystitis presenting as a colovesical fistula in an elderly woman is described. The literature on this rare condition is reviewed.


Keywords: gangrenous cystitis; colovesical fistula

  14. Clinical efficacy of combined therapy for perianal eczema caused by anal diseases in 160 cases

    Directory of Open Access Journals (Sweden)

    Zhi-Chao LIU

    2007-01-01

    Full Text Available Perianal eczema is a kind of inflammatory dermatosis on the perianal skin and mucosa. The aim of the study was to evaluate the clinical efficacy of the combined therapy of medicine and operation for the perianal eczema caused by the anal diseases such as hemorrhoids, fissures and fistulas. One hundred and sixty patients with perianal eczema were involved in this study. They were randomly divided into four groups and treated by different therapies for four weeks respectively. Group A (40 patients was only treated with medicine, Group B (40 patients only with operation, Group C (40 patients firstly with medicine and then with operation and Group D (40 patients firstly with operation and then with medicine. The efficacy was determined as reduction of lesion size relative to initial size. The cure rate was 22.50%, 32.50%, 57.50% and 45.00% in Group A, B, C and D, respectively. The effective rate was 40.00%, 52.50%, 85.00% and 75.00%, respectively. The efficacy was significantly different (H=20.8689, g = 3, P value =0.0001. The results of group comparison showed that there were significant difference between Group C and Group A, Group C and Group B, Group D and Group A (all P values, < 0.05. It was concluded that the combined therapy of medicine and operation is optimal choice for the perianal eczema caused by the anal diseases such as hemorrhoids, fissures, and fistula. It highly improves the cure rate and efficacy rate.

  15. COMPARATIVE STUDY OF FISTULECTOMY BY CORING TECHNIQUE IN FISTULA IN ANO, USING RADIOFREQUENCY CAUTERY AND MONOPOLAR CAUTERY

    Directory of Open Access Journals (Sweden)

    Madhura M

    2015-12-01

    Full Text Available Fistula in ano is common condition in perineal region. Anorectal fistulas are divided into four distinct types according to the Parks’ classification: intersphincteric, transsphincteric, suprasphincteric, and extrasphincteric.1 The ultimate goal of fistula surgery is to eradicate it without disturbing or disturbing minimally the anal sphincter mechanism. The radiofrequency scalpel is an innovative instrument, which allows cutting and coagulating tissues in an atraumatic manner and which facilitates in accelerating and improving the surgical procedure conversely to the electric scalpel.2 This prospective study which will be conducted in a single centre and in this study we are comparing use of monopolar cautery and radiofrequency cautery units for the patients with fistula in ano operated during the period of February 2012 to February 2015. All fistulas will be treated by fistulectomy using coring technique. Results will be analyzed on following points like intraoperative bleeding, clearance of visual field, intra- and post-operative odema, and time required for every procedure, recurrence. AIMS AND OBJECTIVES OF STUDY 1. To compare intraoperative bleeding during surgery using both the units (cautery/RF cautery during surgery. 2. To assess clearance of field of vision intraoperatively. 3. To see for intraoperative and post-operative edema. 4. To assess time required for the procedure. 5. Final results in terms of recurrence. CONCLUSION Radiofrequency ablation is better method for fistulectomy compared to monopolar cautery in terms of intraoperative blood loss, post-operative pain, oedema, and healing period. But if procedure is better taken care of recurrence is avoidable. Operative time required for monopolar cautery exceeds radiofrequency cautery.

  16. A Content Incontinent: Report of Liposomal Bupivacaine Induced Fecal Incontinence

    Directory of Open Access Journals (Sweden)

    Emanuel A. Shapera

    2016-01-01

    Full Text Available Proper surgical management of anal fistula demands sound clinical judgment and extraordinary care to prevent incontinence and adequate postoperative pain control and provide satisfactory resolution to optimize quality of life. Fecal incontinence can be a devastating complication of procedures performed for fistula in ano. We report a unique case in which temporary incontinence (for less than 4 days followed injection of liposomal bupivacaine for postoperative pain control after draining seton placement for fistula in ano. Patients and physicians should be aware as it may be mistaken for a more serious anatomical and permanent cause of fecal incontinence.

  17. Splenic arteriovenous fistula treated with percutaneous transarterial embolization

    DEFF Research Database (Denmark)

    Madsen, M.A.; Frevert, S.; Madsen, P.L.;

    2008-01-01

    Splenic arteriovenous fistula is a rare complication following splenectomy. We report a case of a large splenic arteriovenous fistula 23 years after splenectomy in a 50-year old male with abdominal pain, gastro-intestinal bleeding, ascites, diarrhoea, dyspnoea, portal hypertension and heart failure....... The arteriovenous fistula was successfully treated with percutaneous transarterial embolization and the patient gained almost complete recovery. This case demonstrates the usefulness of embolization of an otherwise surgical demanding arteriovenous fistula Udgivelsesdato: 2008/11...

  18. Colo-vesical fistula: Complete healing without surgical intervention

    OpenAIRE

    2014-01-01

    INTRODUCTION Colo-vesical (CV) fistulae are the most common type of fistulae associated with diverticular disease. Surgery remains the mainstay of treatment, without which, CV fistulae rarely achieve complete healing. PRESENTATION OF CASE Herein, we report the case of a 62-year-old man who developed a CV fistula after reversal of Hartmann's procedure (initially for management of diverticular abscess), which healed with conservative management alone. DISCUSSION We discuss possibilities of the ...

  19. ENTEROHEPATIC FISTULA ASSOCIATED WITH LIVER ABSCESS - AN EXTREMELY RARE PRESENTATION

    OpenAIRE

    Vedaraju; Srinivas,; Ashwini; Vijayaraghavachari; Adarsh; Riya Jeeson

    2015-01-01

    Gastrointestinal (GI) fistulas represent abnormal duct like communications between the gut and another epithelial - lined surface , such as another organ system , the skin surface , or elsewhere along the GI tract itself. (1) The development of a GI fistula can markedly increase patient morbidity and mortality , rendering detection of the fistula critical. Imaging often plays a pivotal role in the diagnosis and management of GI fistula....

  20. Urachus Fistula: A Rare First Presentation of Diverticulitis

    Directory of Open Access Journals (Sweden)

    C. Dickhoff

    2008-09-01

    Full Text Available Urachus fistulas are rare, especially in adulthood. In grown-ups urachus fistulas are usually a reflection of Crohn’s disease. We present a patient in whom an urachus fistula was the first presentation of diverticulitis of the sigmoid colon. The need for proper preoperative diagnostic imaging is discussed.

  1. Colovesical fistula resulting from a perforated colonic duplication.

    Science.gov (United States)

    Decter, R M; Kaplan, K M; Eggli, K D; Krummel, T M

    1998-09-01

    Colovesical fistulas in children are most often associated with high anorectal imperforations. Acquired enterovesical fistulas in children only rarely have been reported as a consequence of an inflammatory process. We present a case of an acquired colovesical fistula formed by the erosion of an abscess at the distal end of a colonic duplication in a child who presented with fever of unknown origin.

  2. Effects of arteriovenous fistulas on cardiac oxygen supply and demand

    NARCIS (Netherlands)

    Bos, W.J.W.; Zietse, R.; Wesseling, K.H.; Westerhof, N.

    1999-01-01

    Background. Arteriovenous (AV) fistulas used for hemodialysis access may affect cardiac load by increasing the preload while decreasing the afterload. In dogs, AV fistulas have also been shown to affect coronary perfusion negatively. We investigated the net effect of AV fistulas on cardiac oxygen su

  3. Changes in aetiological determinants of urinary fistula

    Institute of Scientific and Technical Information of China (English)

    Prosper E. Gharoro; Chukwunwendu A. Okonkwo

    2009-01-01

    Objective: Objective: To investigate the localization and aetiological factors associated with urinary fistulae at the University Teaching Hospital in Benin-City, Nigeria. Methods: Records on 96 patients treated by the authors at the gynaecological ward of the University of Benin Teaching Hospital, Benin-City, Nigeria between January 1997 and December 2006 were analyzed. Information extracted and analyzed included data on socio-biological, demographic, and obstetric event of the antecedent pregnancy. Results: The average age of patients with vesico-vaginal fistula(VVF) was 34 years with a mean parity of 3. The various mean values for patients' height, weight and body mass index (BMI) were 1.58m, 58.29kg and 24.13 respectively. The majority (92.7%) of fistulas are obstetric in origin. While 5.21% were due to total abdominal hysterectomy and 2.08% due to post irradiation for advanced gynecological malignancy. 53(55.21%) patients had obstetric operative interventions (Forceps or vacuum extraction, and or caesarean section). Caesarean section contributed 23.96% to the total figure. Juxta-cervical fistula was the most frequent, next mid vagina and followed by vesico-uterine (32. 98%, 24.4% and 19.15% respectively).Conclusion: Obstetric surgical intervention by care providers is a major cause of VVF formation with particular reference to Caesarean section. Vesico-uterine fistulas are on the increase.

  4. Pneumobilia,chronic diarrhea,vitamin K malabsorption:A pathognomonic triad for cholecystocolonic fistulas

    Institute of Scientific and Technical Information of China (English)

    Savvoula Savvidou; John Goulis; Alexandra Gantzarou; George Ilonidis

    2009-01-01

    Cholecystocolonic fistula (CF) is an uncommon type of internal biliary-enteric fistulas,which comprise rare complications of cholelithiasis and acute cholecystitis,with a prevalence of about 2% of all biliary tree diseases.We report a case of a spontaneous CF in a 75-year-old diabetic male admitted to hospital for the investigation of chronic watery diarrhea and weight loss.Massive pneumobilia demonstrated on abdominal ultrasound and computerized tomography,along with chronic,bile acid-induced diarrhea and a prolonged prothrombin time due to vitamin K malabsorption,led to the clinical suspicion of the fistula.Despite further investigation with barium enema and magnetic resonance cholangio-pancreatography,diagnosis of the fistulous tract between the gallbladder and the hepatic flexure of the colon could not be established preoperatively.Open cholecystectomy with fistula resection and exploration of the common bile duct was the preferred treatment of choice,resulting in an excellent postoperative clinical course.The incidence of biliary-enteric fistulas is expected to increase due to the parallel increase of iatrogenic interventions to the biliary tree with the use of endoscopic retrograde cholangio-pancreatography and the increased rate of cholecystectomies performed.Taking into account that advanced imaging techniques fail to demonstrate the fistulas tract in half of the cases,and that CFs usually present with non-specific symptoms,our report could assist physicians to keep a high index of clinical suspicion for an early and valid diagnosis of a CF.

