Lateral Pouches Research Articles

Morphology, feeding and behaviour of British Magelona (Annelida: Magelonidae), with discussions on the form and function of abdominal lateral pouches

Morphology, feeding and behaviour of British Magelona (Annelida: Magelonidae), with discussions on the form and function of abdominal lateral pouches

Diagnosis and treatment of diverticulums in laryngopharynx and cervical esophagus

To explore the clinical presentations, diagnosis and treatment of diverticulums in laryngopharynx and cervical esophagus. Nineteen cases of diverticulums in laryngopharynx and cervical esophagus with general clinical information available from 1985 to 2010 at Peking Union Medical College Hospital were reviewed retrospectively and analyzed with a literature review. One case of lateral hypopharyngeal pouch presented with fetor oris and pharyngalgia. Three cases of Killian-Jamieson diverticulums had fetor oris and dysphagia. Among 15 cases of Zenker diverticulums, 3 had fetor oris, sour regurgitation and dysphagia while another 12 cases were asymptomatic. Seven patients with subjective complaints underwent diverticulectomy through open surgeries or endoluminal approaches and their symptoms were resolved and no recurrences were found during a follow-up period of 6 months-18 years. In 12 cases of asymptomatic Zenker diverticulums, observation was adopted and there was no complaint during a follow-up period of 1 - 25 years. Lateral hypopharyngeal pouch, Killian-Jamieson diverticulum and Zenker's diverticulum are rare entities with different clinical presentations. For symptomatic diverticulum, the most common treatment is surgical resection of diverticulectom and the prognosis is satisfactory. But for asymptomatic diverticulum, observation suffices.

New species of Thyasira, Mendicula, and Axinulus (Bivalvia, Thyasiroidea) from Sub-Antarctic and Antarctic waters

Three new thyasirid species from the Sub-Antarctic and Antarctic waters are described: Thyasira patagonica, Mendicula sudamericana, and Axinulus antarcticus. T. patagonica is characterized by its strong commarginal sculpture, shell as height as length or higher than long, posterior auricle delimited by a deep submarginal sulcus, and a long and sloping straight anterior half of dorsal margin. M. sudamericana distinguished by its longer than high shell outline, elongated tooth-like enlargement anterior to beak, gills with only one demibranch at each side, and foot with a marked heel. A. antarcticus has a minute, subquadrate shell, hinge with a small swelling anterior to beak, gills with a single demibranch, and the lateral body pouch elongated and almost smooth. The present study provides the first reliable record of thyasirids, with a single demibranch from the Southern Ocean. Moreover, characters for a better definition of Mendicula are provided.

Imagerie précoce de la réduction gastrique type gastrectomie en gouttière

Sleeve gastrectomy is a new bariatric surgical procedure with promising early results and low morbidity and mortality. We have evaluated the early imaging findings and value of upper GI study (UGI) and CT. Twenty five patients (mean age=38.9 years, mean BMI=51.5 kg/m2) following sleeve gastrectomy for morbid obesity underwent UGI at day 1. CT was immediately performed in patients with suspected leak or as a follow-up examinations in patients with suspected complication. The different imaging features observed were recorded. UGI demonstrated 13 normal examinations (52%), an abnormal appearance in 11 cases (44%) with opacification of a lateral pouch, and one complication (leak confirmed on CT). Two patients underweent CT (day 3 and day 15) for suspected complication, with demonstration of leak in both cases. An abnormal appearance after sleeve gastrectomy is frequently observed on UGI. Routine UGI at day 1 is useful to detect large leaks. CT with oral contrast should be performed in all patients with imaging or clinical suspicion of leak.

Orbiniidae polychaetes (Polychaeta: Scolecida) from Coiba Island, eastern Pacific of Panama, with description of a new species

Santa Cruz and El Gambute, two mangrove systems with associated tidal flats, were sampled in Coiba National Park, Coiba Island, Pacific of Panama. At each site, two samplings were done at low, middle and high intertidal levels in February and November of 1997. A new orbiniid species were found: Orbinia oligopapillata n. sp. is characterized by having 15-16 thoracic chaetigers with four or five rows of uncini and up to three papilliform postchaetal processes on neuropodial lobes by the abdominal parapodia bearing flail-tipped neurochaetae, and by the presence on anterior-most abdominal chaetigers of interramal cirri and a low number of subpodial and stomach papillae. A specimen belonging to genus Leitoscoloplos Day, 1977 is described as "Leitoscoloplos sp.", characterized by the lateral pouches on its abdominal chaetigers, a unique case for the family because these brooding structures have only been previously cited in two species of Scoloplos. Naineris sp. is characterized by the number of its thoracic chaetigers, branchiae, uncini and bilobed abdominal neuropodia with protruding aciculae.

