Case Of Fistula Research Articles

Anatomical considerations regarding a high-flow arteriovenous fistula below the conus medullaris in a patient with hereditary hemorrhagic telangiectasia: Case report.

Cauda equina radicular arteriovenous fistulas are rare "low flow" shunting lesions characterized by direct communication between the radicular artery and vein of a cauda equina nerve root. None have been associated with hereditary hemorrhagic telangiectasia and a high-flow cauda equina radicular arteriovenous fistula has never been reported. We present a unique case of a high-flow cauda equina radicular arteriovenous fistula in a patient with hereditary hemorrhagic telangiectasia. Marked flow-induced vascular remodeling posed significant diagnostic and therapeutic challenges which will be highlighted in this report. A 39-year-old female with genetically confirmed hereditary hemorrhagic telangiectasia presented with progressive thoracic myelopathy secondary to a high-flow single-hole arteriovenous fistula below the conus. The feeding artery, arising from the anterior spinal artery, and draining vein had a paramedian course, favoring the diagnosis of a cauda equina radicular arteriovenous fistula (supplied by a proximal radicular artery) over a filum terminale arteriovenous fistula. Transarterial embolization was attempted but significant elongation and tortuosity of the anterior spinal artery precluded microcatheter access to the fistulous point. Surgical disconnection was successfully performed. The intraoperative findings supported the diagnosis of cauda equina radicular arteriovenous fistula. Delayed neurologic deterioration secondary to overshooting venous thrombosis was observed. She recovered after the initiation of therapeutic anticoagulation. To the best of our knowledge, we hereby report the first high-flow cauda equina radicular arteriovenous fistula. The accurate differentiation of cauda equina radicular arteriovenous fistula from filum terminale arteriovenous fistulas, while challenging, is important to avoid treatment-related complications. Careful preoperative planning, the use of specialized endovascular and surgical techniques, and meticulous postoperative care can ensure the safe and complete disconnection of high-flow cauda equina radicular arteriovenous fistulas.

A rare case of second branchial fistula with two external openings

Branchial apparatus was first described by Von Baer, but Von Ascheron was the one who described the anomalies in its development. The branchial cyst, sinus and fistula are anomalies of the branchial apparatus which consists of five mesodermal arches separated by invagination of ectoderm (clefts) and endoderm (pouch). Here we present a case of bilobulated second branchial fistula which had both openings over the skin of right anterolateral aspect of the neck. A seven years old girl, presented to ENT OPD, complaining of swelling on right side of the neck associated with discharge from an opening over the swelling since birth. The swelling was painless, progressively increasing in size. Her mother revealed that she had occasionally had a clear discharge from the openings since birth. On examination, dumbbell shaped cystic swelling approx. 5×2 cm in size with two pinhead openings on both the ends, noticed along the anterior border of SCM over the middle third of the neck. Radiological and histopathological investigations confirmed the diagnosis of second branchial fistula. Patient was managed with complete surgical excision. Second branchial anomalies present along the anterior border of sternocleidomastoid. Fistulous tract commonly extends into the pharynx, most commonly in the region of tonsillar fossa. This case report describes a congenital anomaly for which the definitive treatment was surgery. Unlike, other complete second branchial fistula it had two external openings and it was a bilobulated tract, which makes this case a rare variety of branchial fistula

Compartive Study between Conventional Laying-Open Technique with Sphincter Repair and Ligation of Intersphincteric Fistula Tract (LIFT) in Treatment of High Trans-Sphincteric Perianal Fistula