  5. Transarterial detachable coil embolization combined with ipsilateral intermittent carotid oppression for traumatic carotid-cavernous fistula with small fistula

    Institute of Scientific and Technical Information of China (English)

    Qing Huang; Hongbing Zhang; Gang Wang; Jun Yang; Yanlong Hu; Jianxin Liu

    2015-01-01

    One case of traumatic carotid-cavernous fistula (TCCF) with small fistula treated by transarterial detachable coil embolization was reported.The intermittent ipsilateral carotid compression was used to identify the final blocking of the residual fistula.The follow-up digital subtraction angiography showed that the TCCF was cured finally, From this case, we conclude that this method may be an effective way to treat TCCF with small fistula.

  6. Eguchipsammia fistula Microsatellite Development and Population Analysis

    KAUST Repository

    Mughal, Mehreen

    2012-12-01

    Deep water corals are an understudied yet biologically important and fragile ecosystem under threat from recent increasing temperatures and high carbon dioxide emissions. Using 454 sequencing, we develop 14 new microsatellite markers for the deep water coral Eguchipsammia fistula, collected from the Red Sea but found in deep water coral ecosystems globally. We tested these microsatellite primers on 26 samples of this coral collected from a single population. Results show that these corals are highly clonal within this population stemming from a high level of asexual reproduction. Mitochondrial studies back up microsatellite findings of high levels of genetic similarity. CO1, ND1 and ATP6 mitochondrial sequences of E. fistula and 11 other coral species were used to build phylogenetic trees which grouped E. fistula with shallow water coral Porites rather than deep sea L. Petusa.

  7. Successful tubes treatment of esophageal fistula

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Aim: To discuss the merits of "tubes treatment" for esophageal fistula (EF). Methods: A 66-year-old female who suffered from a bronchoesophageal and esophagothoratic fistula underwent a successful "three tubes treatment" (close chest drainage, negative pressure suction at the leak, and nasojejunal feeding tube), combination of antibiotics, antacid drugs and nutritional support. Another 55-year-old male patient developed an esophagopleural fistula (EPF) after esophageal carcinoma operation. He too was treated conservatively with the three tubes strategy as mentioned above towards a favorable outcome. Results:The two patients recovered with the tubes treatment, felt well and became able to eat and drink, presenting no complaint. Conclusion: Tubes treatment is an effective basic way for EF. It may be an alternative treatment option.

  8. Vascular access for hemodialysis: arteriovenous fistula.

    Science.gov (United States)

    Malovrh, Marko

    2005-06-01

    The long-term survival and quality of life of patients on hemodialysis (HD) is dependant on the adequacy of dialysis via an appropriately placed vascular access. The optimal vascular access is unquestionably the autologous arteriovenous fistula (AVF), with the most common method being the conventional radio-cephalic fistula at the wrist. Recent clinical practice guidelines recommend the creation of native fistula or synthetic graft before the start of chronic HD therapy to prevent the need for complication-prone dialysis catheters. This could also have a beneficial effect on the rapidity of worsening kidney failure. A multidisciplinary approach (nephrologists, surgeons, radiologists and nurses) should improve the HD outcome by promoting the use of AVF. An important additional component of this program is the Doppler ultrasound for preoperative vascular mapping. Such an approach may be realized without unsuccessful surgical explorations, with a minimal early failure rate and a high maturation, even in patients with diabetes mellitus.

  9. Mucinous adenocarcinoma arising from chronic anorectal fistulas and review of the literatures%慢性肛瘘继发黏液腺癌诊治分析(附4例报告)

    Institute of Scientific and Technical Information of China (English)

    吴瑶; 刘连成; 陈希琳

    2011-01-01

    Objective To evaluate the clinical features, pathology, treatment, and outcome of patients with fistula-associated anal adenocarcinoma. Methods A retrospective study was made to analyze clinical,treatment, and pathological features of 4 cases mucinous adenocarcinoma from chronic anal fistula. Results The canceration of anal fistula was due to chronic inflammation and scarring. The definitive diagnosis of the carcinoma depends on biopsy of the fistula and the related tumor. Conclusion If surgical treatment for perineal abscess or anorectal fistula is not successful for a long time, mucinous adenocarcinoma should be suspected. Biopsy of fistulous tracts and perianal abscesses are thus paramount in the early diagnosis and subsequent treatment of these tumours.%目的 探讨肛瘘继发黏液腺癌临床特点、病理、治疗和预后.方法 对4例病例的临床表现、治疗方法进行回顾性分析.结果 反复发作的慢性炎症刺激是肛瘘癌变的主要诱因,确诊依靠瘘管及相关肿物的病理学活检.结论 对于长期不愈的脓肿和/或肛瘘患者,应保持警惕黏液腺癌可能,对于瘘道或脓肿周围组织活检有助于早期诊断和治疗.

  10. [Acquired coronary-cameral fistula complicated by a ventricular pseudoaneurysm].

    Science.gov (United States)

    Hammami, R; Bosmans, J; Voormolen, M; Vermeulen, T; Salgado, R; Vrints, C

    2013-12-01

    Coronary-cameral fistulas are usually congenital, rarely acquired; the complication of this anomaly with ventricular pseudoaneurysm is exceptional. We report a new case of acquired coronary-cameral fistula, occurred in a patient who had received a bypass graft and who had suffered from angina 1 year after the surgery. On computed tomography coronary angiography, the fistula seems to communicate the first diagonal to a left ventricle pseudoaneurysm. Embolization of the fistula and filling of the pseudoaneurysm by neurocoil were successfully performed. The clinical and angiographic control after 3 months showed symptoms improvement and absence of recanalization of the fistula.

  11. [Colo-anal anastomosis. Our experience].

    Science.gov (United States)

    Morlino, A; Tramutola, G; Rossi, M T; Scutari, F

    2009-03-01

    The aim of study is to report the results of our experience about ultra-low rectum carcinomas treated with anterior resection and colo-anal anastomosis. The surgery still represents the treatment of choice for the cancer of the rectum. The problems concern the conservation of the sphincter functions (anal and urethral), and sexual function and the reduction of the locoregional recurrences. From 2005 to 2007, 33 patients underwent surgery for low and ultralow rectal carcinoma (30 treated with neoadjuvant radio-chemotherapy, and 3 only with surgery). In 16 of these we have performed a colo-anal anastomosis, in 11 an ultralow colorectal anastomosis and in 7 a Miles resection. We report our updated results.

  12. Lymphogranuloma Venereum Presenting as a Rectovaginal Fistula

    Directory of Open Access Journals (Sweden)

    C. M. Lynch

    1999-01-01

    Full Text Available Lymphogranuloma venereum (LGV is a rare form of the sexually transmitted disease caused by Chlamydia trachomatis. In the United States, there are fewer than 350 cases per year. In a review of the world’s literature, there has not been a case reported in the last thirty years of a case ofLGV presenting as a rectovaginal fistula. We present a case of an otherwise healthy American woman who presented with a rectovaginal fistula. Although uncommon, LGV does occur in developed countries and may have devastating tissue destruction if not recognized and treated before the tertiary stage. Infect. Dis. Obstet. Gynecol. 7:199–201, 1999.

  13. Aortocaval Fistula in a Behcet's Disease Patient

    Directory of Open Access Journals (Sweden)

    Yusuf Ata

    2009-01-01

    Full Text Available Behcet's disease (BD is a chronic, recurrent, systemic disease that is characterized by oral and genital ulcers and oculocutaneous inflammatory lesions. Cardiovascular involvement especially large artery involvement is a serious and vital complication of BD. Pseudoaneurysms in the major arteries may be the cause of sudden death in BD. In our case a pulsatile abdominal mass was determined to be an aortic pseudoaneurysm associated with BD and an aortocaval fistula. Here we report this case and a short review of literature because this is the first reported aortocaval fistula in a BD patient in English literature.

  14. Conservative Management of a Delayed Neovesicocutaneous Fistula

    Directory of Open Access Journals (Sweden)

    Koichi Kodama

    2014-01-01

    Full Text Available A neovesicocutaneous fistula is a rare complication after orthotopic bladder reconstruction, particularly in the late postoperative period. We report the case of a 59-year-old man who had undergone ileal neobladder construction 17 months previously. He presented with urinary retention concomitant with urinary tract infection due to a neovesicourethral anastomotic stricture. After a combination of transurethral catheter drainage and broad-spectrum antibiotic therapy for 3 weeks, the fistulous tract completely closed. Therefore, conservative treatment may be regarded as a valid option for a delayed neovesicocutaneous fistula.

  15. [A gastropleural fistula can be treated thoracoscopically].

    Science.gov (United States)

    Laugesen, Sofie; Nekrasas, Vytautas; Haahr, Poul Erik

    2014-09-29

    Gastropleural fistula (GPF) is although uncommon a severe and sometimes fatal complication after prior thoracic surgery, trauma or malignancy. Standard therapy has often included major surgery such as laparotomia with gastrectomi. In this case report we present a patient with GPF who underwent thoracoscopia for closure of the fistula. To our knowledge this is the first report of its kind in the Danish and English literature. Thoracoscopic treatment of GPF may be associated with less morbidity and mortality, and should be considered as the initial procedure of choice.

