RESUMO
BACKGROUND: Anal fistula is a common benign anorectal disease that often requires surgical intervention for effective treatment. In recent years, preoperative colonoscopy as a diagnostic tool in patients with anal fistula has garnered increasing attention due to its potential clinical application value. By investigating underlying inflammatory bowel disease (IBD), polyps, and other abnormalities, preoperative colonoscopy can offer insights to refine surgical strategies and improve patient outcomes. METHODS: This retrospective study focused on 1796 patients with various benign anorectal diseases who underwent preoperative intestinal endoscopy and met surgical criteria within the preceding three years at the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine. Among these patients, 949 diagnosed with anal fistula comprised group A, while 847 patients without anal fistula were assigned to group B for comparison. The investigation encompassed an analysis of general patient information, endoscopic findings, polyp histopathology, distribution of bowel inflammation sites, and results of inflammatory bowel disease assessments between the two patient cohorts. A subgroup analysis was also conducted on 2275 anal fistula patients with no surgical contraindications. This subgroup was categorized into Group A (949 patients who underwent preoperative intestinal endoscopy) and Group C (1326 patients who did not undergo preoperative colonoscopy). The study compared the rates of detecting endoscopic lesions and IBD-related findings between the two subgroups. RESULTS: The study initially confirmed the comparability of general patient information between groups A and B. Notably, the abnormal detection rate in group A was significantly higher than in group B (P < 0.01). In terms of endoscopic findings, the anal fistula group (group A) exhibited higher rates of detecting bowel inflammation, inflammatory bowel disease, and polyps compared to the non-anal fistula group (group B) (P < 0.05). The distribution of inflammation locations indicated higher detection rates in the terminal ileum, ileocecal region, and ascending colon for group A compared to group B (P < 0.05). Although the incidence of IBD in group A was higher than in group B, this difference did not reach statistical significance (P > 0.05). Subsequently, the analysis of the subgroup (groups A and C) revealed a significant disparity in intestinal endoscopic detection rates (P < 0.01) and statistically significant differences in detecting IBD (P < 0.05) and Crohn's disease (P < 0.05) between the two anal fistula subgroups. CONCLUSIONS: The findings of this study underscore the substantial clinical value of preoperative colonoscopy in the comprehensive evaluation of patients with anal fistula. Preoperative colonoscopy aids in ruling out localized perianal lesions caused by underlying inflammatory bowel disease, thereby mitigating the likelihood of missed diagnoses and enhancing treatment outcomes. This research highlights the importance of incorporating preoperative colonoscopy as a valuable diagnostic tool in managing anal fistula patients.
Assuntos
Doenças Inflamatórias Intestinais , Fístula Retal , Humanos , Estudos Retrospectivos , Colonoscopia , Fístula Retal/diagnóstico , Fístula Retal/cirurgia , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/cirurgia , InflamaçãoRESUMO
BACKGROUND: Previously published short-term results (week 16) of this trial showed a significant improvement in clinical, radiologic and biochemical outcomes in Crohn's disease patients with therapy-refractory perianal fistulas after treatment with hyperbaric oxygen therapy. OBJECTIVE: To assess the long-term (week 60) efficacy, safety and feasibility of hyperbaric oxygen therapy in perianal fistula in Crohn's disease. METHODS: Crohn's disease patients with high perianal fistula(s) failing conventional treatment >6 months were included. Exclusion criteria were presence of a stoma, rectovaginal fistula(s) and recent changes in treatment regimens. Patients received 40 hyperbaric oxygen sessions and outcomes were assessed at week 16 and week 60. RESULTS: Twenty patients were included (median age 34 years). At week 16, median scores of the perianal disease activity index and modified Van Assche index (co-primary outcomes) decreased from 7.5 (95% CI 6-9) to 4 (95% CI 3-6, p < 0.001) and 9.2 (95% CI 7.3-11.2) to 7.3 (95% CI 6.9-9.7, p = 0.004), respectively. At week 60, the respective scores remained significantly lower than baseline: 4 (95% CI 3-7, p < 0.001) and 7.7 (95% CI 5.2-10.2, p = 0.003). Perianal disease activity index score of 4 or less (representing inactive perianal disease) was observed in 13 patients at week 16 and 12 patients at week 60. Using fistula drainage assessment, 12 and 13 patients showed a clinical response at week 16 and 60, respectively, and clinical remission was achieved in four patients for both time points. At week 16, a statistically significant biochemical improvement (C-reactive protein and faecal calprotectin levels) was found, but this effect was no longer significant at week 60. CONCLUSIONS: The clinical and radiologic improvement of perianal fistula in Crohn's disease, that was found at week 16 after treatment with hyperbaric oxygen therapy, is maintained at 1-year follow-up.
