Fistula In Patients Research Articles

A prospective study of fistula in ano with reference to clinicopathology, imaging and management

Background: The aim was to study and review clinical presentation, pathological aspects & prevalent modalities of investigation and treatment for fistula in ano.Methods: A prospective study of 90 patients of fistula in ano admitted from March 2015 to December 2016 was done. Fistulography was done as a preliminary investigation in 72 cases and MR Fistulography was done for complex and recurrent fistula (16 cases). Patients were operated and histopathology of fistula tract was done. In patients with clinical suspicion of tuberculosis smear examination of pus with ziehl neelsen staining for acid fast bacilli (AFB) and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) on pus/slide was used to find out tuberculosis in patients of anal fistula. The clinical presentation, operation performed, pathological findings were recorded & a descriptive analysis was done.Results: A prospective study of 90 patients of fistula in ano admitted from March 2015 to December 2016 was done. Fistulography was done as a preliminary investigation in 72 cases and MR Fistulography was done for complex and recurrent fistula (16 cases). Patients were operated and histopathology of fistula tract was done. In patients with clinical suspicion of tuberculosis smear examination of pus with ziehl neelsen staining for acid fast bacilli (AFB) and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) on pus/slide was used to find out tuberculosis in patients of anal fistula. The clinical presentation, operation performed, pathological findings were recorded & a descriptive analysis was done.Conclusions: With careful clinical evaluation, appropriate imaging studies and conventional surgical techniques anal fistula can be treated effectively with less morbidity, incontinence and recurrence.

CLINICAL CHARACTERISTICS, CLASSIFICATION AND RESULTS OF TREATMENT RECURRENT ANAL FISTULA

Objectives: To evaluate the results of surgical treatment of recurrent anal fistula. Methods: This was a cross-sectional, descriptive study including 30 recurrent anal fistula patients who underwent surgery from March 2017 to August 2018 at Hue University Hospital of Medicine and Pharmacy and Hue Central Hospital. Results: Male/female radio was 4/1. The highest proportion was among the ages of 21 – 60 (90%). The most common clinical presentation was perianal discharge in 86.7% of cases. The average duration of disease was found to be 2.5 ± 1.7 months approximately. Early postoperative complications rate is. 36.7% including: air or facial incontinence (33.4%),,postoperative hemorrhage (3.s3%). Average wound healing time is 7.5 ± 2.3 weeks and delayed wound healing rate is 100%. Results of surgical treatment of recurrent fistula anal are good 90%, mid 6.7%, poor 3.3%. Conclusions: Surgical treatment of recurrent anal fistula must depend upon the understanding the relative between anal sphincter and fistula tract. Surgical procedures have to be suitable for each type of anal fistulas. Key words: anal fistula, recurrent, surgical treatment

Perianal fistulas in adult patients with Crohn's disease in Germany - aretrospective cross-sectional analysis of claims data from German sickness funds.

Perianal fistulas (PF) are presumably a frequent extraintestinal manifestation of Crohn's disease (CD), causing significant functional impairment. This study aims to gain representative data on the prevalence, characteristics, and treatment of CD patients suffering from PF in Germany. A retrospective cross-sectional analysis of claims data from several German company health insurance funds included adult patients with CD and PF in 2015. The dataset comprised in- and outpatient services with diagnoses, drug prescriptions, and other patient data. It is representative for age, gender, and region and allows extrapolation to the total German statutory health insurance (SHI) population. A systematic literature review was conducted to discuss these results in the international context. A CD prevalence of 299 per 100 000 and a PF prevalence in CD patients of 3.4 % was observed in this cross-sectional study. PF are most prevalent in young age groups (< 24 to 39). One-third of patients with PF received biologics and surgery. Surgical procedures were performed in 31.3 % of PF patients in the inpatient setting and in 4.4 % of PF patients in the outpatient setting. All complicated perianal fistula patients received at least 1 inpatient surgery and 44.8 % received biologic therapy. This claims data analysis in German patients estimates a CD prevalence in the SHI population that corresponds well to previously reported data. The prevalence rate for PF in CD patients is comparable with a previous cross-sectional German claims data analysis but is markedly lower than cumulative risks reported in longitudinal cohort studies. PFpatients are young and treatment intensive with one-third requiring biologic treatment or inpatient surgery.

