Treatment of Colocutaneous Fistula in the Left Thigh.

Aim There are few publications on the surgical management of a colocutaneous fistula in the thigh. Here, we describe a patient who presented with a 2-year history of fecal fistula in the left thigh, following a history of drainage of a psoas abscess. This is followed by a discussion of appropriate treatment modalities for this type of fistula. Methods To determine the appropriate treatment for our patient with chronic fistula, we thoroughly reviewed the relevant literature in an Internet-based search and selected a staged operative approach for our patient. Results Using a staged surgical procedure, we were able to resolve the colocutaneous fistula without the occurrence of comorbidities. Conclusion Substantial morbidity is associated with the presence of colocutaneous fistulas. The best possible approach is prevention of its occurrence, but this is not always feasible. Measures for management of an acute fistula differ from those in patients with chronic fistula. Medical management can be more effective in acute cases, while chronic cases require surgical management. We used a staged surgical method with a few risks for our patient and he is in good health 1 year after treatment.

Challenges Encountered in Placement of Ostomy Bag for Palliative Care in a Patient with Colorectal Cancer.

Fecal fistula develop in patients with cancer associated with difficult management situation, which is often complicated by prior treatment including surgery, radiation therapy, and chemotherapy. Affecting factors such as timing of additional adjuvant therapy or palliative care, technical considerations for operating on irradiated bowel, poor wound healing, increased risk of additional fecal fistula, and decreased likelihood of spontaneous fecal fistula closure all need to be considered in this scenario. Here, the authors focus specifically on the management of fecal fistula associated with cancer and/or radiation- induced injury to the bowel.

Determinants of postoperative morbidity and mortality in children managed for typhoid intestinal perforation in Kano Nigeria.

BACKGROUND: Intestinal perforation is a serious but poorly understood complication of typhoid fever. This study aims to determine the patient factors associated with postoperative morbidity and mortality. METHODS: We retrospectively reviewed the records of all children presenting to our unit with typhoid intestinal perforation (TIP) between March 2009 and December 2013. The patients were grouped based on postoperative outcome status and were compared with respect to patient related variables, using chi square test. Multivariate analysis was performed using a binary logistic regression model. Significance was assigned to a p-value <0.05. RESULTS: The records of 129 children were analyzed. There were 78 (60.5%) boys and 51 (39.5%) girls. The male/female ratio was 1.53:1. Their ages ranged from 3years to 13years (mean 8.14years; SD 2.61years). A single intestinal perforation was seen in 73.4% (94/128) of them, while 26.6% (34/128) had two or more. Mortality rate was 10.9%. Multivariate analysis showed that multiple intestinal perforations significantly predicted postoperative mortality (p=0.005) and development of postoperative fecal fistula (p=0.013), while serum albumin <32g/L was a predictor of postoperative surgical site infection (p=0.002). CONCLUSION: Multiple intestinal perforations, a postoperative fecal fistula and hypoalbuminemia adversely affected outcome in our patients. LEVEL OF EVIDENCE: III (Retrospective study). Type of study-Prognosis study.

Richter's Hernia Presenting As Faecal Fistula In Female; A Rare Entity.

Strangulated hernia in quite common in surgical practice and always present with its typical symptoms. In this hardly found unique case, a 76-year's old female with no co morbid presented to us with abdominal pain, vomiting and diarrhoea initially and later developed left groin abscess after 4 days of swelling. It was assumed to be inguinal lymphadenitis leading to abscess formation but after complete evaluation on digital examination, diagnosis of Strangulated Femoral hernia of Richter type was made. This distinguishing presentation among the list of all hernias has to be discussed for the differential diagnosis.

A complicated true sliding hernia presenting as a spontaneous enteroscrotal fistula in an adult.

A 26-year-old man presented with an irreducible right inguino-scrotal swelling and fecal discharge from the scrotum. Exploratory laparotomy and inguinal exploration revealed that the caecum, appendix, and terminal ileum had herniated into the scrotum and had perforated through the skin forming a fecal fistula. The herniated gangrenous bowel was resected and a stoma fashioned. Spontaneous entero-scrotal fistulae are very rare and eight pediatric cases have been mentioned in literature till date. We report the first case of true sliding hernia presenting as spontaneous entero-scrotal fistula in an adult.