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Alberti P, Westgarth-Taylor C, Trovalusci E, Charlton R, Brisighelli G. HIV-associated rectovaginal fistulae in children: a single-centre retrospective study in the antiretroviral era. Pediatr Surg Int 2024; 40:181. [PMID: 38976031 DOI: 10.1007/s00383-024-05762-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE Acquired rectovaginal fistulae (RVF) are a complication of paediatric HIV infection. We report our experience with the surgical management of this condition. METHODS We retrospectively reviewed the records of paediatric patients with HIV-associated RVF managed at Chris Hani Baragwanath Academic Hospital (2011-2023). Information about HIV management, surgical history, and long-term outcomes was collected. RESULTS Ten patients with HIV-associated RVF were identified. Median age of presentation was 2 years (IQR: 1-3 years). Nine patients (9/10) underwent diverting colostomy, while one demised before the stoma was fashioned. Fistula repair was performed a median of 17 months (IQR: 7.5-55 months) after colostomy. An ischiorectal fat pad was interposed in 5/9 patients. Four (4/9) patients had fistula recurrence, 2/9 patients developed anal stenosis, and 3/9 perineal sepsis. Stoma reversal was performed a median of 16 months (IQR: 3-25 months) after repair. Seven patients (7/9) have good outcomes without soiling, while 2/9 have long-term stomas. Failure to maintain viral suppression after repair was significantly associated with fistula recurrence and complications (φ = 0.8, p < 0.05). CONCLUSION While HIV-associated RVFs remain a challenging condition, successful surgical treatment is possible. Viral suppression is a necessary condition for good outcomes.
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Affiliation(s)
- Piero Alberti
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher Westgarth-Taylor
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Emanuele Trovalusci
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Paediatric Surgery Unit, Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Robyn Charlton
- Department of Paediatrics, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Giulia Brisighelli
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Bhardwaj A, Manchanda V, Kumar P, Sengar M. Rectourethral Fistula after Posterior Urethral Valves Ablation in an Infant: A Rare Complication. J Indian Assoc Pediatr Surg 2024; 29:165-167. [PMID: 38616826 PMCID: PMC11014165 DOI: 10.4103/jiaps.jiaps_192_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 04/16/2024] Open
Abstract
Acquired rectourethral fistula (RUF) is a rare but major complication of posterior urethral valve ablation. We present a case of a 1-year-old boy managed in a staged manner by completion of posterior urethral valves ablation, colostomy, RUF division through anterior sagittal transanorectal approach, and stoma closure. The child is continent for urine and feces.
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Affiliation(s)
- Ankur Bhardwaj
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Vivek Manchanda
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Parveen Kumar
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Mamta Sengar
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India
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Gomez Rosado JO, Castellano C, Genao Cruz J, Esgusquiza J. Rectovaginal Fistula in a 10-Year-Old With Hirschsprung Disease: A Case Report. Cureus 2024; 16:e57316. [PMID: 38690493 PMCID: PMC11060009 DOI: 10.7759/cureus.57316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
Hirschsprung disease is an uncommon medical condition caused by the lack of migration of ganglion cells to the rectum during embryonic development, affecting the peristaltic movements of the intestine. It is a chronic medical condition responsible for chronic constipation and intestinal obstruction. We present the case of a 10-year-old female with a history of Hirschsprung disease and colectomy admitted to a pediatric hospital for the management of multiple colonic ulcers and severe anemia who subsequently developed a rectovaginal fistula. This patient's admission was complicated by perianal and vaginal excoriations, a paralytic ileus, and fecal incontinence. This case report is unique due to the development of a rare pediatric complication of Hirschsprung disease.
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Affiliation(s)
- Jomaries O Gomez Rosado
- College of Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Courteney Castellano
- College of Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Jossias Genao Cruz
- Department of Pediatrics, Broward Health Medical Center, Fort Lauderdale, USA
| | - Jonas Esgusquiza
- Department of Pediatrics, Broward Health Medical Center, Fort Lauderdale, USA
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Vurture G, Kayton M, Staab V, Appelbaum H. Fibrin Glue Repair of a Traumatic Rectovaginal Fistula in a Pediatric Patient. J Pediatr Adolesc Gynecol 2023; 36:491-493. [PMID: 36889455 DOI: 10.1016/j.jpag.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Rectovaginal fistulas are often associated with obstetric trauma and present with leakage of stool or flatus from the vagina. They are often repaired via fistulaectomy, but sometimes more complex repairs are needed. There are limited data regarding success using fibrin glue to close the tract. CASE A developmentally delayed pediatric patient presented with right hip pain. Imaging studies identified a hairpin penetrating the rectovaginal space. The hairpin was removed during an exam under anesthesia, and the subsequent rectovaginal fistula was closed with fibrin glue. Closure of the tract has persisted for more than 1 year without need for further intervention. SUMMARY AND CONCLUSION Fibrin glue may be a minimally invasive and safe approach for rectovaginal fistulas in the pediatric patient.
