Device for occlusion of rectovaginal fistula: clinical trials

Salpingo Enteric Fistula: A Case Report

Background

Few cases with fistulous communication between the GI system and female adnexal structure have been reported in the literature, and bilateral contrast spillage has been reported only in one case, and this case is the second one all over the world.

Case Presentation

The case was a 27-year-old woman with a diagnosis of primary infertility. She was booked with hysterosalpingogram (HSG) as part of the routine workup in the infertility clinic. There was a positive history of pelvic surgery for bilateral adnexal cysts for her in 2014. In this case, previous pelvic surgery without any medical problems was the strongest risk factor for tubo-intestinal fistula. Cystectomy performed for the left adnexal cyst and the right adnexal cyst was only drained. The pathologic report for the left ovarian cyst was endometriosis. HSG result showed evidence of bilateral fallopian tube opacification with contrast outlining from the fallopian tubes. Contrast leakage happened to the adjacent small intestine in the right side and peritoneal cavity on the left side.

Conclusion

Fistulous connections between fallopian tube and intestine will remain an exceptional rarity. The reported case could be a good lesson illustrating that the adherence to general surgical principles (meticulous hemostasis, careful applying of diathermy, etc.) and a watchful postoperative care could protect the patient from both usual and unusual complications.

Anorectal injury following pelvic radiotherapy

BACKGROUND

Current knowledge of the effects of radiation on the anorectum is based on a limited number of studies. Variability in delivery techniques, both currently and historically, combined with a paucity of prospective and randomized studies makes interpretation of the literature difficult. This review presents the existing evidence and identifies areas that require further work.

METHODS

This review is based on a literature search (Medline and PubMed) and manual cross-referencing.

RESULTS AND CONCLUSION

More than three-quarters of patients receiving pelvic radiotherapy experience acute anorectal symptoms and up to one-fifth suffer from late-phase radiation proctitis. About 5 per cent develop other chronic complications, such as fistula, stricture and disabling faecal incontinence. The risk of rectal cancer may be increased. Conservative treatment options are of limited value. Surgery may be considered if symptoms are severe, provided sphincter function is adequate and recurrent disease is excluded. Large prospective studies with accurate dosimetric data and long-term follow-up are needed to provide meaningful information on which to base new strategies to minimize the side-effects from radiotherapy.

Pelvic fistulas complicating pelvic surgery or diseases: spectrum of imaging findings

Pelvic fistulas may result from obstetric complications, inflammatory bowel disease, pelvic malignancy, pelvic radiation therapy, pelvic surgery, or other traumatic causes, and their symptoms may be distressing. In our experience, various types of pelvic fistulas are identified after pelvic disease or pelvic surgery. Because of its close proximity, the majority of such fistulas occur in the pelvic cavity and include the vesicovaginal, vesicouterine, vesicoenteric, ureterovaginal, ureteroenteric and enterovaginal type. The purpose of this article is to illustrate the spectrum of imaging features of pelvic fistulas.

Vaginal reconstruction using the bladder and/or rectal walls in patients with radiation-induced fistulas

OBJECTIVE

In irreparable or recurrent vesicovaginal fistulas and cloacal defects following high-dose irradiation therapy for gynecological malignancies, urinary diversion is the last resort to achieve a socially acceptable solution. In a select group of young and tumor-free patients, additional vaginal reconstruction may be indicated. Multiple operative procedures are available, but the results are often disappointing in the previously irradiated area.

MATERIALS AND METHODS

In six such patients with large radiogenic vesicovaginal defects (n = 5) or a cloacal fistula (n = 1), a continent reservoir using the transverse colon with an umbilical stoma was performed. At the end of the operation, the bladder was incorporated into a neovagina by incising the urethra, anterior vaginal wall, and the posterior bladder wall with electrocautery from the urethral meatus to the dome of the fistula.

RESULTS

No postoperative complications related to the vaginal reconstruction occurred. After a mean follow-up of 4.7 years, all patients had a capacious vagina and a wide introitus; the neovagina measured a mean of 18 cm in length. Five patients with a partner reported a normal sexual life. No dyspareunia or discomfort from bladder or urethral mucosa during intercourse was reported.

CONCLUSIONS

Following continent urinary diversion due to irreparable vesicovaginal fistulas, a neovagina can be created by simple dissection of the posterior bladder and anterior vaginal wall. When a colostomy is present, the neovagina can additionally be augmented with a bowel flap of the Hartmann stump or by incising the rectovaginal septum. The technique affords good functional and cosmetic results.