Assuntos
Doença de Crohn , Oxigenoterapia Hiperbárica , Fístula Retal , Adulto , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Feminino , Seguimentos , Humanos , Fístula Retal/diagnóstico , Fístula Retal/etiologia , Fístula Retal/terapia , Resultado do TratamentoRESUMO
The anorectal malformation with long perineal fistula is a rare anomaly in the spectrum of anorectal malformations. Aim of the study is to describe the series of patients with anorectal malformation with long perineal fistula and compare the outcome with patient with standard perineal fistula. From March 2012 to January 2019, 7 patients who suffered from anorectal malformation with long perineal fistula were retrospectively reviewed. Three were operated on primarily by our department, and 4 cases were re-operated after a perineal anoplasty repair performed elsewhere. Four were operated by laparoscopy assisted anorectoplasty, and 3 cases were repaired by posterior sagittal anorectoplasty. The follow-up outcomes were compared with 71 cases of normal perineal fistula (NPF) in the same period. 7 cases have been followed up for 0.5-4 years (M = 2.57 ± 1.26) after definitive surgery. Their bowel function score was lower than normal perineal fistula (SPF = 12, range: 5-18; NPF = 18.5, range: 18-20). Four cases underwent anorectomanometry. The incidence of rectoanal inhibitory reflex was lower in the special type group. (p = 0.14). Three cases of contrast enema using barium: 2 cases of colorectal dilatation and thickening changes, 1 case showed no obvious abnormalities. Anorectal perineal fistula should be examined by distal colostogram at preoperation. This should be altered in: When suspecting a case of anorectal malformation type long perineal fistula a preoperative contrast enema could give insight of the anatomy befor performing a anoplasty.
Assuntos
Malformações Anorretais/diagnóstico , Fístula Retal/diagnóstico , Canal Anal/fisiologia , Canal Anal/cirurgia , Malformações Anorretais/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Laparoscopia , Masculino , Fístula Retal/cirurgia , Estudos RetrospectivosRESUMO
Recommendations are advice that is given and considered to be beneficial; however, they are still suggestions and are therefore open to different interpretations. In this sense, the final objective of the review has been to try to homogenize, with the evidence available, the approach to the diagnosis and medical/surgical treatment of one of the most complex manifestations of Crohn's disease, such as simple and complex perianal fistulas.
Assuntos
Doença de Crohn/complicações , Fístula Retal/terapia , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Endoscopia/métodos , Feminino , Fissura Anal/etiologia , Fissura Anal/terapia , Humanos , Oxigenoterapia Hiperbárica , Imunossupressores/uso terapêutico , Imageamento por Ressonância Magnética/métodos , Transplante de Células-Tronco Mesenquimais , Proctite/tratamento farmacológico , Proctite/etiologia , Proctite/cirurgia , Fístula Retal/classificação , Fístula Retal/diagnóstico , Fístula Retal/etiologia , Fístula Retovaginal/etiologia , Fístula Retovaginal/cirurgia , Fístula Retovaginal/terapia , Salicilatos/uso terapêutico , Retalhos Cirúrgicos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodosRESUMO
AIM: Crohn's anal fistula should be managed by a multidisciplinary team. There is no clearly defined 'patient pathway' from presentation to treatment. The aim of this study was to describe the patient route from presentation with symptomatic Crohn's anal fistula to starting anti-tumour necrosis factor (anti-TNF) therapy. METHOD: Case note review was undertaken at three hospitals with established inflammatory bowel disease services. Patients with Crohn's anal fistula presenting between 2010 and 2015 were identified through clinical coding and local databases. Baseline demographics were captured. Patient records were interrogated to identify route of access, and clinical contacts during the patient pathway. RESULTS: Seventy-nine patients were included in the study, of whom 54 (68%) had an established diagnosis of Crohn's disease (CD). Median time from presentation to anti-TNF therapy was 204 days (174 vs 365 days for existing and new diagnosis of CD, respectively; P = 0.019). The mean number of surgical outpatient attendances, operations and MRI scans per patient was 1.03, 1.71 and 1.03, respectively. Patients attended a mean of 1.49 medical clinics. Seton insertion was the most common procedure, accounting for 48.6% of all operations. Where care episodes ('clinical events per 30 days') were infrequent this correlated with prolongation of the pathway (r = -0.87; P < 0.01). CONCLUSION: This study highlights two key challenges in the treatment pathway: (i) delays in diagnosis of underlying CD in patients with anal fistula and (ii) the pathway to anti-TNF therapy is long, suggesting issues with service design and delivery. These should be addressed to improve patient experience and outcome.