Abstract Background Complex anal fistula has been a hot topic in clinic. Many surgical techniques have been described for the treatment of such anal fistula, including the use of seton, fibrin glue, collagen plugs, rectal advancement flaps, fistulotomy with sphincter repair, and rerouting the fistula tract. However, the results have been variable, and no one procedure is superior to the others absolutely. It is worth our concern that the goal of any treatment procedure is to obliterate the tract and to have low recurrence rates while maintaining full continence. A fistulotomy lays open the fistulous tract, thus leaving smaller unepithelized wounds, which hastens the wound healing. Until now, fistulotomy is still the most widely used. But, the high cure rate is limited by the fact that laying open a transsphincteric fistula tract and cutting both the internal and the external sphincter has the risk of fecal incontinence ranging up to 40%. Objective To retrospectively evaluate the success rate, the recurrence and incontinence when using the Conventional laying-open and sphincter Repair technique in comparison to Ligation of Intersphincteric Fistula Tract (LIFT) for treating high trans-shpincteric perianal fistula. Patients and Methods This was a cohort retrospective, comparative study that was conducted on cases of fistula in the anus, who were subjected to surgery in Ain Shams University Hospitals and Ain shams specialized hospitals in the period from October 2021 to March 2022 (at least 30 cases) to evaluate the success rate, the recurrence rate, and incontinence rate when using the conventional laying open with sphincter repair technique compared to ligation of inter-sphincteric fistula tract (LIFT) For High trans-sphincteric perianal fistula. Results Regarding Relation of recurrence with demographic data of the studied patients, de novo/recurrent, Wexner score before and after operation and complications. that there was no statistically significant relation found recurrence with demographic data of the studied patients, de novo/recurrent, Wexner score before and after operation while there was statistically significant relation found with complications. Conclusion LIFT procedure is an effective and preferred sphincter-saving technique for fistula-inano with shorter healing time and lower incidence of postoperative anal incontinence, but have higher incidence of recurrence as compared to conventional layopen with sphincter repair which have a lower incidence of recurrence but have a relatively longer Healing time and higher incidence of postoperative anal incontinence. Both techniques are effective, have post operative good results and safe in treatment of high transsphincteric perianal fistula but Further research work is still warranted to confirm the long term outcome of these 2 techniques with a larger sample size and a longer follow up period. To know which technique is superior over the other.

Complex Fistula Management: Interval Tightening of Rubber Seton and Regular Wound Dressing Case Study

Anorectal abscess and fistula in ano pose common challenges in colorectal surgeons. This case series of 25 patients with complex fistula in ano highlights the importance of precise preoperative evaluation, including imaging modalities such as CT scan and MRI. Surgical management involved the placement of cutting rubber setons in most cases, combined with a ten-day antibiotic course. Follow-up evaluations at six months revealed successful outcomes in terms of wound healing and continence maintenance through patient education on kegel exercises. This study emphasizes the significance of individualized treatment strategies and meticulous postoperative care for achieving favorable results in complex fistula cases.

Large cameral coronary artery fistula in a 5 months old infant with unusual presentation and fatal outcome: -case report

BackgroundCongenital coronary fistulas (CAFs) are uncommon abnormalities communicating the coronary arteries with the cardiac chambers or portion of the systemic or pulmonary circulation. Over 90% of the cases drain into the right side of the heart with only 3% terminating in the left ventricle. Infants with a large CAFs may develop congestive heart failure.Case presentationA 5 months old female infant presented with labored breathing and worsening of bluish discoloration of the lips and extremities following a prolonged cry. She had a history of breastfeeding difficulty and noticeable bluish discoloration of the lips and extremities since birth. The infant was wasted and had a fast heart rate, bluish lips, and nail beds with clubbing of fingers and toes. A cardiac murmur was noted during her medical checkup. Chest x-ray showed cardiomegaly. Echocardiography and CT angiography showed large Cameral CAF involving the left main and left anterior descending artery draining into the left ventricle. The tricuspid valve was dysplastic, there was secundum ASD, and VSD with a right to left shunt. The patient developed episode of cyanotic spells after crying excessively following a CT angiographic procedure which culminated in respiratory arrest and her demise. She was managed as a case of hypoxic spells in the ICU before her death.ConclusionThis report unveiled unfamiliar case of Cameral coronary artery fistula with left-to-left shunting, cyanosis, and dysplastic tricuspid valve.

Percutaneous device closure of hemodynamically significant coronary fistula following endomyocardial biopsy in a pediatric heart transplant patient.

