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Al-Hajj A, Hamze W, El Koubayati G, Haddad F, Noujeim A. A Vesicocutaneous Fistula Treated With Urinary Diversion, Negative Pressure Wound Therapy, and Time. Cureus 2024; 16:e65313. [PMID: 39184688 PMCID: PMC11344087 DOI: 10.7759/cureus.65313] [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] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
A 38-year-old motor vehicle accident victim presented for acute urinary retention due to a clogged Foley catheter, which was inserted two weeks prior during surgery for pelvic and spine fixation and extra-peritoneal bladder rupture. Imaging studies revealed persistent bladder leaks despite primary and, later, secondary surgical repair. A combination of novel non-surgical techniques, that is, urinary diversion, negative pressure dressings, and waiting proved beneficial in our case, and led ultimately to complete clinical and radiological resolution of the fistula.
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Affiliation(s)
- Adham Al-Hajj
- Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
- Department of Surgery, Division of Urology, Lebanese Hospital Geitaoui, Beirut, LBN
| | - Wassim Hamze
- Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
- Department of Surgery, Division of Urology, Lebanese Hospital Geitaoui, Beirut, LBN
| | - Georgio El Koubayati
- Department of Internal Medicine, Division of Clinical Immunology, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
- Department of Internal Medicine, Division of Clinical Immunology, Lebanese Hospital Geitaoui, Beirut, LBN
| | - Fady Haddad
- Department of Internal Medicine, Division of Clinical Immunology, Lebanese Hospital Geitaoui, Beirut, LBN
| | - Antoine Noujeim
- Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
- Department of Surgery, Division of Urology, Lebanese Hospital Geitaoui, Beirut, LBN
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Lodhia J, Mremi A, Robert B, Sadiq A, Bright F, Mbwambo OJ, Ngowi BN. An unusual presentation of penetrating bladder injury with vesicocutaneous fistula: a case report. BMC Urol 2023; 23:80. [PMID: 37138272 PMCID: PMC10158159 DOI: 10.1186/s12894-023-01254-1] [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: 12/16/2022] [Accepted: 04/19/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Blunt trauma to the urinary bladder is common with penetrating injury being a rare occasion. Most common entry pint for penetrating injuries includes buttock, abdomen and perineum with thigh being rare. There are a number of complications that may develop as a result of penetrating injury with vesicocutanous fistula being a rare occurrence that usually presents with typical sign and symptoms. CASE PRESENTATION We present a rare case of penetrating bladder injury through medial upper thigh as an entry point that had complicated into vesicocutaneous fistula with atypical presentation of long-standing pus discharge that had been managed by incision and drainage several times with no success. MRI demonstrated a presence of fistula tract and a foreign body (piece of wood) in-situ confirmed the diagnosis. CONCLUSION Fistulas are a rare complication of bladder injuries and can cause negative impact on the quality of life of patients. Delayed urinary tract fistulations and secondary thigh abscesses are uncommon therefore a high index of suspicion is needed for early diagnosis. This case emphasizes the importance of radiological tests in aiding the diagnosis and ultimately proper management.
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Affiliation(s)
- Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania.
- Faculty of Medicine, Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania.
| | - Alex Mremi
- Faculty of Medicine, Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania
- Department of Pathology, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Bahati Robert
- Department of General Surgery, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Adnan Sadiq
- Faculty of Medicine, Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania
- Department of Radiology, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Frank Bright
- Faculty of Medicine, Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania
- Department of Urology, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Orgeness Jasper Mbwambo
- Faculty of Medicine, Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania
- Department of Urology, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Bartholomeo Nicholaus Ngowi
- Faculty of Medicine, Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania
- Department of Urology, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
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Fukai S, Tsujinaka S, Miyakura Y, Matsuzawa N, Hatsuzawa Y, Maemoto R, Kakizawa N, Rikiyama T. Anal fistula metastasis of rectal cancer after neoadjuvant therapy: a case report. Surg Case Rep 2022; 8:57. [PMID: 35357598 PMCID: PMC8971341 DOI: 10.1186/s40792-022-01410-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anal metastasis of colorectal cancer is very rare and may present synchronously or metachronously, regardless of pre-existing anal diseases. We report a case of anal fistula metastasis after completion of neoadjuvant therapy for rectal cancer, followed by surgical resection of the primary tumor and metastatic lesion. CASE PRESENTATION A 50-year-old man was diagnosed with rectal cancer located 5 cm from the anal verge, with a clinical stage of cT3N0M0. He denied any medical or surgical history, and physical examination revealed no perianal disease. He underwent preoperative chemoradiation therapy (CRT) consisting of a tegafur/gimeracil/oteracil potassium (S-1)-based regimen with 45 Gy of radiation. After completion of CRT, computed tomography (CT) revealed the primary tumor's partial response, but a liver mass highly suggestive of metastasis was detected. This mass was later diagnosed as cavernous hemangioma 3 months after CRT initiation. He then underwent and completed six cycles of consolidation chemotherapy with a capecitabine-based regimen. Subsequent colonoscopy revealed the complete response of the primary tumor, but CT showed thickening of the edematous rectal wall. Therefore, we planned to perform low anterior resection as a radical surgery. However, he presented with persistent anal pain after the last chemotherapy, and magnetic resonance imaging revealed a high-intensity mass behind the anus, suggestive of an anal fistula. We considered the differential diagnosis of a benign anal fistula or implantation metastasis into the anal fistula. Fistulectomy was performed, and a pathological diagnosis of tubular adenocarcinoma, suggestive of implantation metastasis, was made. Thereafter, we performed laparoscopic abdominoperineal resection. Histopathological examination revealed well-differentiated adenocarcinoma, ypT2N0, with a grade 2 therapeutic effect. Subsequent immunohistochemistry of the resected anal fistula showed a CDX-2-positive, CK20-positive, CK7-negative, and GCDFP-15 negative tumor, with implantation metastasis. There was no cancer recurrence 21 months after the radical surgery. CONCLUSIONS This is the first report of anal fistula metastasis after neoadjuvant therapy for rectal cancer in a patient without a previous history of anal disease. If an anal fistula is suspected during or after neoadjuvant therapy, physical and radiological assessment, differential diagnosis, and surgical intervention timing for fistula must be carefully discussed.
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Affiliation(s)
- Shota Fukai
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
| | - Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
| | - Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
| | - Natsumi Matsuzawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
| | - Yuuri Hatsuzawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
| | - Ryo Maemoto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
| | - Nao Kakizawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
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