Assuntos
Doença de Crohn/diagnóstico , Doença de Crohn/tratamento farmacológico , Fístula Retal/diagnóstico , Fístula Retal/tratamento farmacológico , Tempo para o Tratamento/estatística & dados numéricos , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Estudos de Coortes , Comorbidade , Procedimentos Clínicos , Doença de Crohn/epidemiologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hospitais de Ensino , Humanos , Incidência , Pessoa de Meia-Idade , Avaliação das Necessidades , Prognóstico , Fístula Retal/epidemiologia , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Fator de Necrose Tumoral alfa/administração & dosagem , Adulto JovemRESUMO
PURPOSE: Long-standing fistulizing and stenotic proctitis (LFSP) in Crohn's disease (CD) indicates the end stage of the disease. Definitive diversion such as proctectomy is considered to be the only surgical option. The impact of intersphincteric sphincter-sparing anterior rectal resection (IAR) as an alternative to proctectomy is unclear. The aim of this study was to evaluate feasibility, morbidity, outcome, and quality of life (QL) in patients with LFSP undergoing intended IAR. PATIENTS AND METHODS: Out of a single institution database, 15 patients with LFSP intended for surgery from 856 patients with CD were selected for follow-up analyses. RESULTS: In 12/15 cases, IAR was carried out while 3/15 patients underwent primary proctectomy due to malignancy (n = 2) or due to patient's wish (n = 1). In one case, IAR revealed unexpected malignancy, which led to secondary proctectomy. In patients with IAR, complete healing of fistulas and stenosis was observed in 46% (n = 5) while 36% (n = 4) of patients showed relapse of fistula and 18% (n = 2) developed restenosis. Ileostomy closure was performed in seven patients from which six patients remained stoma free. QL and fecal incontinence measured by standardized scoring systems were unchanged while stool frequency was reduced after IAR in patients with ileostomy closure. The rate of malignancy in this cohort was 20% (n = 3). CONCLUSION: LFSP in CD was associated with 20% of malignant transformation. Although IAR fails to improve QL, it is a suitable procedure for the treatment of fistulas and stenosis associated with acceptable healing rates and can avoid a permanent stoma.
Assuntos
Canal Anal/cirurgia , Doença de Crohn/cirurgia , Proctite/cirurgia , Fístula Retal/cirurgia , Reto/cirurgia , Adolescente , Adulto , Idoso , Canal Anal/patologia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Bases de Dados Factuais , Progressão da Doença , Feminino , Seguimentos , Humanos , Ileostomia/métodos , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão , Proctite/complicações , Proctite/diagnóstico , Proctocolectomia Restauradora/efeitos adversos , Proctocolectomia Restauradora/métodos , Qualidade de Vida , Fístula Retal/complicações , Fístula Retal/diagnóstico , Reoperação/métodos , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
A rectoseminal vesicle fistula is a rare complication after a low anterior resection for rectal cancer, usually developing in the outpatient postoperative period with pneumaturia, fever, scrotal swelling or testicular pain. A diagnostic water-soluble contrast enema, cystography and computed tomography reveal a tract from the rectum to the seminal vesicle. Anastomotic leakage is thought to be partially responsible for the formation of such tracts. This report presents three cases of rectoseminal vesicle fistula, and the presumed course of the disease and optimal treatment options are discussed.