  16. Fistulas carótido cavernosa

    OpenAIRE

    2014-01-01

    Las fistulas carotido-cavernosas son patologías vasculares relativamente infrecuentes que tiene una etiología de mayor frecuencia traumática que espontanea. Su diagnóstico no siempre es sencillo y requiere de conocer la patología para poder tener la sospecha clínica y poder brindar solución de manera rápida y minimizar secuelas. El tratamiento de las fistulas ha mejorado con el tiempo y con el advenimiento de la cirugía endovascular, con esto se han ido descubriendo mejores accesos y mecanism...

  17. Colovesical fistula demonstrated on renal cortical scintigraphy.

    Science.gov (United States)

    Stathaki, Maria; Vamvakas, Lampros; Papadaki, Emmanouela; Papadimitraki, Elisavet; Tsaroucha, Angeliki; Karkavitsas, Nikolaos

    2012-11-01

    A 70-year-old man with a history of weight loss, changes in bowel habits, and hematochezia had rectal adenocarcinoma. He was palliated with diverting colostomy, followed by radiochemotherapy. Bilateral hydronephrosis was found incidentally on lower abdominal CT scan. He underwent 99mTc dimercaptosuccinic acid scan prior to percutaneous nephrostomy tube placement. Apart from the renal cortex, scintigraphy showed activity in the ascending colon continuous to the activity of the bladder. This indicated urine extravasation on account of a colovesical fistula, complicating postoperative radiation treatment. Here we highlight the contribution of renal cortical scintigraphy in the detection of colovesical fistulas.

  18. Laparoscopic repair for vesicouterine fistulae

    Directory of Open Access Journals (Sweden)

    Rafael A. Maioli

    2015-10-01

    Full Text Available ABSTRACT Objective: The purpose of this video is to present the laparoscopic repair of a VUF in a 42-year-old woman, with gross hematuria, in the immediate postoperative phase following a cesarean delivery. The obstetric team implemented conservative management, including Foley catheter insertion, for 2 weeks. She subsequently developed intermittent hematuria and cystitis. The urology team was consulted 15 days after cesarean delivery. Cystoscopy indicated an ulcerated lesion in the bladder dome of approximately 1.0cm in size. Hysterosalpingography and a pelvic computed tomography scan indicated a fistula. Materials and Methods: Laparoscopic repair was performed 30 days after the cesarean delivery. The patient was placed in the lithotomy position while also in an extreme Trendelenburg position. Pneumoperitoneum was established using a Veress needle in the midline infra-umbilical region, and a primary 11-mm port was inserted. Another 11-mm port was inserted exactly between the left superior iliac spine and the umbilicus. Two other 5-mm ports were established under laparoscopic guidance in the iliac fossa on both sides. The omental adhesions in the pelvis were carefully released and the peritoneum between the bladder and uterus was incised via cautery. Limited cystotomy was performed, and the specific sites of the fistula and the ureteral meatus were identified; thereafter, the posterior bladder wall was adequately mobilized away from the uterus. The uterine rent was then closed using single 3/0Vicryl sutures and two-layer watertight closure of the urinary bladder was achieved by using 3/0Vicryl sutures. An omental flap was mobilized and inserted between the uterus and the urinary bladder, and was fixed using two 3/0Vicryl sutures, followed by tube drain insertion. Results: The operative time was 140 min, whereas the blood loss was 100ml. The patient was discharged 3 days after surgery, and the catheter was removed 12 days after surgery

  19. Radiological findings in biliary fistula and gallstone ileus

    Energy Technology Data Exchange (ETDEWEB)

    Oikarinen, H. [Univ. Hospital, Oulu (Finland). Dept. of Diagnostic Radiology; Paeivaensalo, M. [Univ. Hospital, Oulu (Finland). Dept. of Diagnostic Radiology; Tikkakoski, T. [Univ. Hospital, Oulu (Finland). Dept. of Diagnostic Radiology; Saarela, A. [Univ. Hospital, Oulu (Finland). Dept. of Surgery

    1996-11-01

    Purpose: Biliary fistual and gallstone ileus are rarely found. The diagnosis is difficult and may be delayed until operation. We reviewed the radiological findings in a retrospective material. Material and Methods: The cases of 16 patients treated for biliary fistula were analyzed with respect to findings at imaging. Ten patients had a spontaneous fistula. Nine of them had an internal bilioduodenal fistula and one had an external fistula with stones passing through a subcutaneous abscess. Five patients also had gallstone ileus and one patient a rare gastric outlet obstruction caused by a gallstone (Bouveret`s syndrome). Six patients had an iatrogenic fistula. One of them had internal bile ascites and 5 an external fistula, one of which was a biliocystic fistula resulting from attempted hepatic cyst sclerotherapy. Results: Various imaging modalities were used and there was often a delay in the diagnosis. Imaging did not show the fistula itself in any of the spontaneous cases. However, a nonvisualized or shrunken gallbladder seen at US often coexisted in these cases. CT yielded the diagnosis in one case of gallstone ileus, and a Gastrografin metal yielded it in the case of Bouveret`s syndrome. Fistulography and cholangiography provided a correct diagnosis of fistula in all cases of iatrogenic biliocutaneous fistulas. Conclusion: Patients with biliary fistula usually undergo examinations with nonspecific results. The imaging findings could be more specific if the possibility of this diagnosis were remembered. (orig.).

  20. A Delayed Recrudescent Case of Sigmoidocutaneous Fistula due to Diverticulitis

    Directory of Open Access Journals (Sweden)

    Takaaki Fujii

    2007-10-01

    Full Text Available Colocutaneous fistula caused by diverticulitis is relatively rare, and a delayed recrudescent case of colocutaneous fistula is very uncommon. We herein report a rare case of a Japanese 56-year-old male with delayed recrudescent sigmoidocutaneous fistula due to diverticulitis. A colocutaneous fistula was formed after a drainage operation against a perforation of the sigmoid colon diverticulum. After 5 years from treatment, he was admitted to our hospital because of lower abdominal pain. We diagnosed the recrudescent sigmoidocutaneous fistula by abdominal computed tomography and gastrografin enema, and managed the patient with total parenteral nutrition and antibiotics. As the fistula formation did not improve, a low anterior resection with fistulectomy was performed. The postoperative course was uneventful and the patient was discharged. It has been reported that, in fistulas of the skin caused by diverticular disease, complete closure of the fistula by conservative therapy may not be possible. This case also implies the possibility of a recurrence of the fistula even if the conservative treatment was effective. In cases of colocutaneous fistulas due to diverticulitis, radical surgery is considered necessary because of possibility of recurrence of the fistula.

  1. Epidemiology and outcome of patients with postoperative abdominal fistula

    Directory of Open Access Journals (Sweden)

    Janaina Wercka

    2016-04-01

    Full Text Available ABSTRACT Objective: to present the epidemiological profile, incidence and outcome of patients who developing postoperative abdominal fistula. Methods: This observational, cross-sectional, prospective study evaluated patients undergoing abdominal surgery. We studied the epidemiological profile, the incidence of postoperative fistulas and their characteristics, the outcome of this complication and the predictors of mortality. Results: The sample consisted of 1,148 patients. The incidence of fistula was 5.5%. There was predominance of biliary fistula (26%, followed by colonic fistulas (22% and stomach (15%. The average time to onset of fistula was 6.3 days. For closure, the average was 25.6 days. The mortality rate of patients with fistula was 25.4%. Predictors of mortality in patients who developed fistula were age over 60 years, presence of comorbidities, fistula closure time more than 19 days, no spontaneous closure of the fistula, malnutrition, sepsis and need for admission to the Intensive Care Unit Conclusion: abdominal postoperative fistulas are still relatively frequent and associated with significant morbidity and mortality.

  2. Secondary Iliac-Enteric Fistula to the Sigmoid Colon Complicated with Entero-Grafto-Cutaneous Fistula

    Directory of Open Access Journals (Sweden)

    Gábor Bognár

    2008-04-01

    Full Text Available We report the case of a 67-year-old man who was admitted to our department with acute rectal bleeding. The patient had had previous aortoiliac surgery with the utilization of an aortobifemoral vascular prosthesis. Diagnosis of aortoenteric fistula was made between the distal suture line of the right graft leg and the sigmoid colon. This fistula had an enterocutaneous component. After exploratory laparotomy, primary resection of the sigmoid colon, exstirpation of the enterocutaneous fistula, excision of the right graft leg and extraanatomical crossover bypass were successfully performed. This study reports a rare type of aorto/ilac-enteric fistula to the left colon complicated with an entero-grafto-cutaneous component and describes an unusual and successful surgical treatment method.

  3. Why do we have to review our experience in managing cases with idiopathic fistula-in-ano regularly?

    Institute of Scientific and Technical Information of China (English)

    Claudio Fucini; Iacopo Giani

    2011-01-01

    "Why do we have to review our experience in managing idiopathic fistula-in-ano regularly?" In order to answer this apparently simple question, we reviewed our clinical and surgical cases and most important relevant literature to find a rational and scientific answer. It would appear that whatever method you adopt in fistula management, there is a price to pay regarding either rate of recurrence (higher with conservative methods) or impairment of continence (higher with traditional surgery). Since, at the moment, reliable data to identify a treatment as a gold standard in the management of anal fistulas are lacking, the correct approach to this condition must consider all the anatomic and clinicopathological aspects of the disease; this knowl-edge joined to an eclectic attitude of the surgeon, who should be familiar with different types of treatment, is the only guarantee for a satisfactory treatment. As a conclu-sion, it is worthwhile to remember that adequate initial treatment significantly reduces recurrence, which, when it occurs, is usually due to failure to recognise the tract and primary opening at the initial operation.