A grounded theory of regaining normalcy and reintegration of women with obstetric fistula in Kenya

BackgroundObstetric fistula is a reproductive health problem causing immense suffering to 1% of women in Kenya that is formed as sequelae of prolonged obstructed labour. It is a chronic illness that disrupts women lives, causing stigma and isolation. Fistula illness often introduces a crisis in women’s life begetting feelings of shame and serious disruption to their social, psychological, physical and economic lives, in addition to dealing with moral and hygiene challenges. Currently, women undergo free of charge surgery at vesicovaginal fistula (VVF) camps held in national referral hospitals and dedicated fistula centres generating a significant pool of women who have undergone surgery and are ready to regain normal lives.ObjectiveThe purpose of this study was to explore experiences of women immersing back into communities and their return to normalcy after surgery in three VVF repair centres in Kenya. We set out to answer the question: what strategies improve obstetric fistula patients’ reintegration process?MethodsWe used grounded theory methodology to capture the reintegration and regaining normalcy experiences of women after surgery. Narrative interviews were held with 60 women during community follow-up visits in their homes after 6–19 months postoperatively. Grounded theory processes of theoretical sampling, repeated measurement; constant comparative coding in three stage open, axial and selective coding; memoing, reflexivity and positionality were applied. Emergent themes helped generate a grounded theory of reintegration and regaining normalcy for fistula patients.ResultsTo regain normal healthy lives, women respond to fistula illness by seeking surgery.. After surgery, four possible outcomes of the reintegration process present; reintegration fully or partially back into their previous communities, not reintegrated or newly integrating away from previous social and family settings. The reintegration statuses point to the diversity outcomes of care for fistula patients and the necessity of tailoring treatment programs to cater for individual patient needs.ConclusionThe emerging substantive theory on the process of reintegration and regaining normalcy for fistula patients is presented. The study findings have implications for fistula care, training and policy regarding women’s health, suggesting a model of care that encompasses physical, social, economic and psychological aspects of care after surgery and discharge.

55: Pilot study assessing the prevalence of schistosomiasis haematobium among tanzanian obstetric fistula patients and potential impact of infection on fistula characteristics and surgical outcomes

To determine the prevalence of Schistosomiasis hematobium infection among obstetric fistula patients seeking surgical repair at a single institution in Tanzania and explore the relationship between Schistosomiasis hematobium infection and obstetric fistula characteristics and success of surgical closure. In a cross-sectional pilot study, all consenting female patients presenting for obstetric fistula repair at a hospital in Tanzania (October 2016 to September 2017) were tested for presence of S. hematobium via urine light microscopy pre-operatively. Intra-operative fistula characteristics were recorded by a single fistula surgeon using the Goh criteria: fistula size, degree of fibrosis and distance from urethral meatus. Surgical outcomes, such as successful fistula closure, were assessed after catheter removal. The relationship between schistosomiasis infection and fistula characteristics as well as surgical success were assessed using Fisher’s exact test. The sample included 55 patients, aged 13-70, and the overall prevalence of S. hematobium infection was 31%. Demographic and clinical characteristics were similar between patients with and without Schistosomiasis, with the exception of age. Infected patients were younger (mean age 27) than those without infection (mean age 37). While there were higher rates of fibrosis and lower rate of cure among fistula patients with Schistosomiasis when compared to fistula patients without, these findings did not achieve statistical significance. 75% of women without S. hematobium infection underwent successful fistula surgery, while only 65% of infected women were cured of their fistulas (p=0.53). In this small sample of women presenting for surgical management of obstetric fistula, a third have detectable S. hematobium infection in their urine. Although there were no statistically significant differences between fistula characteristics or surgical success rates based on infection status, our conclusions are limited by the size of our sample.

Postoperative noninvasive ventilation and complications in esophageal atresia–tracheoesophageal fistula