Coronary artery fistula is a rare but well-documented complication of right ventricular endomyocardial biopsy, particularly in the adult population. Typically, these fistulae never reach clinical or hemodynamic significance, but some may cause coronary steal and ventricular dysfunction. We report a case of a significant coronary artery fistula requiring device closure in the cardiac catheterization laboratory with subsequent improvement of clinical symptoms and cardiac function.

Ultra-Proximal Jejunostomy Application after McKeown-Type Esophagectomy: A Retrospective Case-Series Study.

Jejunostomy is the main form of enteral nutritional support after McKeown-type esophagectomy. However, this requires the jejunum to be secured to the abdominal wall, which can lead to catheter-related complications. Here, we present a new type of jejunostomy, ultra-proximal jejunostomy, which does not require fixation of the jejunum to the abdominal wall. Patients who underwent McKeown-type esophagectomy between January 2021 and March 2022 were included in this study. Postoperative outcomes of patients who underwent ultra-proximal jejunostomy are also presented. Forty-three patients were able to receive enteral nutritional support via an ultra-proximal jejunostomy after McKeown-type esophagectomy, and no cases of enteral fistulas were observed. The pain in the left lower abdomen largely disappeared after the removal of the jejunostomy tube in all patients, and there was no difficulty in removing the tube. To date, none of these patients have experienced bowel obstruction or jejunal torsion. An ultra-proximal jejunostomy is a safe and feasible method and a better option for enteral nutrition support after McKeown-type esophagectomy.

Cystoscope-guided trans-anal Fistula-tract Laser Closure (FiLaC) of late onset recurrent recto-urethral fistula post anorectal malformation repair: A case report

Management of persistent and recurrent rectourethral fistula after primary treatment of anorectal malformations (ARM) is challenging. Various surgical techniques have been proposed and until today there is no consensus on the optimal approach. We describe a case of late onset recurrent rectourethral fistula after neonatal ARM repair, treated with a minimally invasive cystoscope-guided trans-anal Fistula-tract Laser Closure (FiLaC). A male patient suffering from ARM, type recto-bulbar fistula, was treated with an anorectoplasty during the neonatal period. Post-operatively, no reoperations were needed and long term follow-up demonstrated good functional outcome. At the age of 19 years, the patient presented with complaints of anal urinary leakage during micturition. Voiding-cysto-urethrography and perineal Nuclear Magnetic Resonance (NMR) demonstrated a fistula tract between the bulbar urethra and the distal rectum. Given the lack of associated urinary tract infections or fecaluria and the absence of fecal or urinary incontinence in between micturition, we decided to perform a trans-luminal, non-surgical approach. By analogy with the minimally invasive laser treatment of peri-anal fistula in adults, we performed a trans-anal cystoscope-guided FiLaC. We observed a fast post-operative recovery with an excellent one-year follow-up, illustrated by the elimination of symptoms, absence of fistula opening on rectoscopy and disappearance of the fistula-tract continuity on voiding-cysto-urethrography. This case exemplifies the potential benefits of using minimally invasive FiLaC treatment for the management of recurrent and persistent recto-urethral fistula following primary treatment of ARM. Long term follow-up is awaited to confirm the value of FiLaC in this treatment setting.

Thoracoscopic approach as surgical management of esophageal epiphrenic diverticulum.