Assuntos
Adenocarcinoma/cirurgia , Doenças dos Genitais Masculinos , Complicações Pós-Operatórias , Fístula Retal , Neoplasias Retais/cirurgia , Glândulas Seminais , Idoso , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Retal/diagnóstico , Fístula Retal/terapia , Neoplasias Retais/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Rectal perforations due to glycerin enemas (GE) typically occur when the patient is in a seated or lordotic standing position. Once the perforation occurs and peritonitis results, death is usually inevitable. We describe two cases of rectal perforation and fistula caused by a GE. An 88-year-old woman presented with a large rectal perforation and a fistula just after receiving a GE. Her case was further complicated by an abscess in the right rectal wall. The second patient was a 78-year-old woman who suffered from a rectovesical fistula after a GE. In both cases, we performed direct endoscopic abscess lavage with a saline solution and closed the fistula using an over-the-scope-clip (OTSC) procedure. These procedures resulted in dramatic improvement in both patients. Direct endoscopic lavage and OTSC closure are very useful for pararectal abscess lavage and fistula closure, respectively, in elderly patients who are in poor general condition. Our two cases are the first reports of the successful endoscopic closure of fistulae using double OTSCs after endoscopic lavage of the debris and an abscess of the rectum secondary to a GE.
Assuntos
Abscesso/cirurgia , Colonoscopia/métodos , Enema/efeitos adversos , Glicerol/administração & dosagem , Perfuração Intestinal/cirurgia , Doenças Retais/cirurgia , Fístula Retal/cirurgia , Reto/cirurgia , Abscesso/diagnóstico , Abscesso/etiologia , Idoso , Idoso de 80 Anos ou mais , Colonoscopia/instrumentação , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Doenças Retais/diagnóstico , Doenças Retais/etiologia , Fístula Retal/diagnóstico , Fístula Retal/etiologia , Reto/lesões , Instrumentos Cirúrgicos , Irrigação Terapêutica , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Genital fistulas (GF) can arise in the course of Crohn's disease (CD), are difficult to manage and determine a significant alteration of the quality of life. AIMS: To review the joint experience of the Inflammatory Bowel Disease Units in six University Hospitals in the management of GF in Crohn's disease on female patients. RESULTS: A total of 47 patients with GF were identified, affecting 3.8% of women with CD treated in our centers. A 47.5% of patients were smokers. The median of time from the diagnosis of CD reached 102 months. According to anatomical type, GF were classified as rectovaginal (74.5%), anovaginal/anovulvar (21.3%) and enterovaginal (4.3%). Main symptoms were vaginal discharge of fecal material (55.3%), vaginal passage of gas (40.4%), or both. Fistulas were treated with antibiotics in 59.6% of patients, without any lasting success. Thiopurines were used in 80.9% of cases, with 13.2% of complete and 23.7% of partial responses. Anti TNF-alpha therapy was applied in 63.8%, with a 16.7% of complete and a 30% of partial responses (all responding patients received infliximab). Surgery was indicated in 38.3% of patients, with a 22% of complete responses after a first operation and 38.8% after reintervention. In all, definitive closure after one or more of these therapies was achieved in only 31.9% of cases. CONCLUSION: Genital fistulas are a significant problem in female Crohn's disease patients. Therapy is not well defined and only partially effective (one in three cases). Surgical therapy stands out as the most effective treatment.