PurposeThis study examines the impact of postoperative noninvasive ventilation strategies on outcomes in esophageal atresia–tracheoesophageal fistula (EA-TEF) patients. MethodsA single center retrospective chart review was conducted on all neonates followed at the EA-TEF Clinic from 2005 to 2017. Primary outcomes were: survival, anastomotic leak, stricture, pneumothorax, and mediastinitis. Statistical significance was determined using Chi-square and logistic regression (p ≤ .05). ResultsWe reviewed 91 charts. Twenty-five infants (27.5%) were bridged with postextubation noninvasive ventilation (15 on Continuous Positive Airway Pressure (CPAP), 5 on Noninvasive Positive Pressure Ventilation (NIPPV), and 14 on High-Flow Nasal Cannula (HFNC)). Overall, 88 (96.7%) patients survived, 25 (35.7%) had a stricture, 14 (20%) had anastomotic leak, 9 (12.9%) had a pneumothorax, and 4 (5.7%) had mediastinitis. Use of NIPPV was associated with increased risk of mediastinitis (P = .005). Use of HFNC was associated with anastomotic leak (P = .009) and mediastinitis (P = .036). ConclusionsThese data suggest that postoperative noninvasive ventilation techniques are associated with a significantly higher risk of anastomotic leak and mediastinitis. Further prospective research is needed to guide postoperative ventilation strategies in this population. Type of studyRetrospective study. Level of evidenceIV.

Predictors of Urinary Retention After Vesicovaginal Fistula Surgery: A Retrospective Case-Control Study

The objective of this study is to determine the predictors for urinary retention after vesicovaginal fistula surgery. This was a retrospective case-control study of women who underwent vesicovaginal fistula repair between January 2014 and December 2017 at the Fistula Care Centre in Lilongwe, Malawi. Cases were defined as patients with documented urinary retention, defined as a postvoid residual that is 50% greater than the total void of at least 100 mL. The cases and controls were matched by the 3 components of the Goh classification system in a ratio of 1:5. Univariate analysis was used to detect differences between demographic, clinical characteristics, and operative techniques between cases and control. Logistic regression analysis was performed for estimation of odds ratios (ORs). There were no statistically significant differences between the 40 cases and 187 controls, when comparing age, gravidity, parity, body mass index, and length of postoperative catheterization. The median amount of postvoid residual noted at the time of diagnosis was 240 mL (range, 55-927 mL). Odds for urinary retention was 3 times higher among those with vertical closure than patients with horizontal closure of the bladder (OR, 2.91; 95% confidence interval, 1.35-6.20). Patients with prior fistula repairs were significantly less likely to develop urinary retention compared to those receiving surgery for the first time (OR, 0.27; 95% confidence interval, 0.10-0.67). Vertical closure of the bladder and patients without a history of prior fistula repairs are predictors for developing urinary retention after fistula repair surgery.

Time to recovery from obstetric fistula and determinants in Gondar university teaching and referral hospital, northwest Ethiopia

BackgroundObstetric fistula is an abnormal connection between the vagina and rectum and/or bladder, which leads to continuous urinary or fecal incontinence. It is a serious problem in the world poorest countries, where most mothers give birth without any medical care. In most cases obstetric fistula is preventable and can be treated successfully, if it is carried out by a competent surgeon with a good follow-up of postoperative care. However, there remains to explore more on the duration of obstetric fistula recovery and determinant factors. The aim of this study was to estimate the average recovery time of obstetric fistula and to identify its determinants in Gondar University teaching and referral hospital, northwest Ethiopia.MethodA retrospective follow up study was conducted at Gondar University teaching and referral hospital. A total of 612 fistula cases were included in the study and simple random sampling technique was applied to select the study subjects. Kaplan-Meier and log rank test were computed to explore the data. Weibull regression survival model with univariate frailty was done to identify the determinant factors of time to recovery.ResultsOf 612 fistula patients, 539(88.07%) were recovered. The Average (median) recovery time was 5.14 (IQR = 3.14, 9.14) weeks. Using Antibiotic (AHR = 1.49, 95% CI = 1.11–2.01), having history of antenatal care (ANC) (AHR = 1.95, 95% CI = 1.39–2.73), being literate (AHR = 2.23, 95% CI = 1.62–3.06), duration of bladder catheterization (AHR = 0.93, CI = 0.90–0.95) and being multiparous (AHR = 1.51, 95% CI = 1.17–1.96) were a significant predictors of the rate of recovery. Also, underweight (AHR = 0.45, 95% CI = 0.30–0.68), overweight (AHR = 0.56, 95% CI = 0.41–0.76), being obese (AHR = 0.41, 95% CI = 0.21–0.80), having extensive fistula (AHR = 0.82, 95% CI = 0.73–0.91), large fistula (AHR = 0.42, 95% CI = 0.23–0.78), medium width (AHR = 0.62, 95% CI = 0.43–0.91) and large width (AHR = 0.42, 95% CI = 0.23–0.78) were statistically significant predictors of the rate of recovery from fistula patients.ConclusionThe average recovery time from obstetric fistula patients was 5.14 weeks. Small Length and width of fistula, patients’ educational status (literacy), antibiotic use, history of antenatal care visits, normal BMI, short period catheterization and being multiparous were the significant determinate variables which shorten the recovery time of obstetric fistula.