Management of diverticulum of the lower esophagus or epiphrenic diverticulum can be performed using the abdominal or thoracic approach. In some cases, the thoracic approach is preferred, but few studies have described thoracoscopic resection. The objective of the present study was to investigate the thoracoscopic approach for management of epiphrenic esophageal diverticulum. From 2008 to 2018, all patients undergoing surgery for epiphrenic esophageal diverticulum by the thoracoscopic approach were included in this single-center, retrospective, observational study. Data on diverticulum, surgery and follow-up were assessed. During the study period, 14 patients underwent surgery. Two patients had two diverticula. The mean location of the superior edge of the diverticulum was 7cm (2-14cm) above the gastro-esophageal junction. The mean size of the diverticulum was 39 millimeters (20-60). Thoracoscopic approach was used in all patients. No conversion to thoracotomy was required. Mean operative time was 168min (120-240). No postoperative mortality occurred. The overall complication rate was 40% (6 complications out of 15 resections), with three major complications including leaks (n=2) and a case of bronchoesophageal fistula (n=1). Median length of hospital stay was 12 days (8-40). At a mean postoperative follow-up of 20.7 months (5-71), 85% of patients had complete disappearance of preoperative symptoms without recurrence of the diverticulum on the barium swallow study test. Thoracoscopic approach as management of epiphrenic diverticulum is feasible, with acceptable short-term morbidity. The thoracoscopic approach is also effective in resolving preoperative symptoms.

Analysis of risk factors for complications after laparoscopic cholecystectomy

ObjectiveTo analyze the risk factors of complications after laparoscopic cholecystectomy in 478 patients in our hospital. Methods: The clinical data of 478 patients who underwent laparoscopic cholecystectomy in our hospital from March 2018 to September 2022 were collected, and the occurrence of postoperative complications and related risk factors were analyzed. Results: A total of 36 patients (7.53%) had complications, including 9 cases (1.88%) of abdominal hemorrhage, 8 cases (1.67%) of bile duct injury, and 19 cases (3.97%) of biliary fistula. Univariate analysis showed that adhesions of Calot triangle, anatomical variation and gallbladder wall thickness greater than 5 mm were associated with postoperative complications (all P < 0.05). Multivariate analysis showed that: Calot triangle adhesion (OR = 3.041, 95%CI = 1.422–6.507), anatomical variation (OR = 4.368, 95%CI = 1.764–10.813) and gallbladder wall thickening (OR = 2.827, 95%CI = 1.422–6.507). 95%CI = 1.274–6.275) were independent risk factors for complications after laparoscopic cholecystectomy (all P < 0.05). Conclusion: In order to reduce the occurrence of postoperative complications, the risk factors of LC should be well understood and the preoperative preparation should be made.

Clinical efficacy of low-temperature plasma radiofrequency ablation in children with pyriform fossa fistula

ObjectiveTo evaluate clinical efficacy of low-temperature plasma radiofrequency ablation in children with pyriform fossa fistula. MethodsFrom June 2015 to August 2021, 80 children with pyriform fossa fistula who underwent low-temperature plasma radiofrequency ablation to occlude internal fistula in our hospital were included in this retrospective study. Antibiotics were routinely used for 3–5 days after operation. Indwelling gastric tube was given for 5–7 days, and nasal feeding was given. The curative effect, recurrence rate and incidence of postoperative complications were observed. ResultsThere were 67 cases of left pyriform fossa fistula and 13 cases of right pyriform fossa fistula. The average follow-up time was 16 months. During postoperative follow-up, 2 cases recurred, and the recurrence rate was 2.5%. The recurrence time was 10–21 months after operation. Temporary hoarseness occurred in 7 children after operation and recovered within 3 months after discharge. Children developed one or several clinical symptoms, such as choking cough, dysphagia, infection and esophageal injury. ConclusionLow-temperature plasma radiofrequency ablation has the advantages of low recurrence rate and incidence of postoperative complication rate for internal fistula closure in children with pyriform fossa fistula. It is a safe and effective treatment for children without surgical contraindications.

Colo-renal-duodenal fistula in pediatric patient with acute lymphoblastic leukemia: A rare presentation

Colo-renal fistulas are uncommon presentations in the pediatric population and usually have an underlying insult, which can be vascular, infective, inflammatory, penetrating trauma, tumor, or iatrogenic in postintervention or postoperative procedures. Although few cases of such fistulae are published earlier, there is extreme paucity of literature on colo-renal fistulas in association with acute lymphoblastic leukemia (ALL). A thorough literature search revealed only one similar case report in a 15-year-old patient, to the best of our knowledge. Here, we present another case of a 6-year-old female patient, a known case of T-cell ALL with febrile neutropenia, uncontrolled hypertension, and fever spikes. The patient developed a colo-renal-duodenal fistula subsequent to a vascular and infective insult to the right kidney.