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Affiliation(s)
- Gregory Vurture
- Division of Pediatric Gynecology, Department of Obstetrics and Gynecology, Jersey Shore University Medical Center, Neptune, New Jersey.
| | - Mark Kayton
- Division of Pediatric Surgery, Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Victoriya Staab
- Division of Pediatric Surgery, Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Heather Appelbaum
- Division of Pediatric Gynecology, Department of Obstetrics and Gynecology, Jersey Shore University Medical Center, Neptune, New Jersey
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Ngongo CJ, Raassen TJ, Mahendeka M, Lombard L, van Roosmalen J, Temmerman M. Rare causes of genital fistula in nine African countries: a retrospective review. BMC Womens Health 2022; 22:497. [PMID: 36474228 PMCID: PMC9724406 DOI: 10.1186/s12905-022-02050-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Most genital fistulas result from prolonged, obstructed labor or surgical complications. Other causes include trauma (from accidents, traditional healers, or sexual violence), radiation, carcinoma, infection, unsafe abortion, and congenital malformation. METHODS This retrospective records review focuses on rare fistula causes among 6,787 women who developed fistula after 1980 and sought treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Zambia, Rwanda, Ethiopia, Somalia, and South Sudan. We compare fistula etiologies across countries and assess associations between rare causes and type of incontinence (urine, feces, or both). RESULTS Rare fistula accounted for 1.12% (76/6,787) of all fistulas, including traumatic accidents (19/6,787, 0.28%), traumatic sexual violence (15/6,787, 0.22%), traumatic injuries caused by traditional healers (13/6,787, 0.19%), unsafe abortion (10/6,791, 0.15%), radiation (8/6,787, 0.12%), complications of HIV infection (6/6,787, 0.09%), and congenital abnormality (5/6,787, 0.07%). Trauma caused by traditional healers was a particular problem among Somali women. CONCLUSION Fistulas attributable to rare causes illuminate a variety of risks confronting women. Fistula repair training materials should distinguish trauma caused by traditional healers as a distinct fistula etiology. Diverse causes of fistula call for multi-pronged strategies to reduce fistula incidence.
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Affiliation(s)
- Carrie J. Ngongo
- grid.62562.350000000100301493Global Health Division, RTI International, Research Triangle Park, USA
| | | | - Marietta Mahendeka
- grid.413123.60000 0004 0455 9733Bugando Medical Centre, Mwanza, Tanzania
| | | | - Jos van Roosmalen
- grid.10419.3d0000000089452978Leiden University Medical Centre and Athena Institute VU University, Amsterdam, the Netherlands
| | - Marleen Temmerman
- grid.470490.eCentre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya ,grid.5342.00000 0001 2069 7798Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Hirano T, Ohge H, Watadani Y, Uegami S, Shimada N, Nakashima I, Yoshimura K, Takahashi S. Post-traumatic rectourethral fistula in an adolescent managed via a transperineal approach using a local gluteal tissue interposition flap: a case report. Surg Case Rep 2021; 7:259. [PMID: 34914015 PMCID: PMC8677871 DOI: 10.1186/s40792-021-01335-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Rectourethral fistula is a rare disease with a wide variety of etiologies and clinical presentations. A definitive surgical procedure for rectourethral fistula repair has not been established. Case presentation A 13-year-old boy sustained a penetrating injury to the perineum, and developed a symptomatic rectourethral fistula thereafter. Conservative management through urinary diversion and transanal repair was unsuccessful. Fecal diversion with loop colostomy was performed, and three months later, a fistula repair was performed via a transperineal approach with interposition of a local gluteal tissue flap. There were no postoperative complications, and magnetic resonance imaging studies confirmed the successful closure of the fistula. The urinary and fecal diversions were reverted 1 and 6 months after the fistula repair, respectively, and postoperative excretory system complications did not occur. Conclusions The transperineal approach with interposition of a local gluteal tissue flap provides a viable surgical option for adolescent patients with rectourethral fistulas who are unresponsive to conservative management.
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Affiliation(s)
- Toshinori Hirano
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan.
| | - Hiroki Ohge
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Yusuke Watadani
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Shinnosuke Uegami
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Norimitsu Shimada
- Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama, Kure, Hiroshima, 737-0023, Japan
| | - Ikki Nakashima
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Kosuke Yoshimura
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
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Ventura FL, Nguyen CM, Dang A, Baliss M, Sonstein LK. A Curious Case of Rectal Ejaculation. Cureus 2021; 13:e17330. [PMID: 34447650 PMCID: PMC8381446 DOI: 10.7759/cureus.17330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/24/2022] Open
Abstract
Rectal-prostate fistulas are uncommon anatomical connections between the prostatic urethra and rectum that are typically iatrogenic but can also result from other underlying pathology. Here, we present a unique case of a rectal-prostate fistula causing the rectal passage of sperm. A 33-year-old male with a history of illicit drug use presented with five days of testicular pain and a substantial amount of sperm passage from his rectum with ejaculation for the past two years. Computed tomography and voiding cystourethrogram (VCUG) of the pelvis revealed evidence of a rectal-prostate fistula. He was treated with piperacillin-tazobactam, and a surgical fistula repair was performed. Further investigation divulged a three-week comatose state due to cocaine and phencyclidine intoxication two years prior with documentation suggesting a traumatic Foley catheter placement and strong suspicion for premature balloon dilation in the prostatic urethra. Repeat VCUG revealed resolution of the fistula with mildly reduced antegrade ejaculatory volume. Cases secondary to Foley catheter placement have not been previously reported in the literature. Even though urethral catheters have been shown to be effective tools in healthcare, it is crucial for clinicians to recognize the numerous potential complications that oftentimes become an afterthought to many providers. This case not only highlights a rare complication of catheter use but also emphasizes the importance of provider mindfulness when utilizing seemingly benign therapies such as Foley catheters.
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Affiliation(s)
- Frank L Ventura
- Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Christopher M Nguyen
- Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Alexander Dang
- Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Michelle Baliss
- Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Lindsay K Sonstein
- Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
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