MRI Before Fistula Surgery: Will It Change the Operation?—a Prospective Study

The last word in anal fistula surgery has not been written. The literature is unclear on which patient should undergo a pre-operative magnetic resonance imaging [MRI]. Most guidelines are clear that complex and recurrent fistulae, or those with a background of inflammatory bowel disease, should undergo an MRI evaluation, but otherwise the guidelines are hazy and ill defined. In this study, over a 3-month period, all patients who clinically presented with anal fistula underwent MRI of the ano-rectal region. The clinical findings on digital rectal examination [DRE] were compared to the final radiological diagnosis, and the peri-operative findings. The fidelity of the MRI diagnosis was the endpoint of the analysis, as was the impact on the operative strategy. A change in operative course was brought about by the MRI, in a percentage of 16.1% which is quite significant. None of the patients had an endo-anal ultrasound as it is not part of our protocol. It is concluded that the addition of the MRI changed the surgical approach in a significant proportion of patients with fistula in ano and consequently it is now part of our regular workup of every anal fistula patient, to do an MRI preoperatively. By adding MRI, our recurrence rates came down significantly which is quite evident in the follow-up.

Non-Fistulous Complications of Prolonged Obstructed Labour among Obstetric Fistula Patients in Southern Nigeria

Background: Long-term complications of prolonged obstructed labour are multisystemic, obstetric fistula about the most devastating. Efforts at controlling obstetric fistula pay little attention to the non-fistulous injuries which reduce the quality of life of the affected women even after a successful fistula repair. The objectives of this study were to determine the burden of the non-fistulous complications among fistula patients, identify these injuries and the factors associated with them. Methods: This cross-sectional study was conducted at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria from July to December 2016. The hospital has performed over 2600 free fistula repairs. This study was approved by the Research and Ethics Committee of the hospital. The study population comprised of women who developed obstetric fistula following prolonged obstructed labour. Direct questioning, examination findings, operation findings and laboratory results, using a pre-tested, semi-structured and interviewer-administered proforma were used to collect data. Informed consent was obtained from the subjects. Data were analyzed using the Statistical Package for Social Sciences [SPSS] version 21. Frequency and proportions were used to describe categorical variables while means and standard deviation were used to describe continuous variables. Association between categorical variables and direct obstructed labour injuries was tested using chi-square test and predictors of obstructed labour injuries were determined using logistic regression. A P-value 0.05 was considered statistically significant. Results: One hundred and sixty one (161) women participated in the study. The mean age of the women was 33.4 years while the mean parity was 3.2. Non-fistulous complications of prolonged obstructed labour were found in 96.9% (156) of the women. These included cervical retraction (42.2%), obstetric nerve palsy (30.4%), vaginal scarring (29.8%), partial urethral loss (16.1%), anal sphincter injury (3.1%), cervical stenosis (5.0%) and urethral stenosis (3.7%). Others were ammoniacal dermatitis (29.2%), secondary amenorrhoea (21.7%), secondary infertility (9.3%), dyspareunia (6.8%), hypomenorrhea (1.2%) and bladder stone (3.7%). Majority (79.4%) of the women with cervical retraction had caesarean section (CS) as against 20.6% who had vaginal delivery. This was statistically significant (P 0.001). A higher proportion of participants with amenorrhea were delivered via CS (44.3%) compared to those who had vaginal delivery (21.2%). This was also statistically significant (P = 0.012). Neurologic injury was associated with primiparity although this was not statistically significant (P = 0.171). Conclusion: Almost all fistula patients also have non-fistulous complications of prolonged obstructed labour. Efforts to manage the fistula should equally address these complications. We advocate comprehensive care for identification and management of these injuries to improve the quality of life and overall well-being of these women. To reduce complications like cervical retraction, there should be an emphasis on safer caesarean section for women with prolonged obstructed labour.