An Unusual Meniscal Ganglion Cyst That Triggered Recurrent Hemarthrosis of the Knee

A 58-year-old woman suffered spontaneous recurrent hemarthrosis of the knee. In the clinical course, pigmented villonodular synovitis was mostly suspected, but in arthroscopic surgery the lateral meniscus appeared to be upturned and stuck into the lateral pouch with the meniscal ganglion cyst. It was suggested that meniscal tear with meniscal ganglion cyst was related with recurrent hemarthrosis. Generally, both the meniscal ganglion cysts and spontaneous recurrent hemarthrosis are highly rare conditions. In this case, we speculated that a negligible power could induce the meniscal tear with recurrent hemarthrosis in the particular situation in which the meniscal ganglion cyst existed. In other words, the meniscal ganglion cyst might basically and physically relate with hemorrhagic condition. Arthroscopically, the meniscal ganglion cyst was removed together with the anterior segment of the lateral meniscus. Recurrent hemarthrosis was treated successfully by resection of the meniscus.

Ileoanal pouch procedures in children

Purpose: The aim of this study was to review the long-term experience with colectomy and the ileoanal pouch procedure (IAPP) in children from one hospital. Methods: Between 1977 and 2001, 168 children under 18 years of age underwent colectomy and IAPP. One hundred thirty-one had ulcerative colitis (UC). Twenty-six had familial colonic polyposis (FP), 9 had Hirschsprung's disease (HD), and 2 had colonic inertia. Ninety-seven had a J-pouch, 62 had a lateral pouch, and 9 had a straight pull-through (SP). The mean age was 13.9 years. Results: Complications within 2 years included pouchitis (16%), ileoanal strictures (14%), and adhesions (7%). There were no deaths. Fifty-six patients (33%) required reoperation, including 20 revisions of large pouches and 8 conversions of SP to pouches because of stool frequency. Six children (3.6%) had later pouch removal (3 had Crohn's disease). Stool frequency at 6 months was 3.8 (mean). At 6 months 5% had occasional soiling. Eighty-four percent can delay defecation over 1½ hours; 82% can urinate without a bowel movement. With a mean follow-up of 11.2 years, 94.6% are functioning well. Conclusions: Colectomy with IAPP is the preferred operation for children with UC, FP, and selected HD. The J-pouch is the preferred technique because of simplicity of construction and sparsity of complications. J Pediatr Surg 36:1689-1692. Copyright © 2001 by W.B. Saunders Company.

Enhanced formation of fibrosis in a rabbit aneurysm by gelatin hydrogel incorporating basic fibroblast growth factor.

This study was undertaken to analyze whether the controlled release of basic fibroblast growth factor (bFGF) can promote intrasaccular thrombosis in an experimental aneurysmal model. Carotid aneurysms were constructed in 80 rabbits with venous pouches and treated by placing gelatin hydrogels into each aneurysm incorporating 0, 25, 50, or 100 microg of bFGF or incorporating 100 microg of bFGF with different water contents. In the controls, the venous pouches either were not treated or were treated with gauze alone. Gelatin hydrogel was used for the controlled release of bFGF into the aneurysms. The formation of fibrosis in the aneurysms was histologically viewed to assess the area occupied by the fibrous tissues at 3 and 6 weeks after the hydrogel application. The effect of the bFGF dose and water content on obliterating the aneurysm by the hydrogels incorporating bFGF was also investigated. Six weeks after the application of gelatin hydrogels with a water content of 95 wt% incorporating 100 microg of bFGF, the lateral pouch orifice was completely closed, obliterating the aneurysm at the level of tissue appearance, in contrast to hydrogels incorporating lower doses of bFGF and other control agents. The venous pouch aneurysm was histologically occupied with the newly formed fibrous tissue, and the fibrous tissue area and percentage of the aneurysmal lumen occupied by the fibrosis-gauze complex were significantly larger than those of other hydrogel applications (P < 0.05). The neointima tissue was homogeneously covered with a monolayer of Factor VIII-positive cells. The fact that there was no difference in the water content in the fibrosis formation induced by the bFGF-incorporated gelatin hydrogels indicated that the hydrogel biodegradability did not affect the obliteration of the aneurysm. Local controlled release of bFGF stimulated the formation of in vivo fibrosis, resulting in obliteration of the aneurysm. The long-term results of the fibrous organization remain speculative.