Assuntos
Doença de Crohn/complicações , Fístula/diagnóstico , Fístula/terapia , Doenças da Vulva/terapia , Adalimumab , Adolescente , Adulto , Fatores Etários , Anti-Infecciosos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Ciprofloxacina/uso terapêutico , Feminino , Fístula/etiologia , Humanos , Infliximab , Fístula Intestinal/diagnóstico , Fístula Intestinal/etiologia , Fístula Intestinal/terapia , Metronidazol/uso terapêutico , Purinas/uso terapêutico , Fístula Retal/diagnóstico , Fístula Retal/etiologia , Fístula Retal/terapia , Fístula Retovaginal/diagnóstico , Fístula Retovaginal/etiologia , Fístula Retovaginal/terapia , Estudos Retrospectivos , Fumar , Fatores de Tempo , Falha de Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fístula Vaginal/diagnóstico , Fístula Vaginal/etiologia , Fístula Vaginal/terapia , Doenças da Vulva/diagnóstico , Doenças da Vulva/etiologia , Adulto JovemRESUMO
OBJECTIVES: To present this clinical series to report our initial experience with our technique as an alternative approach for treatment of rectourethral fistulas (RUFs). RUFS are a devastating complication of the urinary tract. The most appropriate approach remains controversial. METHODS: From March 2002 to August 2007, 8 patients with RUF were referred to our institution. The etiology of the RUF was a fractured pelvis in 2, radical prostatectomy in 1, transurethral resection of the prostate in 1, anterior bowel resection in 1, and a pull-through operation in 3. Of the 8 patients, 5 had undergone urinary diversion and 3 had undergone a previous repair that had failed. They were evaluated and treated using the posterior sagittal approach with rectal mobilization. The fistulas were excised, and both the urethra and rectum were repaired. The inferior half of the gluteus maximus muscle was used as barrier in 5 of the 8 patients. The operative and immediate and late postoperative complications were recorded. The clinical outcome was defined as success when the patients experienced no fecaluria or pneumaturia. RESULTS: All 8 patients, with a mean age of 38.7 years, were completely cured of their RUF. The mean operative time was 290 minutes, and the mean blood loss was 637.5 mL. The median hospital stay was 18 days. Early postoperative complications included wound infection in 1 and deep vein thrombosis in 1 patient. One patient developed a late complication of urinary incontinence. CONCLUSIONS: Our approach is safe, provides excellent exposure, and allows for dissection under direct vision. The gluteus maximus flap is a good, nearby flap that can be used with minimal host morbidity.
Assuntos
Procedimentos de Cirurgia Plástica/métodos , Fístula Retal/cirurgia , Reto/cirurgia , Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Adulto , Idoso , Anastomose Cirúrgica/métodos , Nádegas , Criança , Pré-Escolar , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Qualidade de Vida , Fístula Retal/diagnóstico , Fístula Retal/etiologia , Estudos Retrospectivos , Medição de Risco , Estudos de Amostragem , Retalhos Cirúrgicos , Resultado do Tratamento , Doenças Uretrais/diagnóstico , Doenças Uretrais/etiologia , Fístula Urinária/diagnóstico , Fístula Urinária/etiologia , Incontinência Urinária/prevenção & controle , Ferimentos e Lesões/complicações , Adulto JovemRESUMO
Introducción: Las fistulas anales complejas son de difícil manejo y en general afectan la calidad de vida de los pacientes que las padecen. Cuando el trayecto compromete gran cantidad del músculo esfinteriano existe el riesgo de una incontinencia postoperatoria. Para prevenir el daño, en los últimos años surgieron tratamientos alternativos, entre ellos el tapón bioprotésico anal. Objetivo: Demostrar la eficacia del tapón bioprotésico anal en el tratamiento de las fistulas anales complejas. Diseño: Estudio observacional retrospectivo. Pacientes y métodos: Se colocaron 15 tapones en 12 pacientes (6 varones) con una edad promedio de 47 años (rango, 26-71). El 62 por ciento de los pacientes presentaban antecedentes de dos o más cirugias previas por fístulas anales complejas (9 transesfinterianas altas, l extraesfinteriana, l recto-vaginal, l pouch-vaginal). Se utilizó la ecografía endoanal de 3600 como estudio complementario del diagnóstico en todos los casos. El procedimiento fue realizado bajo anestesia general, en posición de litotomía y se utilizó profilaxis antibiótica. Una vez localizado el trayecto fistuloso se irrigó con solución de iodopovidona para ubicar el orificio primario. Se colocó el tapón anal a través del trayecto fistuloso fijándolo al orifico interno y recortando el excedente al nivel del orificio externo. El tiempo de seguimiento fue de 2 a 13 meses. Resultados: El tratamiento fue exitoso en 8 pacientes con una única colocación del tapón. De los casos recidivados, se les colocó un nuevo tapón a tres pacientes; evolucionando con éxito dos de ellos. El porcentaje global de respuesta favorable fue del 82 por ciento. No se registró morbi-mortalidad referida al método. Conclusión: El tratamiento de las fistulas anales con el tapón bioprotésico es una alternativa segura y efectiva, con posibilidades de volver a realizarse sin afectar la continencia.