Prevention of oronasal fistula in primary palatoplasty with acellular dermal matrix

Palatal fistula after primary palatoplasty remains one of the most difficult complications that plastic surgeons have to face. Once the fistula has developed, the complexity of the reconstruction increases significantly, and the revisional surgery results are not promising. The recent use of acellular dermal matrix (ADM) provides a new perspective for the reconstructive surgeon. Our goal is to reduce and prevent the postoperative oronasal fistula in patients with cleft palate by placing an ADM in the zone 3 and 4 of Pittsburgh (hard palate and hard–soft palate junction), creating an extra layer for support of the cleft palate. Seven children diagnosed of palatal cleft with high risk of developing oronasal fistula were operated. The technique of choice was two-flap palatoplasty with lateral incisions and intravelar veloplasty and three-layered closure with ADM in the hard palate and hard–soft palate junction. One patient developed a 3-mm oronasal fistula at 3-month follow-up, with spontaneous closure at 12 months. The rest of the children had an uneventful evolution. Our rate of postoperative oronasal fistula was 0% at 12 months. The use of ADM in primary palatoplasty had been of great use to prevent complications in high-risk oronasal fistula patients.

Serum uric acid and uric acid to HDL-cholesterol ratio in coronary artery fistulas

Aim: In this study, we aimed to evaluate retrospectively uric acid and uric acid / high-density lipoprotein (HDL) ratio in patients with coronary artery fistula who underwent coronary angiography in our cardiology clinic. Coronary artery fistulas (CAF) are seen most often congenitally but also may be acquired and often encounter an asymptomatic clinic. In chronic diseases, e.g., chronic kidney disease, metabolic syndrome, a decrease in HDL is observed, while high uric acid levels have been associated with adverse events.Material and Methods: A total of 111 patients were included in the study, including 46 patients with coronary fistula and 65 controls with normal coronary arteries. Demographic data, laboratory parameters and structural features of the fistula were recorded. Transthoracic echocardiography was performed in all patients.Results: Baseline characteristics were similar between the groups. Previous medications were similar between the two groups. Uric acid [5.9 (4.0-8.0) vs. 4.5 (3.5-8.3)) and uric acid / HDL ratio (14 (7-30) vs. 10 (5-32)] were found to be significantly higher in the fistula group (p 0.001). The creatinine, fasting glucose, cholesterol panel, and hemogram parameters were not significantly different between the groups. Right ventricular end-diastolic (RVED) diameter was significantly higher in CAF group (2.68±0.79, 2.50±0.35; p=0.03). The other echocardiographic measurements were not significantly different between the two groups. Conclusion: The uric acid and uric acid / HDL ratio (UHR), which we can easily look at in peripheral blood, were found to be significantly elevated in fistula patients compared to the control group. The clinical significance of the result could be supported by large-scale studies in the future.

EARLY AND MIDTERM FOLLOW UP AFTER EARLY TOTAL SURGICAL REPAIR OF ESOPHAGEAL ATRESIA WITH TRACHEO- ESOPHAGEAL FISTULA

Background / Study Objective: to asses and present our short and intermediate outcome i early repair of Esophageal Atresia with TracheΟ- Esophageal Fistula Patients: 24 patients diagnosed as EA with TEF treated at our hospital (Zagazig University Hospital, collected over a period of 4 years from Jan 2012 tell October 2016 Objectives: is to evaluate the short and long outcome of surgical repair of TracheΟesophageal fistula Methods: From Jan 2012 tell October 2016, All cases diagnosed as EA with TEF treated at our hospital where included in this study. The follow up period was 2 year in average, age, sex, weight at birth, associated anomalies, surgical approach, postoperative complications and outcome. Results: 24 newborns (16 males and 8 females) with EA/TEF were treated at our hospital with an average weight 2.1 kg (700 g to 3200 g). Aged from birth to 3 days. At the time of admission 1 (4.16 %) had aspiration pneumonia. Early esΟphago-esophageal anastΟmosis was decided for all cases Conclusion: Factors contributing to mortality included prematurity, low birth weight, presence of associated serious anomalies, and delay in diagnosis or aspiration pneumonia.

A statistical analysis of incidence, etiology, and management of palatal fistula.