  4. 痔、瘘围手术期中西医护理心得%Nursing Experience of Chinese and Western Medicine in the Perioperative Period of Hemorrhoids and Fistula

    Institute of Scientific and Technical Information of China (English)

    孙惠芳

    2015-01-01

    目的简述混合痔、肛瘘患者的最佳护理效果。方法回顾性总结40例混合痔、40例肛瘘住院患者围手术期间运用中西医结合护理,取得良好的临床护理效果。结果所有患者都顺利治愈,无并发症发生。结论对混合痔、肛瘘患者从入院至出院进行中西医护理,取得较好的效果。%Objective The best nursing results of the mixed hemor hoid, anal fistula patients. Methods A retrospective summary of 40 cases of mixed hemor hoid, 40 cases of hospitalized patients with anal fistula perioperative period by Integrated Traditional Chinese and Western medicine combined with nursing, obtain good clinical nursing ef ect. Results Al patients were cured without complications. Conclusion The patients with mixed hemor hoid, anal fistula from admission to discharge of traditional Chinese medicine and Western medicine nursing, achieved good results.

  5. Surgical Repair of Congenital Recto-Vaginal Fistula with Atresia Ani in a Cow Calf

    Directory of Open Access Journals (Sweden)

    Abdul Shakoor, Sayyed Aun Muhammad, Muhammad Younus and Muhammd Kashif

    2012-05-01

    Full Text Available A three days old cross bred cow calf affected with recto-vaginal fistula along with atresia ani and fusion of vulvular lips was presented to the Veterinary Teaching Hospital, College of Veterinary and Animal Sciences, Jhang. Emergency surgery was done after the infiltration of local anesthesia at the approximated site of anus. Blind rectal pouch was incised to suture it with the skin by using black breaded silk #1. A 3 inches long incision was made at the site of vulvular fusion to restore the normal genitalia. After exposing the defective site, 4 inches long slit causing direct communication between rectum and vagina (Recto-vaginal fistula was obliterated with chromic cat gut # 1. Having washed with normal saline, Neomycine Sulphate ointment was smeared twice a day at the newly constructed anal opening for two weeks. A course of antibiotic consisting of penicillin and streptomycin was administered intramuscularly for five days. The sutures were removed on 14th post-operative day. Animal was recovered uneventfully without recurrence of any defect up to follow up of 2 months.

  6. Management of fistula-in-ano with special reference to ligation of intersphincteric fistula tract

    Directory of Open Access Journals (Sweden)

    Mohanlal Khadia

    2016-01-01

    Full Text Available Context: The surgical management of fistula-in-ano is still debatable and no clear recommendations have been made available until now. The present study analyses the results of ligation of intersphincteric fistula tract (LIFT technique in treating fistula-in-ano in particular with recurrence, healing time, and continence status. Aims: LIFT in the management of patients of fistula-in-ano of cryptoglandular origin. Settings and Design: Prospective study. Materials and Methods: This is a prospective study of 52 patients admitted from September 2012 to August 2014. Patients were managed with LIFT technique and results of LIFT technique were compared with other studies in terms of recurrence rate, incontinence rate, and other postoperative complications. Results: A total of 52 patients were studied. Median follow-up was 24 weeks. Primary healing was achieved in 32 (71.11% patients. Thirteen patients (28.88% had a recurrence. No patient reported any subjective decrease incontinence after the procedure. Conclusions: LIFT technique is simple and easy to learn. With this method fistula-in-ano could be easily treated even at primary health care level. LIFT technique is a simple and novel modified approach for the treatment of fistula-in-ano with rapid healing rate and without any resultant incontinence.

  7. [Urethral Fistula and Scrotal Abscess Associated with Colovesical Fistula Due to the Sigmoid Colon Cancer].

    Science.gov (United States)

    Nakazawa, Shigeaki; Uemura, Motohide; Miyagawa, Yasushi; Tsujimura, Akira; Nonomura, Norio

    2015-09-01

    We report here a rare case of urethral fistula and scrotal abscess associated with colovesical fistula due to sigmoid colon cancer. An 84-year-old male was referred to our hospital complaining of macrohematuria, fecaluria, pneumaturia and micturitional pain. Computed tomography (CT) showed colovesical fistula. Other examinations, including colonoscopy and cystoscopy, did not reveal a clear cause for the colovesical fistula. Only an elevated serum level of the tumor marker CA19-9 suggested the possibility of sigmoid colon cancer. Eleven days after hospitalization, bilateral scrotal contents had swollen rapidly to the size of a goose egg. CT suggested urethral fistula with scrotal abscess formation. Drainage of scrotal abscess and colostomy were performed. Intraoperatively, the fistula of the bulbar urethra was revealed. Because increased serum CA19-9 suggested a diagnosis of sigmoid colon cancer, cystectomy and sigmoid colectomy with right nephrectomy were performed. Pathological examination revealed adenocarcinoma of sigmoid colon with bladder invasion. His condition was improved with rehabilitation 6 months after operation.

  8. Hallazgos ecográficos en la proctalgia espontánea y postoperatoria Ultrasound findings in spontaneous and postoperative anal pain

    Directory of Open Access Journals (Sweden)

    I. Pascual

    2008-12-01

    endoprobe providing 360º images. Results: ninety-five cases of anal pain were studied by endoanal ultrasonography. Sixty-seven cases of anal pain ocurred in patients with previous perineal or pelvic surgery: anal fissure (48, hemorrhoidectomy (12, episiotomy (4, fistula (2, and prostatectomy (1. After fissure surgery, incomplete sphincterotomy was the first cause of anal pain. Twenty-eight patients had no previous surgery, and more than 57.14% of them were found to have internal anal sphincter hypertrophy. Conclusions: patients with anal pain can be studied by endoanal ultrasounds in spite of the use of an endoprobe. With this exploration a cause of pain is found in 81.93% of cases. Internal anal sphincter hypertrophy is the most frequent finding associated with spontaneous anal pain.

  9. Coronary Arteriovenous Fistula Causing Hydrops Fetalis

    Directory of Open Access Journals (Sweden)

    Nilüfer Çetiner

    2014-01-01

    Full Text Available Fetal heart failure and hydrops fetalis may occur due to systemic arteriovenous fistula because of increased cardiac output. Arteriovenous fistula of the central nervous system, liver, bone or vascular tumors such as sacrococcygeal teratoma were previously reported to be causes of intrauterine heart failure. However, coronary arteriovenous fistula was not reported as a cause of fetal heart failure previously. It is a rare pathology comprising 0.2–0.4% of all congenital heart diseases even during postnatal life. Some may remain asymptomatic for many years and diagnosed by auscultation of a continuous murmur during a routine examination, while a larger fistulous coronary artery opening to a low pressure cardiac chamber may cause ischemia of the affected myocardial region due to steal phenomenon and may present with cardiomyopathy or congestive heart failure during childhood. We herein report a neonate with coronary arteriovenous fistula between the left main coronary artery and the right ventricular apex, who presented with hydrops fetalis during the third trimester of pregnancy.

  10. Endovascular treatment of hemodialysis arteriovenous fistulas

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Hansen, Marc A; Schroeder, Torben V;

    2012-01-01

    Purpose: The purpose of this study was to investigate if the immediate hemodynamic outcome of an endovascular intervention on a dysfunctional hemodialysis arteriovenous fistula is a prognostic factor for primary patency. Methods: This was a prospective observational study including 61 consecutive...

  11. Duodenocolic fistula due to safety pin ingestion.

    Science.gov (United States)

    Cay, Ali; Imamoğlu, Mustafa; Sarihan, Haluk; Sayil, Ozgür

    2004-01-01

    The authors describe the case of a 16-month-old boy with benign duodenocolic fistula due to safety pin ingestion who presented with abdominal pain, diarrhea and weight loss. Etiology, symptomatology, diagnosis and management are discussed and the literature is reviewed. Early diagnosis and surgical management are necessary to avoid serious morbidity.

  12. Appearance of a colovesical fistula at cystoscopy

    OpenAIRE

    2015-01-01

    Key Clinical Message Colovesical fistulae typically present with pneumaturia and/or fecaluria. Diverticulitis, inflammatory bowel disease, and malignancies of the colon are the commonest causes. The fistulous tract and adjacent organs are best demonstrated by contrast-enhanced CT scan with rectal contrast or MRI. Biopsy at cystoscopy/colonoscopy is necessary for complete evaluation and treatment planning.

  13. Appearance of a colovesical fistula at cystoscopy.

    Science.gov (United States)

    Aiken, William D; Reid, Gareth; Powell, Leo-Paul

    2015-11-01

    Colovesical fistulae typically present with pneumaturia and/or fecaluria. Diverticulitis, inflammatory bowel disease, and malignancies of the colon are the commonest causes. The fistulous tract and adjacent organs are best demonstrated by contrast-enhanced CT scan with rectal contrast or MRI. Biopsy at cystoscopy/colonoscopy is necessary for complete evaluation and treatment planning.

  14. Congenital H-type anovestibuler fistula

    Institute of Scientific and Technical Information of China (English)

    Mesut Yazlcl; Barlas Etensel; Harun Gürsoy; Sezen Ozklsaclk

    2003-01-01

    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.

  15. Scimitar syndrome with pulmonary arteriovenous fistulas.

    Science.gov (United States)

    Le Rochais, J P; Icard, P; Davani, S; Abouz, D; Evrard, C

    1999-10-01

    Right abnormal pulmonary venous return into the inferior vena cava associated with abnormal fissure, dextrocardia, and systemic arterial supply of a variable degree, are the characteristics of the scimitar syndrome. We report on a patient in whom this rare syndrome was associated with pulmonary arteriovenous fistulas within the involved lung.