Introduction: The complex anal fistulas have a difficult treatment and generally affect the patients lifestyle. When the tracts run through the upper anal sphincters the risk of postoperative incontinence is higher. The anal bioprosthetic plug is an alternative treatment for preventing the damage. Aim: To demonstrate the efficacy of the anal plug in the treatment of the complex anal fistulas. Design: Observational retrospective study. Patients and Methods: Fifteen plugs were applied to 12 patients (6 males), mean age 47 (range, 26-71) years. The 62 per cent of patients had multiple previous surgeries for complex fistulas (9 high transsphincteric, 1 extrasphincteric, 1 recto-vaginal, 1 pouch-vaginal fistulas). The 360º anal ultrasound was applied in all cases. The surgical technique was performed under general anesthesia, in lithotomy position, with antibiotics prophylaxis. During surgery iodopovidone was used to confirm the localization of the internal opening. The plug was inserted via the fistula tract and attached to the internal opening. Any portion of the plug implanted remaining out of the tract was removed. The length of follow-up was 2 to 13 months. Results: The treatment was successful in 8 patients with one plug implantation. In 3 cases of recurrence, another plug was inserted and two fistulas healed. The overall success rate was 82 pre cent. There was no morbidity or mortality with the method. Conclusion: The anal bioprosthetic plug is a safe and effective treatment for anal fistulas, with the possibility of re-implantation without affecting anal continence.
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Bioprótese/tendências , Fístula Retal/cirurgia , Fístula Retal/complicações , Fístula Retal/diagnóstico , Fístula Retal/terapia , Reto/cirurgia , Adesivo Tecidual de Fibrina/uso terapêutico , Seguimentos , Incontinência Fecal/etiologia , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Observacionais como Assunto , Recidiva , Estudos Retrospectivos , Reto , Resultado do TratamentoRESUMO
Presentamos dos casos clínicos en los cuales durante la realización de una adenomectomía retropúbica por patología prostática benigna se produce una fístula prostatorectal. Describimos la cirugía de reparación de la misma con colgajo de músculo gracilis o recto interno, y su posterior buena evolución. Presentamos imágenes cistográficas y de enemas opacos que presentan un antes y un después de dicha cirugía. Los pacientes están sin incontinencia ni problemas relacionados con la cirugía de desinserción muscular
We present two cases in which during retropubic prostatectomy for benign prostatic disease a prostatorectal fistula ocurred. We describe its reparation using a pedicled flap of gracilis muscle. We also present cistografic and opaque enema images wich shows the before and after of this surgery. Patients had good outcome without incontinence nor problems related to muscle desinsertion surgery
Assuntos
Masculino , Pessoa de Meia-Idade , Humanos , Fístula/diagnóstico , Fístula/terapia , Colostomia/métodos , Nutrição Parenteral/métodos , Cistoscopia/métodos , Fístula Retal/diagnóstico , Fístula Retal/cirurgia , Retalhos Cirúrgicos , Prostatectomia/métodos , Doença Iatrogênica , Próstata/patologia , Próstata/cirurgia , Próstata , Cirurgia Colorretal/métodos , Retalhos Cirúrgicos/patologia , Retalhos Cirúrgicos/tendênciasRESUMO
Chronic inflammatory bowel disease is diagnosed and monitored by the combination of colonoscopy and small bowel enteroklysis. Magnetic resonance imaging has become the gold standard for the imaging of perirectal and pelvic fistulas. With the advent of ultrafast MRI small and large bowel imaging has become highly attractive and is being advocated more and more in the diagnostic work up of inflammatory bowel disease. Imaging protocols include fast T1-weighted gradient echo and T2-weighted TSE sequences and oral or rectal bowel distension. Furthermore, dedicated imaging protocols are based on breath-hold imaging under pharmacological bowel paralysis and gastrointestinal MR contrast agents (Hydro-MRI). High diagnostic accuracy can be achieved in Crohn's disease with special reference to the pattern of disease, depth of inflammation, mesenteric reaction, sinus tract depiction and formation of abscess. In ulcerative colitis, the mucosa-related inflammation causes significantly less bowel wall thickening compared to Crohn's disease. Therefore with MRI, the extent of inflammatory changes is always underestimated compared to colonoscopy. According to our experience in more than 200 patients as well as the results in other centers, Hydro-MRI possesses the potential to replace enteroklysis in the diagnosis of chronic inflammatory bowel disease and most of the follow-up colonoscopies in Crohn's disease. Further technical improvements in 3D imaging will allow interactive postprocessing of the MR data.
