DIFFICULT FISTULAE

DIFFICULT FISTULAE

BA Taylor

North Cheshire

M62 Coloproctology Course

AS (17.10.47)May ’04: L ischio-rectal abscess27.7.04: Abdominal colic & altered

bowel habit: RE; fistula at 3 o’clock

13.12.04: EUA; “high” trans-sphincteric fistulaext. opening 3 o’clockint. opening 6 o’clock

AS (17.10.47)

AS (17.10.47)13.12.04: EUA

ext. sphincter skeletonized

mucosa/int. sphincter divided

tight (“cutting”) Seton4.1.05: well10.2.05: EUA; minimal residual

division29.3.05: well

KC (4.7.55)30.9.01: R ischio-rectal abscess1.11.01: Discharged (no fistula apparent)7.8.03: Recurrent R ischio-rectal abscess

Drained; horseshoe (5-9 o’clock)

No obvious fistula9.3.04: Healed; discharged

Histology: non-specific

KC (4.7.55)27.9.04: Recurrent R ischio-rectal abscess

EUA; ? int. opening at 6 o’clock2.10.04: Further (posterior) collection9.11.04: Fully healed; offered EUA6.12.04: EUA; high complex supra-levator

fistula. Int. opening at dentate; X2 ext. openings in scar. MR scan

KC (4.7.55)

KC (4.7.55)

KC (4.7.55)

Jan ’05: EUA; external openings cored out

Fistula track curetted

Fibrin glue to track

Overnight stay

March ’05: Healed (so far!)

KH (21.12.84)19.2.03: Abdominal colectomy & ileostomy

Severe CUC20.5.03: Adhesiolysis, proctectomy, double

stapled J pouch-anal anastomosis4.6.03: EUA; tiny pouch-vaginal fistula5.6.03: laparotomy, adhesiolysis, stoma

KH (21.12.84)16.9.03: EUA; no fistulaOct ’03: pouchogram; no fistula11.11.03: EUA (air insufflation/

methylene blue); no fistulaPouchoscopy; normal

Jan ’04: Admission for ileostomy closure

EUA; obvious pouch-vaginal fistula at anastomosis

KH (21.12.84)

KH (21.12.84)

22.3.04: Mucosectomy, direct closure of fistula and pouch advancementHand-sewn, endo-anal re-

anastomosis.June ’04: Pouchogram –veJuly ’04: EUA; ileostomy closureSept ’04: Well

VB (29.8.75)6.10.04: 4th degree obstetric injury

Levators mobilized & overlapped

Perineal muscles closed

Mucosa /skin closed

28.2.05: Excellent bowel function/flatus PV15.3.05: EUA; small ano-vaginal fistula

VB (29.8.75)