  16. KRAS and BRAF mutations in anal carcinoma

    DEFF Research Database (Denmark)

    Serup-Hansen, Eva; Linnemann, Dorte; Høgdall, Estrid

    2015-01-01

    the frequency and the prognostic value of KRAS and BRAF mutations in a large cohort of patients with anal cancer. One hundred and ninety-three patients with T1-4N0-3M0-1 anal carcinoma were included in the study. Patients were treated with curative (92%) or palliative intent (8%) between January 2000...... and January 2010. KRAS mutations were detected using Therascreen(®)KRAS real-time PCR assay (Qiagen) and V600E or V600D/K BRAF mutations were uncovered using Pyrosequencing. The frequency of KRAS and BRAF mutations was low; KRAS mutations were detected in 1.6% and BRAF mutations in 4.7% of the biopsies....... No impact of KRAS or BRAF status on survival was found. In conclusion, both KRAS and BRAF mutations are rare in anal cancer. The low frequency of KRAS mutations support protocols exploring EGFR-targeted therapy in patients with metastatic anal cancer, while treatment with BRAF inhibitors might be relevant...

  17. [Diagnostics and conservative treatment of anal incontinence].

    Science.gov (United States)

    Geile, Dorothea; Osterholzer, Georg; Rosenberg, Robert

    2004-01-01

    Anal incontinence is diagnosed primarily by clinical and proctologic examination. Etiological factors of the disease are found in 85% of the patients by additional examinations. Motility dysfunction of colon and rectum has to be excluded (stenosis, dyschezia, internal hernias). Because anal incontinence is a multifactorial disease as a rule, the single compounds have to be diagnosed and have to undergo therapy. Accordingly, useful investigations are: endorectal ultrasound (defect of muscle, inflammatory or tumour infiltration), manometry (alteration of either anal resting pressure and/or anal squeezing pressure) and surface electromyography (ability of contraction, duration of contraction, strength). Neurophysiological examinations are: needle electromyography, pudendal nerve latency time measurement (PNLT). The occurrence of nerve damage determines the outcome of operative intervention! Conservative treatment is indicated in 80 to 90% of all patients, even higher when one includes all patients in the perioperative period. Possible therapy modalities are: nutrition consultation, physiotherapy, pelvic floor training, biofeedback training of pelvic floor and sphincter muscles, electrostimulation and the combination of both (EMG-triggered electrostimulation). Short-term results are satisfying in up to 85% of patients, but later, successful results depend on the patient's willingness or ability to continue training, and on his/her age.

  18. Do We Know What Causes Anal Cancer?

    Science.gov (United States)

    ... cells are more likely to become cancerous. Lowered immunity When the body is less able to fight off infections, viruses like HPV can become more active, which might trigger the development of anal cancer. HIV, the virus that causes AIDS, weakens the ...

  19. Method for Management of Perianal Fistula with New Device: Progressive Curettage of the Tract and Sealing with Platelet-Rich Fibrin

    Directory of Open Access Journals (Sweden)

    Perez Lara

    2016-08-01

    Full Text Available Surgical treatment of high perianal fistulas, which affect a significant proportion of the sphincter apparatus, is difficult and associated with considerable risk of impaired anal continence. The diversity of approaches proposed for the treatment of complex perianal fistulas reflects the fact that no method has yet been shown to be fully satisfactory. We believe the successful treatment of this condition is directly proportional to the amount of fibrous tissue that can be removed. We used a kit of small curettes, of different thicknesses and sizes, incorporating spicules that enable the physician to remove fibrous tissue from the fistula tract. The small size and varying thicknesses of the curettes enable them to mold to the curves of the fistula tract and to remove tissue by de-roofing from the shallowest to the deepest layers, thus excising the entire fibrous tract. The tract is then sealed using autologous fibrin, applied through a catheter, with the help of a monitor indicating the amount of product remaining at all times. Finally, the internal orifice is closed by simple suturing.

  20. Seoseid loov kunstiteose analüüs / Anneli Porri

    Index Scriptorium Estoniae

    Porri, Anneli, 1980-

    2013-01-01

    Kunstiteose analüüsi seosest riikliku õppekavaga, ülevaade kunstiteose analüüsimeetoditest kunstiteaduses ning metoodilistest tähelepanekutest kunsti ja visuaalkultuuri kujutiste vaatamise kohta gümnaasiumi kunstitunnis

  1. Noncavernous arteriovenous shunts mimicking carotid cavernous fistulae

    Science.gov (United States)

    Kobkitsuksakul, Chai; Jiarakongmun, Pakorn; Chanthanaphak, Ekachat; Singhara Na Ayudya, Sirintara (Pongpech)

    2016-01-01

    PURPOSE The classic symptoms and signs of carotid cavernous sinus fistula or cavernous sinus dural arteriovenous fistula (AVF) consist of eye redness, exophthalmos, and gaze abnormality. The angiography findings typically consist of arteriovenous shunt at cavernous sinus with ophthalmic venous drainage with or without cortical venous reflux. In rare circumstances, the shunts are localized outside the cavernous sinus, but mimic symptoms and radiography of the cavernous shunt. We would like to present the other locations of the arteriovenous shunt, which mimic the clinical presentation of carotid cavernous fistulae, and analyze venous drainages. METHODS We retrospectively examined the records of 350 patients who were given provisional diagnoses of carotid cavernous sinus fistulae or cavernous sinus dural AVF in the division of Interventional Neuroradiology, Ramathibodi Hospital, Bangkok between 2008 and 2014. Any patient with cavernous arteriovenous shunt was excluded. RESULTS Of those 350 patients, 10 patients (2.85%) were identified as having noncavernous sinus AVF. The angiographic diagnoses consisted of three anterior condylar (hypoglossal) dural AVF, two traumatic middle meningeal AVF, one lesser sphenoid wing dural AVF, one vertebro-vertebral fistula (VVF), one intraorbital AVF, one direct dural artery to cortical vein dural AVF, and one transverse-sigmoid dural AVF. Six cases (60%) were found to have venous efferent obstruction. CONCLUSION Arteriovenous shunts mimicking the cavernous AVF are rare, with a prevalence of only 2.85% in this series. The clinical presentation mainly depends on venous outflow. The venous outlet of the arteriovenous shunts is influenced by venous afferent-efferent patterns according to the venous anatomy of the central nervous system and the skull base, as well as by architectural disturbance, specifically, obstruction of the venous outflow. PMID:27767958

  2. Laparoscopic Resection of Chronic Sigmoid Diverticulitis with Fistula

    Science.gov (United States)

    Abbass, Mohammad A.; Tsay, Anna T.

    2013-01-01

    Background and Objectives: A growing number of operations for sigmoid diverticulitis are being done laparoscopically. There is a paucity of data on the outcome of laparoscopy for sigmoid diverticulitis complicated by colonic fistula. The aim of this study was to compare the results of laparoscopic resection of sigmoid diverticulitis with and without colonic fistula. Methods: A retrospective review was conducted of all patients who underwent laparoscopic resection of sigmoid diverticulitis complicated by fistula at a single tertiary care institution over a 7-year period. Comparison was made with a group of patients who underwent resection for diverticulitis without fistula during the same study period. Results: Forty-two patients were analyzed (group 1: diverticular fistula, group 2: no fistula). The median age was similar (49 vs. 50 years, P = .68). A chronic abscess was present in 24% of patients in group 1 and 10% in group 2 (P = .40). Fistula types were colovesical (71%), colovaginal (19%), and colocutaneous (10%). Operation types were sigmoidectomy (57% vs. 81%) and anterior resection (43% vs. 19%) in groups 1 and 2, respectively (P = .18). Ureteral catheters were used more frequently in group 1 (67% vs. 33% [P = .06]). No difference was noted in operative time, blood loss, conversion rate, length of stay, overall complications, wound infection rate, readmission rate, reoperation rate, and mortality. All patients healed without fistula recurrence. Conclusions: Patients with sigmoid diverticulitis with fistula can be successfully treated with laparoscopic excision, with similar outcomes for patients without fistula. PMID:24398208

  3. Anal human papillomavirus DNA in women at a colposcopy clinic.

    NARCIS (Netherlands)

    Hauwers, K.W.M. d'

    2012-01-01

    OBJECTIVES: To describe the type-specific prevalence of anal and cervical human papillomavirus (HPV) infections and the cytology in HIV-negative women without a history of cervical cancer, attending a colposcopy clinic. To examine if an HPV positive anal smear is related to anal pathology and conseq

  4. A case of vesicouterine fistula after cesarean section with delivery through the bladder

    DEFF Research Database (Denmark)

    Schroeder, T; Kristensen, J K

    1983-01-01

    We report a case of a vesicouterine fistula subsequent to delivery at cesarean section through the bladder. A first attempt to close the fistula failed but a second operation adhering to the general principles of fistula repair was successful....

  5. Oral and anal vaccination confers full protection against enteric redmouth disease (ERM in rainbow trout.

    Directory of Open Access Journals (Sweden)

    Kasper Rømer Villumsen

    Full Text Available The effect of oral vaccines against bacterial fish diseases has been a topic for debate for decades. Recently both M-like cells and dendritic cells have been discovered in the intestine of rainbow trout. It is therefore likely that antigens reaching the intestine can be taken up and thereby induce immunity in orally vaccinated fish. The objective of this project was to investigate whether oral and anal vaccination of rainbow trout induces protection against an experimental waterborne infection with the pathogenic enterobacteria Yersinia ruckeri O1 biotype 1 the causative agent of enteric redmouth disease (ERM. Rainbow trout were orally vaccinated with AquaVac ERM Oral (MERCK Animal Health or an experimental vaccine bacterin of Y. ruckeri O1. Both vaccines were tested with and without a booster vaccination four months post the primary vaccination. Furthermore, two groups of positive controls were included, one group receiving the experimental oral vaccine in a 50 times higher dose, and the other group receiving a single dose administered anally in order to bypass the stomach. Each group was bath challenged with 6.3 × 10(8 CFU/ml Y. ruckeri, six months post the primary vaccination. The challenge induced significant mortality in all the infected groups except for the groups vaccinated anally with a single dose or orally with the high dose of bacterin. Both of these groups had 100% survival. These results show that a low dose of Y. ruckeri bacterin induces full protection when the bacterin is administered anally. Oral vaccination also induces full protection, however, at a dose 50 times higher than if the fish were to be vaccinated anally. This indicates that much of the orally fed antigen is digested in the stomach before it reaches the second segment of the intestine where it can be taken up as immunogenic antigens and presented to lymphocytes.