Objective:The purpose of this study was to retrospectively review the incidence, profile, and the management of palatal fistula occurring in patients operated for cleft palate in our institute.Materials and Methods:A retrospective analysis was performed on all cleft palatal fistula patients who presented during the period from August 2007 to October 2017, to classify their site, age of presentation, surgery performed, and outcome. A record of the type of cleft palate and previous palatoplasty was also obtained. The outcome in terms of incidence and fistula formation depending on Veau's classification was analyzed.Results:Twenty-two patients reported with palatal fistula during this period. The incidence of fistula formation of our institute was 9.6%. Incisive foramen (13/22) was the most common site of fistula formation. Among various techniques used, local and buccal flaps were found to be useful in a maximum number of cases (14/22). The rate of fistula recurrence was 18.2% (4/22). On retrospective analysis of our institutional data, it was found that the incidence of cleft palate fistula was significantly higher in clefts with Veau Types III and IV (13/18) as compared to Veau Types I and II (5/18).Conclusion:This study shows that the fistula rate of our institution was 9.6%. Complete clefts (unilateral or bilateral) involving both primary and secondary palates predispose more to fistula formation.

The prevalence of psychiatric disorders among genitourinary fistula patients: A study in a tertiary care hospital, Bangladesh

Background: Maternal morbidity and mortality are very potential women’s health issues in many developing countries. Many of these are preventable. The World Health Organization estimated that, the prevalence of obstetric fistula at 0.3% of all deliveries. In Asia, over 200 thousand maternal deaths occur in every year. World-wide it is estimated that, there are over 1000000 new cases of fistula are found each year. Information from UNFPA and Engender health indicates that, well over two million women worldwide are suffering from genital tract fistulas. Aim of the study: The aim of this study was to assess the prevalence of psychiatric disorders among genitourinary fistula patients. Methods and Materials: It was a non-interventional, descriptive, cross sectional study conducted on a special group of population suffering from genitourinary fistula. Prior to commencement of study written permission was taken to work in the “National Fistula Centre” from the Department of Gynaecology &amp; Obstetrics, DMCH. This study was conducted at the National Fistula Centre. This center was established in 2003 in DMCH under the supervision of Gynaecology and Obstetrics Department. One hundred and two (102) patients were included in the study as the study population. Non-probability convenient sampling procedure was used. Samples were collected in two days per week. It was decided that, if any patient refuses, next one will be taken into account, but fortunately none refused the interview. By adopting this method, 102 patients were included and the study was conducted during the period from December 2003 to December 2004. Results: In our study, among total 102 participants the prevalence of the study was 85.29% where include psychiatric illness, depression (63.72%) being the commonest illness. Anxiety disorder was 15.68%, minor emotional disorder was 2.94% and somato form disorder was 2.94%. Fifteen patients (14.70%) were found to be free from psychiatric symptoms. Conclusion: One hundred and two patients diagnosed as genitourinary fistula are studied by Self Reporting Questionnaire (SRQ) to find out psychiatric morbidity among them. Psychiatric diagnosis was confirmed by using DSM – IV criteria under the direct supervision of psychiatrist. The findings of this study may help in the treatment procedure of genitourinary fistula.

Pakistan Comprehensive Fistula Classification: A Novel Scheme and Algorithm for Management of Palatal Fistula/Dehiscence.

It is not easy to find a management-based classification of palatal fistula in the literature. A few attempts have been made to classify the wide variety of fistulae that do not describe the fistula details comprehensively and guide toward its management. The authors have come across a wide variety of fistulae that could not be classified according to any of the prevailing classification systems. The presented classification gives a clear and exact understanding of location and size of fistula/dehiscence. Palatal function has been included as one of the important determinants for devising a management plan. Based on this classification, the authors have proposed an algorithm that encompasses clear guidelines for surgical treatment of these fistulae. Over the past 15 years, the authors' team operated on 2537 palatal fistula patients. The medical records of these patients were reviewed to determine the location, size, and velopharyngeal competence. A new classification and algorithm were developed. Of 2537 patients, 2258 had midline fistulae, 208 had lateral fistulae, and 53 had subtotal fistulae. There were 18 patients with dehiscence. Recurrence developed in 181 patients. The authors believe that this classification and algorithm can help follow a practical approach to manage palatal fistulae and dehiscence.

Pregnancy after Obstetric Fistula: Should It Be Encouraged?