Management of Iatrogenic Obstetric Fistulas in the Urology Department of CHU Point G, Apropos of 62 Cases

Objective: Analyze the epidemiological, anatomo -clinical, therapeutic and evolutionary aspects of iatrogenic obstetric fistulas linked to a gynecological/obstetric procedure (caesarean section, hysterectomy, myomectomy, use of forceps, treatment of uterine prolapse, or vaginal surgery). Patients and Methods: This was a descriptive prospective study, concerning 62 patients hospitalized in the Urology department of the Point-G University Hospital from January 5, 2010 to June 30, 2014 for iatrogenic obstetric fistulas. The epidemiological, anatomo -clinical, therapeutic and evolutionary aspects were analyzed. Results: Iatrogenic obstetric fistulas were found in 19% of patients out of 321 cases of urogenital fistulas hospitalized in urology. The average age was 32 years with extremes of 15 and 52 years. The revealing clinical signs were: permanent loss of urine (87.10%), loss of urine while standing (9.70%), loss of urine while lying down (3.20%). Gynecological/obstetric procedures: caesarean section n= 39, hysterectomy n= 15, myomectomy n= 1, use of forceps n= 5, cure of uterine prolapse, vaginal surgery n= 1) were the most common causes. Type V fistulas were the most encountered with 74.20% and among these V fistulas, retro-trigonal fistulas were the most represented with 37.80% of cases followed by uretero-vaginal fistulas (31.10%) and vesico-uterine fistulas (15.60%). The upper route was used in 41 cases; followed by the low way in 18 cases and the mixed way in 3 cases. Trigono -cervico-uterine duplication was performed in 23 cases followed by uretero -vesical reimplantation in 19 cases. The treatment was satisfactory in 55 cases, i.e. 88.70% (no leakage) and poor in 7 cases.

Unitary system of patent protection as an element of innovation policy of the European Union

The article analyzes the process of establishing a unitary system of patent protection in the European Union as an alternative to national and regional systems and its importance for enhancing the innovation potential and economic development of the EU. It examines the preconditions for the transition from national patents to regional (and subsequently unitary) patents, which are based on the intention of the EU Member States to overcome the territorial principle of patent rights by extending the patent owner’s exclusive rights beyond the territorial borders of one state.It is noted that the transformation of the economy into an innovative one, in which a key role is assigned to intellectual property rights (as a precondition for innovation), has actualized the issue of effective intellectual property legal protection, in particular, concerning patent rights. Since 1997, the European Commission has been highlighting the importance of patents as one of the tools available for protecting innovation and the need to reform the European patent system to increase Europe’s innovation potential and competitiveness. Subsequent decisions of the EU Council were taken to fulfill this task, resulting in the introduction of a unitary system, which includes the European Patent with Unitary Effect (the Unitary Patent) and the Unified Patent Court, as of June 1, 2023. As a result, inventors can obtain unitary patent protection based on the Unitary Patent in all EU Member States participating in the enhanced cooperation mechanism.It is concluded that the unitary patent protection system extends the territoriality principle beyond the national borders of the State within the EU borders, but does not destroy the basic principles of intellectual property rights. In contrast, the article examines the US case law, which demonstrates its own approaches to understanding the principle of territoriality and the presumption against extraterritoriality of patent rights, allowing in certain cases the US patent holder to extend its monopoly to foreign markets.

A Case of Tracheoesophageal Fistula in a Non-metastatic Site During Lenvatinib Treatment for Hepatocellular Carcinoma.