  6. Oral and anal vaccination confers full protection against enteric redmouth disease (ERM) in rainbow trout.

    Science.gov (United States)

    Villumsen, Kasper Rømer; Neumann, Lukas; Ohtani, Maki; Strøm, Helene Kragelund; Raida, Martin Kristian

    2014-01-01

    The effect of oral vaccines against bacterial fish diseases has been a topic for debate for decades. Recently both M-like cells and dendritic cells have been discovered in the intestine of rainbow trout. It is therefore likely that antigens reaching the intestine can be taken up and thereby induce immunity in orally vaccinated fish. The objective of this project was to investigate whether oral and anal vaccination of rainbow trout induces protection against an experimental waterborne infection with the pathogenic enterobacteria Yersinia ruckeri O1 biotype 1 the causative agent of enteric redmouth disease (ERM). Rainbow trout were orally vaccinated with AquaVac ERM Oral (MERCK Animal Health) or an experimental vaccine bacterin of Y. ruckeri O1. Both vaccines were tested with and without a booster vaccination four months post the primary vaccination. Furthermore, two groups of positive controls were included, one group receiving the experimental oral vaccine in a 50 times higher dose, and the other group receiving a single dose administered anally in order to bypass the stomach. Each group was bath challenged with 6.3 × 10(8) CFU/ml Y. ruckeri, six months post the primary vaccination. The challenge induced significant mortality in all the infected groups except for the groups vaccinated anally with a single dose or orally with the high dose of bacterin. Both of these groups had 100% survival. These results show that a low dose of Y. ruckeri bacterin induces full protection when the bacterin is administered anally. Oral vaccination also induces full protection, however, at a dose 50 times higher than if the fish were to be vaccinated anally. This indicates that much of the orally fed antigen is digested in the stomach before it reaches the second segment of the intestine where it can be taken up as immunogenic antigens and presented to lymphocytes.

  7. Risk Factors for Anal HPV Infection and Anal Precancer in HIV-Infected Men Who Have Sex With Men

    OpenAIRE

    Schwartz, Lauren M.; Castle, Philip E.; Follansbee, Stephen; Borgonovo, Sylvia; Fetterman, Barbara; Tokugawa, Diane; Lorey, Thomas S.; Sahasrabuddhe, Vikrant V.; Luhn, Patricia; Gage, Julia C; Darragh, Teresa M.; Wentzensen, Nicolas

    2013-01-01

    Background. Carcinogenic human papillomaviruses (HPVs) cause a large proportion of anal cancers. Human immunodeficiency virus (HIV)–infected men who have sex with men (MSM) are at increased risk of HPV infection and anal cancer compared with HIV-negative men. We evaluated risk factors for HPV infection and anal precancer in a population of HIV-infected MSM.

  8. Mode of delivery after obstetric anal sphincter injury and the risk of long-term anal incontinence

    DEFF Research Database (Denmark)

    Jangö, Hanna; Langhoff-Roos, Jens; Rosthøj, Susanne

    2016-01-01

    BACKGROUND: Primiparous women have an increased risk of obstetric anal sphincter injury; because most of these patients deliver again, there are major concerns about mode of delivery: the risk of recurrent obstetric anal sphincter injury and the risk of long-term symptoms of anal incontinence...

  9. Clinical usefulness of doppler ultrasonography before percutaneous transluminal angioplasty immature native arteriovenous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jeong Eun [Dept. of Radiology, Inje University Seoul Paik Hospital, College of Medicine, Inje University, Seoul (Korea, Republic of); Cho, Young Kwon; Sim, Jae Chan; Lee, So Young; Sung, Su Ah; Hwang, Young Hwan [Eulji General Hospital, College of Medicine, Eulji University, Seoul (Korea, Republic of)

    2013-11-15

    group showed no significant statistical difference. Assessment of immature arteriovenous fistula using doppler ultrasound examination is a very useful method that can replace diagnostic fistulography. Also, PTA of immature arteriovenous fistula is considered an effective initial treatment for inducing successful growth maturation.

  10. Cholecystocolonic fistula mimicking acute cholecystitis diagnosed unequivocally by computed tomography.

    Science.gov (United States)

    Chick, Jeffrey Forris Beecham; Chauhan, Nikunj Rashmikant; Paulson, Vera Ashley; Adduci, Alexander J

    2013-12-01

    Cholecystocolonic fistula is an uncommon potential complication of cholecystitis found intraoperatively in 0.06-0.14 % of patients undergoing cholecystectomy and 0.1-0.5 % of autopsy series. Although cholecystocolonic fistula is the second most common cholecystoenteric fistula, second only to cholecystoduodenal fistula, it is diagnosed preoperatively in only 7.9 % of patients. Failure to preoperatively diagnose cholecystocolonic fistula places surgeons in precarious positions, as they may be forced to convert a seemingly routine cholecystectomy to a more sophisticated procedure coupled with adhesiolysis, colonic suturing, or colonic resection. We report a young patient who presented to the emergency department with complaints indicative of acute cholecystitis; however, preoperative ultrasound was suggestive of a cholecystoenteric fistula. Computed tomography and pathology were pathognomonic with clear visualization of the cholecystocolonic fistulous tract.

  11. Closure of oroantral fistula with rotational palatal flap technique

    Directory of Open Access Journals (Sweden)

    David B. Kamadjaja

    2007-03-01

    Full Text Available Oroantral fistula is one of the common complications following dentoalveolar surgeries in the maxilla. Closure of oroantral fistula should be done as early as possible to eliminate the risk of infection of the antrum. Palatal flap is one of the commonly used methods in the closure of oroantral fistula. A case is reported of a male patient who had two oroantral communication after having his two dental implants removed. Buccal flap was used to close the defects, but one of them remained open and resulted in oroantral fistula. Second correction was performed to close the defect using buccal fat pad, but the fistula still persisted. Finally, palatal rotational flap was used to close up the fistula. The result was good, as the defect was successfully closed and the donor site healed uneventfully.

  12. Tentorial artery embolization in tentorial dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Rooij, Willem Jan van; Sluzewski, Menno [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N. [St. Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)

    2006-10-15

    The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas. (orig.)

  13. [Fistulas of the lower urinary tract in children].

    Science.gov (United States)

    Tonegatti, Luca; Scarpa, Maria-Grazia; Goruppi, Ilaria; Olenik, Damiana; Rigamonti, Waifro

    2015-01-01

    A lower urinary tract fistula consist in an abnormal connection between bladder, urethra and adjacent abdominal organs or skin. There are several types of urinary fistulas in paediatric age and they may be congenital or acquired. Etiology may be due to embriological defects, infectious processes, malignant tumours, pelvic irradiation as well as complications following surgical procedures, especially postsurgical repair of hypospadia or epispadia. Clinical presentation depends on the type of fistula and diagnosis is based on signs, symptoms and radiological or endoscopic examinations. We performed PubMed research using terms such as lower urinary fistulae, urology and paediatrics and we consulted medical texts. We reviewed selected articles and used the relevant ones to perform our study concentrating on classification, diagnosis and treatment of different types of fistulas. Paediatric lower urinary fistulas are an uncommon pathology, but the knowledge of their etiology and classification is important to recognise them and lead the physician to an appropriate treatment, which is surgical in most cases.

  14. Asymptomatic Cholecystocolonic Fistula: A Diagnostic and Therapeutic Dilemma

    Directory of Open Access Journals (Sweden)

    Nicola Antonacci

    2013-01-01

    Full Text Available Cholecystocolonic fistulas (CCF are rare complications of gallstones with a variable clinical presentation. Despite modern diagnostic tools, cholecystocolonic fistulas are often asymptomatic and it is difficult to diagnose them preoperatively. Biliary-enteric fistulae have been found in 0.9% of patients undergoing biliary tract surgery. The most common site of communication of the fistula is the cholecystoduodenal (70%, followed by the cholecystocolic (10–20%, and the least common is the cholecystogastric fistula. Herein, we report a case of female patient with multiple episodes of acute recurrent cholangitis due to common bile duct and gallbladder stones in which preoperative imaging studies were negative for cholecystocolonic fistula that was incidentally discovered and treated during surgery and was appropriately treated. A review of the literature is reported too.

  15. Large rectovaginal fistula due to a cube pessary despite routine follow-up; but what is 'routine'?

    Science.gov (United States)

    Torbey, Matthew J

    2014-11-01

    Vaginal pessaries are generally considered a safe and effective form of management for pelvic organ prolapse. Serious complications such as rectovaginal fistula can develop with or without regular follow-up. This case report describes the rapid development over a 10-week period of a large rectovaginal fistula in a 75-year-old woman, despite routine follow-up and replacement of her cube pessary. Currently, there is a lack of evidence-based guidelines for pessary care and, in particular, the frequency of pessary replacement. Intervals for pessary replacements vary greatly and are often based on the manufacturer's recommendations. This case highlights the rapidity at which serious complications can develop and also represents the first reported case of a cube pessary-induced rectovaginal fistula.

  16. Arteriovenous fistula: An evidence based practice in nursing care

    OpenAIRE

    2013-01-01

    The arteriovenous fistula (AVF) is the most frequent form of vascular access for patients undergoing haemodialysis because it ensures good quality of dialysis and reduce haemodialysis mortality. For this reason, the nephrology nurse plays an important role in the appropriate care of fistula with a view to promoting the longevity and prevention of complications. Purpose: The purpose of this review was to investigate the role of Nephrology nurse in the appropriate care of fistula, promoting lon...