Assuntos
Colite Ulcerativa/diagnóstico , Doença de Crohn/diagnóstico , Imageamento por Ressonância Magnética , Adulto , Sulfato de Bário , Colite Ulcerativa/diagnóstico por imagem , Colite Ulcerativa/patologia , Colo/patologia , Colonoscopia , Meios de Contraste , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/patologia , Diagnóstico Diferencial , Enema , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Fístula Retal/diagnóstico , UltrassonografiaRESUMO
BACKGROUND: Recurrence and incontinence are common after conventional surgery for fistula-in-ano. Medicated seton (ksharsootra) is a time-tested therapy. METHODS: Seton treatment was given to 114 patients with anal fistulae. The initial loose seton was changed weekly to achieve fistulotomy. RESULTS: Application of non-medicated seton did not show any cutting action; hence all patients were treated with ksharsootra after 3 weeks. Anal discharge (n = 114) and burning pain (35) were noted in the first 48-72 hours. The cut-out rate was around 1 cm/week, with mean cut-out time 8.3 weeks (range 3-18). All wounds healed well and patients remained ambulatory. Local induration developed in 18 patients; four had an abscess. There was no incontinence or recurrence over a follow-up of 6 months to 2 1/2 years. CONCLUSIONS: Ksharsootra treatment for anal fistulae is safe and effective, with low complication rates.
Assuntos
Ayurveda , Fitoterapia , Fístula Retal/terapia , Técnicas de Sutura , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Retal/diagnóstico , Estudos Retrospectivos , Segurança , Resultado do Tratamento , CicatrizaçãoRESUMO
Se presenta un estudio prospectivo de 50 anastomosis colónicas controladas radiológicamente entre el séptimo y duodécimo día de postoperatorio. Se controlaron 12 complicaciones anastomóticas (24%0, de las cuales solo 4 (8%) fueron detectadas clínicamente y 10 (20%) radiológicamente. La mortalidad fue de 3 pacientes (6%) de los cuales 2 tenían dehiscencias anastomóticas. El colon por enema sistemático puso en evidencia un mayor número de fístulas anastomóticas, pero no resultó útil para fijar estrategias terapéuticas postoperatorias, pudiendo ser responsable de imágenes falsamente negativas que retardan una reintervención. Se recomienda limitar su utilización a aquellos casos donde la evolución postoperatoria es de interpretación difícil
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Anastomose Cirúrgica/efeitos adversos , Colectomia/efeitos adversos , Fístula Intestinal/diagnóstico , Fístula Retal/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Sulfato de Bário , Fístula Intestinal/epidemiologia , Fístula Intestinal/etiologia , Fístula Retal/epidemiologia , Fístula Retal/etiologia , Complicações Pós-Operatórias , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Fatores de Risco , Deiscência da Ferida Operatória/diagnósticoRESUMO
Se presenta un estudio prospectivo de 50 anastomosis colónicas controladas radiológicamente entre el séptimo y duodécimo día de postoperatorio. Se controlaron 12 complicaciones anastomóticas (24%0, de las cuales solo 4 (8%) fueron detectadas clínicamente y 10 (20%) radiológicamente. La mortalidad fue de 3 pacientes (6%) de los cuales 2 tenían dehiscencias anastomóticas. El colon por enema sistemático puso en evidencia un mayor número de fístulas anastomóticas, pero no resultó útil para fijar estrategias terapéuticas postoperatorias, pudiendo ser responsable de imágenes falsamente negativas que retardan una reintervención. Se recomienda limitar su utilización a aquellos casos donde la evolución postoperatoria es de interpretación difícil
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Fístula Intestinal/diagnóstico , Fístula Retal/diagnóstico , Colectomia/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Sulfato de Bário/diagnóstico , Estudos Prospectivos , Fístula Retal/epidemiologia , Fístula Retal/etiologia , Fatores de Risco , Deiscência da Ferida Operatória/diagnóstico , Fístula Intestinal/epidemiologia , Fístula Intestinal/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/diagnóstico por imagemRESUMO