We report a case of tracheo-esophageal fistula at a non-metastatic site during lenvatinib treatment of hepatocellular carcinoma with multiple bone metastases. A 58-year-old male patient was diagnosed with hepatocellular carcinoma with multiple bone metastases and was treated with atezolizumab-bevacizumab. However, as the bone metastasis progressed, palliative radiation therapy was administered to the third thoracic vertebra, and lenvatinib was administered as a second-line treatment. The patient was hospitalized for aspiration pneumonia five months later. Chest computed tomography and bronchoscopy revealed a 5 cm tracheoesophageal fistula located 3 cm cranial to the carina. We diagnosed a benign tracheoesophageal fistula due to lenvatinib because his previous CT scan showed no metastases at the site of the fistula, and we performed esophageal bypass surgery 4 weeks after discontinuation of the lenvatinib. To the best of our knowledge, this is the first case report of tracheoesophageal fistula at a nonmetastatic site during lenvatinib treatment for hepatocellular carcinoma.

Hearing voices: forensic speaker identification technology and expert listening in the American courtroom

ABSTRACT Police wiretaps and taped emergency dispatch calls are just a couple of examples of the kinds of voice recordings that have made their way into criminal and civil proceedings. In some instances, an expert witness may be called upon to identify the person whose voice was captured on tape or digitally recorded. However, this type of forensic analysis – commonly referred to as “speaker identification” – has not been universally accepted by the courts. In this article, I look at several US cases where the efficacy of forensic speaker identification has been brought into question. Using concepts from Science and Technology Studies (STS) and Sociolegal Studies, I examine the attempts made by experts to have their methods of voice identification accepted at trial as valid and reliable techniques, and the decisions made by judges to either admit or exclude this evidence. I demonstrate that the various rulings regarding the admissibility of speaker identification evidence reflect the interplay between law and science and is the direct result of the “boundary-work” undertaken by experts and how judges assess these activities. I argue that forensic speaker identification evidence must be understood and conceptualised as “law-science hybrids” that are co-produced over the course of a trial.

Perioperative Factors Aggravating Pharyngocutaneous Fistula After Total Laryngectomy: A Single-Center Retrospective Analysis Using the Clavien-Dindo Classification.

Pharyngocutaneous fistula formation represents a major postoperative complication following total laryngectomy. We aimed to investigate the risk factors for pharyngocutaneous fistula development after total laryngectomy and to identify factors that lead to severe cases of pharyngocutaneous fistula. Patients who underwent total laryngectomy between January 2013 and February 2021 were included in the study and were divided into 2 groups: Those with and without pharyngocutaneous fistula. The severity of pharyngocutaneous fistula was graded using the Clavien-Dindo classification. Patients with pharyngocutaneous fistula experienced longer operative time, greater intraoperative blood loss, greater decrease in perioperative hemoglobin level, and longer postoperative hospitalization. Unlike in lower-severity cases, patients with grade IIIb pharyngocutaneous fistula underwent preoperative radiotherapy or chemoradiotherapy; preoperative treatment was thus a risk factor for higher severity of pharyngocutaneous fistula (odds ratio, 35; P = 0.004). Salvage laryngectomy was found to be a predictor of severe pharyngocutaneous fistula development. Prolonged operative time, increased intraoperative blood loss, and decreased postoperative hemoglobin level were found to be predictors of postlaryngectomy pharyngocutaneous fistula formation.

Clinical characteristics of patients with colon complications after necrotizing pancreatitis: a retrospective cohort study