  17. Endovascular treatment for bilateral vertebral arteriovenous fistulas in neurofibromatosis 1.

    Science.gov (United States)

    Siddhartha, W; Chavhan, Govind B; Shrivastava, Manish; Limaye, Uday S

    2003-12-01

    We report a rare case of a 36-year-old woman with neurofibromatosis 1 (NF1) with bilateral vertebro-vertebral arteriovenous fistulas. The patient presented with quadriparesis and had neck pain. Angiography revealed vertebral arteriovenous fistulas bilaterally with dilated epidural venous plexuses compressing the cervical cord resulting in quadriparesis. Endovascular treatment using coils and balloons resulted in successful occlusion of both fistulas. At 6-months postembolization, the patient had improved significantly and is now able to walk with support.

  18. Three-dimensional ultrasound imaging for diagnosis of urethrovaginal fistula.

    Science.gov (United States)

    Quiroz, Lieschen H; Shobeiri, S Abbas; Nihira, Mikio A

    2010-08-01

    We present a novel technique for visualization of a urethrovaginal fistula. A 52-year-old patient presented with persistent urinary incontinence, after having three mid-urethral sling procedures performed within the past year. The diagnosis of a urethrovaginal fistula was made by endovaginal 3-D endovaginal ultrasound and confirmed intraoperatively. We have described a novel technique that may benefit patients with urethrovaginal fistulas that are difficult to visualize.

  19. A rare upper gastrointestinal system bleeding case: Aortoesophageal fistula

    OpenAIRE

    AYYILDIZ, Talat; Nas, Ömer Fatih; YILDIRIM, Çınar; Dolar, Enver; Gurel, Selim

    2014-01-01

    Aortoesophageal fistula is a rare condition with fatal prognosis. It is one of the life-threatining causes of massive upper gastrointestinal bleeding. With this case report, we will discuss an instance of a fatal aortoesophageal fistula in a patient to whom was implanted a stent due to an aorta aneurysm. In endoscopic examination blood clot on the mouth of the fistula was visualized. J. Exp. Clin. Med., 2014; 31:51-53

  20. Early Recognition of H-Type Tracheoesophageal Fistula

    Directory of Open Access Journals (Sweden)

    Muhammad Riazulhaq

    2012-02-01

    Full Text Available Tracheoesophageal fistula (TEF without associated esophageal atresia (EA is a rare congenital anomaly. Diagnosis in neonatal period is usually not made and most of the patients are treated as cases of pneumonia. A case of H-type of tracheoesophageal fistula, diagnosed within 24 hours of delivery based upon choking and cyanosis on first trial of feed, is being reported. Diagnosis was confirmed with contrast esophagram. Through cervical approach fistula was repaired and baby had uneventful post operative outcome.

  1. Squamous cell carcinoma of the anal canal.

    LENUS (Irish Health Repository)

    Martin, F T

    2012-01-31

    Squamous cell carcinoma ofthe anal canal represents 1.5% of all malignancies affectingthe gastrointestinal tract. Over the past 20 years dramatic changes have been seen in both the epidemiological distribution of the disease and in the therapeutic modalities utilised to manage it. CLINICAL MANAGEMENT: Historically abdominoperineal resection had been the treatment of choice with local resection reserved for early stage disease. Work by Nigro et al. has revolutionised how we currently manage carcinoma of the anal canal, demonstrating combined modality chemoradiotherapy as an appropriate alternative to surgical resection with the benefit of preserving sphincter function. Surgery is then reserved for recurrent disease with salvage abdominoperineal resection. This article reviews current literature and highlights the changing therapeutic modalities with selected clinical cases

  2. Management of Anal Squamous Intraepithelial Lesions

    OpenAIRE

    Pineda, Carlos E.; Welton, Mark L.

    2009-01-01

    Anal squamous intraepithelial lesions include both low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and are caused by chronic infection with the human papillomavirus (HPV). The disease is increasing in both incidence and prevalence, especially among patients with the following risk factors: homosexual men, acquired or iatrogenic immunosuppression, and presence of other HPV-related diseases. Although the natural history of the disease is ...

  3. [Combined radio- and chemotherapy of anal cancer].

    Science.gov (United States)

    Dobrowsky, W

    1986-05-30

    The treatment regime in anal carcinoma is changing from being a mainly surgical problem. Combined radio-chemotherapy is of increasing interest as treatment of choice. The new treatment modality, including chemotherapy with Mitomycin C and 5-fluorouracil combined with percutaneous and interstitial radiotherapy is presented. The treatment regimes performed at the University Department for Radiotherapy and Radiobiology Vienna is discussed with regard to tolerance, side effects and local control.

  4. Obstetric fistula in low and middle income countries.

    Science.gov (United States)

    Capes, Tracy; Ascher-Walsh, Charles; Abdoulaye, Idrissa; Brodman, Michael

    2011-01-01

    Vesicovaginal fistula secondary to obstructed labor continues to be an all-too-common occurrence in underdeveloped nations throughout Africa and Asia. Vesicovaginal fistula remains largely an overlooked problem in developing nations as it affects the most marginalized members of society: young, poor, illiterate women who live in remote areas. The formation of obstetric fistula is a result of complex interactions of social, biologic, and economic influences. The key underlying causes of fistula are the combination of a lack of functional emergency obstetric care, poverty, illiteracy, and low status of women. In order to prevent fistula, some strategies include creation of governmental policy aimed toward reducing maternal mortality/morbidity and increasing availability of skilled obstetric care, as well as attempts to increase awareness about its prevention and treatment among policymakers, service providers, and communities. Whereas prevention will require the widespread development of infrastructure within these developing countries, treatment of fistula is an act which can be done "in the now." Treatment and subsequent reintegration of fistula patients requires a team of specialists including surgeons, nurses, midwives, and social workers, which is largely unavailable in developing countries. However, there is increasing support for training of fistula surgeons through standardized programs as well as establishment of rehabilitation centers in many nations. The eradication of fistula is dependent upon building programs that target both prevention and treatment.

  5. [Congenital broncho-biliary fistula: a case report].

    Science.gov (United States)

    Pérez, Cinthia G; Reusmann, Aixa

    2016-10-01

    Congenital tracheo-or-bronchobiliary fistula or congenital he-patopulmonary fistula is a rare malformation with high morbidity and mortality if the diagnosis is not made early. The tracheo-or-bronchobiliary fistula is a communication between the respiratory (trachea or bronchus) and biliary tract. To date, only 35 cases have been published worldwide. We report a case of a neonate with right pneumonia and bilious fluid in the endotracheal tube. Diagnosis was made using bronchoscopy with fluoroscopy. Videothoracoscopy was used to remove the bronchobiliary fistula. Subsequently, a left he-patectomy with Roux-en-Y biliary-digestive anastomosis was performed as bile ductus hypoplasia was present.

  6. Volume Flow in Arteriovenous Fistulas Using Vector Velocity Ultrasound

    DEFF Research Database (Denmark)

    Hansen, Peter Møller; Olesen, Jacob Bjerring; Pihl, Michael Johannes;

    2014-01-01

    Volume flow in arteriovenous fistulas for hemodialysis was measured using the angle-independent ultrasound technique Vector Flow Imaging and compared with flow measurements using the ultrasound dilution technique during dialysis. Using an UltraView 800 ultrasound scanner (BK Medical, Herlev......, Denmark) with a linear transducer, 20 arteriovenous fistulas were scanned directly on the most superficial part of the fistula just before dialysis. Vector Flow Imaging volume flow was estimated with two different approaches, using the maximum and the average flow velocities detected in the fistula. Flow...

  7. Surgical procedure for coronary artery ectasia associated with saccular fistula.

    Science.gov (United States)

    Murakami, Masanori; Gohra, Hidenori; Yagi, Takeshi; Jinbou, Mitsutaka; Kobayashi, Toshiro; Saito, Satoshi; Takahashi, Tsuyoshi; Shiomi, Kotaro; Ono, Siro; Hamano, Kimikazu

    2014-09-01

    Echocardiography of a 60 year-old woman with a three-year history of heart murmur revealed a coronary artery fistula. Coronary angiography indicated right coronary artery ectasia and fistula. The pulmonary-to-systemic blood flow ratio was 1.4, and left-to-right shunt, 29%. On follow-up, infective endocarditis of the tricuspid valve had developed and was treated using antibiotics. The right coronary artery was dilated along its length and was saccular at the distal aspect. At this point, a fistula also connected by the left anterior descending and left circumflex arteries drained into the right ventricle. Fistula closure and reduction aneurysmectomy were performed.

  8. Congenital bronchoesophageal fistula in an adult: A case report

    Institute of Scientific and Technical Information of China (English)

    Lei Su; Xiu-Qin Wei; Xiu-Yi Zhi; Qing-Sheng Xu; Ting Ma

    2007-01-01

    Bronchoesophageal fistulas are usually diagnosed in the neonatal period. As such, the condition is rare in adults.We present a case of a congenital bronchoesophageal fistula in a 62-year-old man with the complaint of severe bouts of cough and choking after swallowing liquid. His workup included a barium esophagogram that revealed a fistula between the esophagus and a right lower lobe bronchus. The diagnosis should be considered in certain individuals with suggestive symptomatology and unexplained respiratory pathology. The fistula was divided and resected, The patient had an uneventful recovery.

  9. Endovascular treatment of traumatic carotid cavernous fistula with trapping technique

    Directory of Open Access Journals (Sweden)

    Benny Young

    2013-08-01

    Full Text Available Conventional endovascular treatment for carotid cavernous fistula (CCF involves a direct delivery of either coils, detachable balloon or both to the fistula with end point of CCF resolution and carotid artery preservation. But in few cases with severe laceration of carotid artery, the feasible endovascular technique applicable is by blocking the filling of fistula from cerebral circulation. This method known as trapping technique which implicates carotid artery occlusion, was performed in our present case with good result. (Med J Indones. 2013;22:178-82. doi: 10.13181/mji.v22i3.588Keywords: Carotid cavernous fistula (CCF, carotid occlusion, trapping technique

  10. Orbicularis oris musculomucosal flap for anterior palatal fistula

    Directory of Open Access Journals (Sweden)

    Tiwari V

    2006-01-01

    Full Text Available Anterior palatal fistulae or residual anterior clefts are a frequent problem following palatoplasty. Various techniques have been used to repair such fistulae, each having its own advantages and disadvantages. We have successfully used orbicularis oris musculomucosal flap to close anterior fistula and residual clefts in 25 patients. This study shows the superiority of this flap over other techniques because of its reliable blood supply, easy elevation and transfer to fistula site and finally because it is a single-stage procedure.

