Management of enema tip-induced rectourethral fistula with gluteus maximus flap: report of a case.

Rectourethral fistulas are uncommon and pose a challenging treatment problem. We report the case of 68-year-old man with rectourethral fistula following enema tip-induced rectal injury. We treated the patient with an alternative surgical method used to close poorly healing defects between the urethra and rectum, by means of a muscular flap of the gluteus maximus muscle. The postoperative course was uneventful. He remained well and asymptomatic 6 months after the surgery. This technique is superior to gracilis muscle transposition, regarding the richer blood supply, anatomic neighborhood, technical simplicity, and avoidance of unnecessary incisions. Gluteus maximus muscle flap seems to be a good alternative technique in the treatment of iatrogenic rectourethral fistula.

A venous ""patch"" technique improves patency rate of primary radiocephalic fistulas.

A retrospective study was designed to evaluate the outcome of native wrist arteriovenous fistula (AVF) constructed with standard versus venous ""patch"" techniques in terms of immediate, early and late failures. Between January 1991 and July 2001, 1948 patients underwent primary wrist radiocephalic AVF. Thirty eight per cent (740) of the fistulas were created using the venous patch technique. Immediate and/or early failure rate was significantly lower in the venous ""patch"" technique (Group II) compared to the standard technique (Group I). Although the difference in late failures between Groups I and II did not reach statistical significance, the cumulative patency rates were significantly better in Group II. Radiocephalic fistula constructed with the use of venous patch is recommended whenever the anatomy is feasible.

Gluteus maximus flap for persistent fecal fistula following rectal resection via the posterior approach.

An alternative technique for the treatment of persistent anastomotic leak following resection of the rectum via combined celiotomy and posterior approach is described. Lower aspect of the gluteus muscle is advanced and sutured to cover the anastomotic gap.