Objective: To investigate the clinical characteristics of colon complications in patients with necrotizing pancreatitis(NP). Methods: The clinical data of 403 patients with NP admitted to the Department of General Surgery,Xuanwu Hospital, Capital Medical University from January 2014 to December 2021 were retrospectively analyzed. There were 273 males and 130 females,aged (49.4±15.4) years(range: 18 to 90 years). Among them,there were 199 cases of biliary pancreatitis,110 cases of hyperlipidemic pancreatitis,and 94 cases of pancreatitis caused by other causes. A multidisciplinary diagnosis and treatment model was used to diagnose and treat patients. Depending on whether the patients had colon complications,they were divided into colon complications group and noncolon complications group. Patients with colon complications were treated with anti-infection therapy,parental nutritional support,keeping the drainage tube unobstructed,and terminal ileostomy. The clinical results of the two groups were compared and analyzed using a 1∶1 propensity score match(PSM) method. The t test,χ2 test, or rank-sum test was used to analyze data between groups,respectively. Results: The incidence of colon complications was 13.2%(53/403),including 15 cases of colon obstruction,23 cases of colon fistula,and 21 cases of colon hemorrhage. After PSM,the baseline and clinical characteristics at admission of the two groups of patients were comparable (all P>0.05). In terms of clinical outcome,compared to patients with NP without colon complications,the number of patients with colon complications who received minimally invasive intervention(88.7%(47/53) vs. 69.8%(37/53),χ2=5.736,P=0.030),the number of minimally invasive interventions (M(IQR))(2(2) vs. 1(1), Z=4.638,P=0.034),the number of patients with multiple organ failure(45.3%(24/53) vs. 32.1%(17/53),χ2=4.826,P=0.041),and the number of extrapancreatic infections(79.2%(42/53) vs. 60.4%(32/53),χ2=4.476,P=0.034) increased significantly. The time required for enteral nutrition support(8(30)days vs. 2(10) days, Z=-3.048, P=0.002), parental nutritional support(32(37)days vs. 17(19)days, Z=-2.592, P=0.009),the length of stay in the ICU(24(51)days vs. 18(31)days, Z=-2.268, P=0.002),and the total length of stay (43(52)days vs. 30(40)days, Z=-2.589, P=0.013) were also significantly prolonged. However,mortality rates in the two groups were similar(37.7%(20/53) vs. 34.0%(18/53),χ2=0.164,P=0.840). Conclusions: Colonic complications in NP patients are not rare,which can lead to prolonged hospitalization and increased surgical intervention. Active surgical intervention can help improve the prognosis of these patients.

Interception of fistulous tract and application of Kshara Sutra: Boon for anal fistulae with scrotal extension: A case series

Abstract Anal fistula primarily occurs due to infection of intersphincteric anal glands. In some cases, the anal fistula can extend into the scrotum. Fistula-in-ano with scrotal extension is a rare condition, and at first glance, such a presentation may be confused with acute scrotal diseases. It is commonly a congenital disorder in children characterized by painful swelling, redness, and pus discharge from the scrotum’s external opening (secondary orifice). Acharya Sushruta mentioned Ksharasutra therapy for managing Bhagandara (fistula-in-ano), a popular method for fistula-in-ano management with a reasonable success rate. Further, to fasten the recovery period in complex anal fistula cases, a modified technique of Ksharasutra is adopted, known as interception of fistulous tract with the application of Ksharasutra (IFTAK) technique. This case series describes three patients diagnosed with anal fistulae with scrotal extension. All patients had previously undergone a failed surgical procedure to cure their fistula. The patients were operated on with the IFTAK technique after proper preoperative evaluation. The postoperative fistulous wound in two cases was cured entirely within 5 weeks, and the third case within 6 weeks of treatment. IFTAK technique has shown promising outcomes in patients with anal fistula with scrotal extension. The success of the treatment with IFTAK is due to the eradication of sepsis by proper interception of the fistula tract. However, the efficacy of the IFTAK technique should be validated through well-planned randomized controlled clinical trials for its implementation as a standard treatment for complex anal fistulae.

Case Study for Exploring the Possibility of Sharing General Education Curriculum through Credit Transfer －Focusing on US and European Cases

General education at universities is facing a challenging situation, due to the declining school-age population and lack of finances in Korea. A number of departments in the fundamental academic areas, which are the foundation of the general education curriculum, have been closed or integrated with other departments, making the situation even worse for education. A shared university model centered on general education can be an alternative that can efficiently utilize limited resources and enhance the quality of education by expanding openness and transparency. Sharing high-quality subjects is a key factor in the success of shared universities. However, attempts to share general education subjects, which were promoted by endogenous reasons, are losing momentum. This study seeks implications and practical methods for the establishment of a shared university centered on general education by exploring cases of credit transfer and statewide general education core curricula in the United States and Europe.