  11. Covered metallic stents for the palliation of colovesical fistula.

    Science.gov (United States)

    Ahmad, Mukhtar; Nice, Colin; Katory, Mark

    2010-09-01

    Colovesical fistula is a distressing condition that is usually managed surgically. For some patients in whom surgery is not feasible, covered colonic stents offer palliation. We present two challenging cases with contrasting outcomes. The first case is a colovesical fistula secondary to malignancy with a successful outcome after stenting and the second a complex diverticular fistula with a poor outcome. From our limited experience, it is a useful technique but careful patient selection is essential to its safe application. There is little published experience of the use of these stents for colovesical fistula.

  12. Heuber Maneuver in Evaluation of Direct Carotid-Cavernous Fistula

    Science.gov (United States)

    Rajagopal, Rengarajan; Mehta, Neeraj; Saran, Sonal; Khera, Pushpinder S.

    2016-01-01

    Summary Carotid-cavernous fistulas are abnormal communications between the carotid system and the cavernous sinus. Elevated venous pressure produces congestion in the orbit with resultant transudation of fluid and increased intraocular pressure, thereby leading to secondary glaucoma which may result in visual loss. Immediate treatment is hence, warranted in these cases. The planning of endovascular management is dependent on many parameters, the most important of which are the size and location of the fistula. Since these are high-flow fistulas, assessment requires certain manoeuvers. Heuber manoeuver is one of the manoeuvers used to demonstrate the size of the fistula.

  13. Anal intraepitelial neoplasia: a narrative review

    Directory of Open Access Journals (Sweden)

    Garazi Elorza

    2016-01-01

    Full Text Available Anal intraepitelial neoplasia (AIN constitutes a major health problem in certain risk groups, such as patients with immunosuppression of varied origin, males who have sexual relations with other males, and females with a previous history of vaginal or cervical abnormalities in cytology. Its relationship with the human papillomavirus (HPV infection has been well documented; however, many of the factors involved in the progression and regression of the viral infection to dysplasia and anal carcinoma are unknown. AIN can be diagnosed through cytology of the anal canal or biopsy guided by high-resolution anoscopy. However, the need for these techniques in high-risk groups remains controversial. Treatment depends on the risk factors and given the high morbidity and high recurrence rates the utility of the different local treatments is still a subject of debate. Surgical biopsy is justified only in the case of progression suggesting lesions. The role of the vaccination in high-risk patients as primary prevention has been debated by different groups. However, there is no general consensus on its use or on the need for screening this population.

  14. Evolutionary History of Multiple Dural Fistula

    Directory of Open Access Journals (Sweden)

    Braulio Martinez-Burbano MD

    2016-12-01

    Full Text Available Intracranial dural arteriovenous fistulas (DAVFs are abnormal communications between arteries and veins or dural venous sinuses, which sit between the sheets of the dura. They represent 10% to 15% of intracranial vascular malformations. Clinical manifestations and prognosis depend on the pattern of venous drainage and location. The clinical presentation of DAVF may be mistaken for vascular or nonvascular brain pathologies. For that reason, within the differential diagnosis come a wide range of conditions, such as secondary headaches, encephalopathies, dementias including those with rapid progression, neurodegenerative diseases, inflammatory processes, or tumors typically at the orbital level or in the cavernous sinus. Diagnosis requires a high degree of suspicion because of the multiplicity of symptoms and presentations, making this pathology an entity that provides a major challenge for clinicians, yet early and multidisciplinary treatment of high-grade fistulas improve the possibility of avoiding poor or unfavorable outcomes for the patient.

  15. Fistulas carótido cavernosa

    Directory of Open Access Journals (Sweden)

    Gerardo Lang Serrano

    2014-03-01

    Full Text Available Las fistulas carotido-cavernosas son patologías vasculares relativamente infrecuentes que tiene una etiología de mayor frecuencia traumática que espontanea. Su diagnóstico no siempre es sencillo y requiere de conocer la patología para poder tener la sospecha clínica y poder brindar solución de manera rápida y minimizar secuelas. El tratamiento de las fistulas ha mejorado con el tiempo y con el advenimiento de la cirugía endovascular, con esto se han ido descubriendo mejores accesos y mecanismos para tratarlo, como lo es el abordaje por la vena oftálmica superior. Sin embargo esto no siempre es posible debido a la variaciones anatómicas que en ella se encuentran, pero cuando se logra tiene resultado cosméticos y funcionales muy adecuados.

  16. Coronary fistula resembling patent ductus arteriosus

    Directory of Open Access Journals (Sweden)

    Sgarbieri Ricardo Nilsson

    2003-01-01

    Full Text Available A 14-year-old girl, presenting with heart failure and a continuous murmur, similar to that of a patent arterial duct, was investigated using echocardiogram and cardiac catheterization revealing a left to right shunt throught a coronary artery fistulae between the first septal branch and the right ventricular outflow tract. The patient was submitted to surgery, occluding the anomalous branch by the suturing of its orifice in the right ventricular outflow tract, under cardiopulmonary bypass. After the operation, cardiac catheterization revealed complete occlusion of the fistula without any residual shunt or compromise to the coronary circulation. In seven years of follow-up the patient is completely free of symptoms.

  17. Evolutionary History of Multiple Dural Fistula

    Science.gov (United States)

    Martinez-Burbano, Braulio; Correa Diaz, Edgar Patricio; Jácome Sánchez, Carolina

    2016-01-01

    Intracranial dural arteriovenous fistulas (DAVFs) are abnormal communications between arteries and veins or dural venous sinuses, which sit between the sheets of the dura. They represent 10% to 15% of intracranial vascular malformations. Clinical manifestations and prognosis depend on the pattern of venous drainage and location. The clinical presentation of DAVF may be mistaken for vascular or nonvascular brain pathologies. For that reason, within the differential diagnosis come a wide range of conditions, such as secondary headaches, encephalopathies, dementias including those with rapid progression, neurodegenerative diseases, inflammatory processes, or tumors typically at the orbital level or in the cavernous sinus. Diagnosis requires a high degree of suspicion because of the multiplicity of symptoms and presentations, making this pathology an entity that provides a major challenge for clinicians, yet early and multidisciplinary treatment of high-grade fistulas improve the possibility of avoiding poor or unfavorable outcomes for the patient. PMID:28203571

  18. Percutaneous transarterial embolization of extrahepatic arteroportal fistula

    Institute of Scientific and Technical Information of China (English)

    Gianluca Marrone; Settimo Caruso; Roberto Miraglia; Ilaria Tarantino; Riccardo Volpes; Angelo Luca

    2006-01-01

    Arteroportal fistula is a rare cause of prehepatic portalhypertension. A 44-year-old male with hepatitis virus C infection was admitted for acute variceal bleeding.Endoscopy showed the presence of large esophageal varices. The ultrasound revealed a mass near the head of pancreas, which was characterized at the colorDoppler by a turbulent flow, and arterialization of portal vein flow. CT scan of abdomen showed a large aneurysm of the gastroduodenal artery communicating into the superior mesenteric vein. The sinusoidal portal pressure measured as hepatic vein pressure gradient was normal, confirming the pre-hepatic origin of portal hypertension. The diagnosis of extrahepatic portal hypertension secondary to arteroportal fistula was established, and the percutaneous embolization was performed.Three months later, the endoscopy showed absence of esophageal varices and ascites. At the moment, the patient is in good clinical condition, without signs of portal hypertension.

  19. Tubular Colonic Duplication Presenting as Rectovestibular Fistula.

    Science.gov (United States)

    Karkera, Parag J; Bendre, Pradnya; D'souza, Flavia; Ramchandra, Mukunda; Nage, Amol; Palse, Nitin

    2015-09-01

    Complete colonic duplication is a very rare congenital anomaly that may have different presentations according to its location and size. Complete colonic duplication can occur in about 15% of all gastrointestinal duplications. Double termination of tubular colonic duplication in the perineum is even more uncommon. We present a case of a Y-shaped tubular colonic duplication which presented with a rectovestibular fistula and a normal anus. Radiological evaluation and initial exploration for sigmoidostomy revealed duplicated colons with a common vascular supply. Endorectal mucosal resection of theduplicated distal segment till the colostomy site with division of the septum of the proximal segment and colostomy closure proved curative without compromise of the continence mechanism. Tubular colonic duplication should always be ruled out when a diagnosis of perineal canal is considered in cases of vestibular fistula alongwith a normal anus.

  20. An unusual case of pancreatic fistula.

    Science.gov (United States)

    Johnston, M J; Prew, C L; Fraser, I

    2013-03-21

    We report an unusual case of a pancreatic fistula communicating with an appendicectomy wound. This occurred following an episode of acute haemorrhagic pancreatitis. The patient was initially admitted with signs and symptoms indicating appendicitis and went to theatre for an open appendicectomy. However, this did not resolve his symptoms and a laparotomy was performed the next day revealing haemorrhagic pancreatitis. He endured a stormy post-operative course, the cause of which was found to be an external pancreatic fistula with discharge of amylase-rich fluid from the Lanz incision. A trial of conservative management failed despite multiple percutaneous drainage procedures and treatment with broad-spectrum antibiotics. After a second opinion was sought, it was decided to fit a roux loop anastomosis between the head of the pancreas and the duodenum to divert the fistulous fluid. This procedure was a success and the patient remains well 2 years later.