Obstetric fistula (OF) is a life-changing morbidity associated with childbirth. It occurs especially after a prolonged obstructed labor and is a major public health problem in the developing countries. The smell of stool and urine leads to the ostracization and rejection of fistula patients by their spouses, families, friends and society in whole. Surgical treatment of fistula is possible. However, this successful outcome of fistula repair surgery is dependent on pre-operative care and the post-operative care such as delaying the commencement of sexual intercourse and delaying conception. Family planning can aid to this. Pregnancy is advised after minimum of 12 months’ post-repair and mode of delivery should be elective cesarean section. Here, we present a case of 23 years’ female, who suffered from obstetric fistula who underwent obstetric fistula repair twice, re-married and conceived after a year with successful elective cesarean delivery.

Situation of Obstetric Fistula in a Marginalized Teagarden Community of Bangladesh: A Qualitative Study

Aims: This study aims to explore why and how difficult it is for obstetric fistula patients living in the underprivileged teagardens community of Bangladesh.&#x0D; Methods: It was a qualitative study conducted in 10 teagardens with approximately fifty thousand population. Five case studies followed by five Focus Group Discussions (FDG) were conducted in places where obstetric fistulas were identified.&#x0D; Results: The mean age of the women was 41 years and the mean duration of suffering was 19 years. All of them got married before the age of 15 and became pregnant in the following year. One woman was divorced, two were separated and two were living with their husband. Only one of them received treatment from a tertiary center but did not continue due to economic constraints; rest of them were never exposed to any treatment or care. They believed that it would be recovered over time. All of them were neglected in their society and were deprived from all social and religious activities in the community. FGDs findings represent that poverty, lack of knowledge and perception are the significant barriers.&#x0D; Conclusions: Underprivileged communities in the teagardens in Bangladesh are far behind in terms of access to quality health care services. Obstetric fistula is particularly still being under reported and undermined and focused intervention is required to eliminate fistula among them.

Research progress of the open abdomen in the treatment of gastrointestinal fistula with complicated intra-abdominal infection

Gastrointestinal fistula patients may suffer from complicated intra-abdominal infection and sepsis with improper treatment, which is characterized by high mortality ranging from 20% to 60%, as well as high medical costs. Gastrointestinal fistula patients with complicated intra-abdominal infections are not often diagnosed early, and proper treatment remains an unsolved problem. Therefore it is a great challenge for surgeons to repair broken intestines under complicated intra-abdominal infection conditions and to repair ruptured intestines under conditions of severe abdominal adhesions and swelling of the intestinal wall and mesentery. After the open abdominal approach was first adopted to treat complicated intra-abdominal infection patients by Duff and Moffat in 1981, it gradually began to be used more widely. However, some investigators have reported that the open abdomen approach has not been effective in controlling controlled mortality, instead, it may even increase mortality. For this reason, the approach has only been used in large medical centers rather than having been widely popularized. In this review, the effect, timing, indications of open abdomen approach and the principles for the open abdominal wound management are summarized, and the reason for the various efficacy among different centers is also analyzed. We provide a new perspective for clinicians to manage the gastrointestinal fistula patients with complicated intra-abdominal infection.

Diagnosis and treatment of intra-abdominal infection complicated with hypothyroidism

Intra-abdominal infection complicated with hypothyroidism is very common. It mostly featured decreased T3, with or without decreased T4, and without elevated thyroid stimulating hormone(TSH). This particular type of hypothyroidism was called "low T3 syndrome" or "thyroid illness syndrome", and is called "non-thyroid illness syndrome" increasingly in recent years. Its pathogenesis has not been fully understood, and probably is associated with abnormality of hypothalamic-pituitary-thyroid axis, disorder of peripheral thyroid hormone metabolism, change in thyroid hormone binding protein, regulation of triiodothyronine receptors, effect of cytokines, and lack of trace element selenium. Intra-abdominal infection complicated with hypothyroidism should be differentiated from primary hypothyroidism, which may be one cause of mental depression, insufficient anabolism, and poor tissue healing. Therefore, the changes of T3 and T4 levels should be actively monitored in patients with severe or prolonged intra-abdominal infection. Whether treatment is needed for intra-abdominal infection complicated with hypothyroidism remains controversial. T3 replacement therapy may improve prognosis. When low T3 syndrome presents as a disease-mediated hypothyroidism, we recommend the use of levothyroxine(L-T4) or liothyronine (L-T3) treatment to improve the prognosis of critical patients. Enteral nutrition can improve hypothyroidism and has good efficacy for enterocutaneous fistula patients with intra-abdominal infection.