Presenting symptoms, diagnostic progression, etiology, therapy, and complications of 44 patients with enterovesical fistulae who came to three Yale teaching hospitals over a 9-year period were reviewed. Patients with diverticulitis as the cause of their fistula were older and came to the hospital with pneumaturia/fecaluria. Patients with pelvic cancer were more likely to have fecaluria, gastrointestinal symptoms, or hematuria. Patients with Crohn's disease were an average of 20 years younger than the patients with cancer or diverticulitis and they came to the hospital with pneumaturia, abdominal pain, abdominal mass, and tenderness. Computerized axial tomography scanning, cystoscopy, charcoaluria, and barium enema were useful in making the diagnosis; intravenous pyelography and colonoscopy were not. One-tenth of the patients were not candidates for operation, and one-quarter of the patients did not undergo complete operative resolution with restoration of enteric and urinary continuity. Nine patients underwent a two-stage repair consisting of resection/repair of the fistula with proximal fecal diversion and subsequent re-establishment of bowel continuity. These patients had a higher morbidity than the 19 patients who underwent one-stage repair. Enterovesical fistula is a challenging entity, the etiology of which may be suspected upon taking the patient's history or performing the physical assessment; however, the definitive diagnosis of enterovesical fistula can remain elusive. Single-stage repair can be achieved with low morbidity and mortality in many candidates.
Assuntos
Fístula Intestinal/diagnóstico , Fístula Intestinal/cirurgia , Fístula da Bexiga Urinária/diagnóstico , Fístula da Bexiga Urinária/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sulfato de Bário , Doenças do Colo/diagnóstico , Doenças do Colo/cirurgia , Cistoscopia , Diverticulite/complicações , Enema , Feminino , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/cirurgia , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Neoplasias Pélvicas/complicações , Complicações Pós-Operatórias , Radiografia , Fístula Retal/diagnóstico , Fístula Retal/cirurgia , Estudos Retrospectivos , Fístula da Bexiga Urinária/diagnóstico por imagem , Fístula da Bexiga Urinária/etiologiaRESUMO
In this study of 14 patients with anorectal anomalies CT and MRI were employed for preoperative assessment. The use of a pressure enhanced water soluble enema via the colostomy proved to be an extremely efficient method for showing a fistula. MRI studies were enhanced by the use of vaseline oil and in one case this technique was used prior to surgery to provide important information by injecting through a perineal fistula. CT and axial MRI proved to be more valuable than sagittal MRI which is only useful for the length of the atretic segment. The authors consider that a combined approach using pressure enhanced water soluble enema and MRI will provide the most valuable preoperative information to plan a successful operative approach and enable an accurate prognostic evaluation of continence in these difficult and complex patients.
Assuntos
Fístula Retal/diagnóstico , Reto/anormalidades , Canal Anal/anormalidades , Pré-Escolar , Enema , Feminino , Humanos , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Cuidados Pré-Operatórios , Tomografia Computadorizada por Raios XRESUMO
This paper presents two unusual fistulae between the rectum and the lower urinary tract in adults, one a posttraumatic fistula following dilatation of a sigmoid colon stricture and the other a congenital anomaly. In both cases a contrast enema was negative; in one case a voiding cystourethrogram was negative. The fistula was demonstrated in case 1 by repeating the enema and having the patient raise his intraabdominal pressure, and in case 2 by having the patient hold while attempting to pass flatus during a cystogram, which demonstrated gas bubbles entering the bladder.