Morphology of the internal reproductive system of the male and female two-spotted stink bug, Perillus bioculatus (F.) (Heteroptera: Pentatomidae) and the transfer of products during mating

Summary The reproductive systems of male and female Perillus bioculatus are typical for the Pentatomidae. A detailed examination of the spermatheca revealed that the duct assembly acts as a valve. When the valve is open, male secretions pass into the spermathecal pouch, but in the closed position sperm pass through the spermathecal duct extension and enter the spermathecal bulb. Males have a composite ejaculatory bulb that is composed of dorsal and ventral units. The dorsal ejaculatory bulb is formed by tissues that are continuous with the walls of the outer ejaculatory duct. Extensions from the dorsal bulb form the medial and lateral ejaculatory pouches. Ectadenia open into the dorsal bulb and their secretions fill the ejaculatory pouches which increase in volume from 3.5 days post-emergence as the male matures. The ventral ejaculatory bulb is muscular and receives the seminal vesicles. Mesadenia open into the seminal vesicles and their secretions, along with sperm, pass through the ventral ejaculatory bulb. The ejaculatory duct consists of outer and inner units. The outer unit is a continuation of the dorsal ejaculatory bulb while the inner unit is a continuation of the ventral ejaculatory bulb. During mating, the male genitalia clasp a tubercle on the vaginal genital plate that contains the opening of the spermathecal duct and materials from the male are introduced directly into the spermathecal duct. Within 1.5 h of mating, male ejaculatory pouch volume decreased 86%, but were completely recharged within 24 h of the completion of mating. Spermathecal pouch volume increased more than twofold after mating for 0.5 h. Three soluble glycoproteins, pi, p2, and p3, with molecular masses of 101.9,86.3, and 72.8 kDa, respectively, were stored in the ejaculatory pouches and transferred to the female spermathecal pouch during mating.

Reconstruction for chronic dysfunction of ileoanal pouches.

A retrospective review was performed to determine the results after surgical reconstruction for chronic dysfunction of ileal pouch-anal procedures for ulcerative colitis and familial colonic polyposis at a university medical center. During the 20-year period from 1978 to 1998, 601 patients underwent colectomy and ileal pouch-anal anastomosis (IPAA) for ulcerative colitis, familial colonic polyposis, or Hirschsprung's disease. A J pouch was used for 351 patients, a lateral pouch for 221, an S pouch for 6, and a straight pull-through for 23. Acute complications after pouch construction have been detailed in previous publications and are not included in this study. Chronic pouch stasis with diarrhea, frequency, urgency, and soiling gradually became more severe in 164 patients (27.3%), associated with pouch enlargement, an elongated efferent limb, and obstruction to pouch outflow, largely related to the pouch configuration used during the authors' early clinical experience. These patients were sufficiently symptomatic to be considered for reconstruction (mean 68 months after IPAA). Transanal resection of an elongated IPAA spout was performed on 58 patients; abdominoperineal mobilization of the pouch with resection and tapering of the lower end (AP reconstruction) and ileoanal anastomosis on 83; pouch removal and new pouch construction on 7; and conversion of a straight pull-through to a pouch on 16. Good long-term results (mean 7.7 years) with improvement in symptoms occurred in 98% of transanal resections, 91.5% of AP reconstructions, 86% of new pouch constructions, and 100% of conversions of a straight pull-through to a pouch. The average number of bowel movements per 24 hours at 6 months was 4.8. Complications occurred in 11.6% of reconstructed patients. Five of the 164 patients (3.1%) required eventual pouch removal and permanent ileostomy. The high rate of pouch revision in this series of patients undergoing IPAA is due to a policy of aggressive correction when patients do not experience an optimal functional result, or have a progressive worsening of their status. Although occasionally a major undertaking, reconstruction of ileoanal pouches with progressive dysfunction due to large size or a long efferent limb has resulted in marked improvement in intestinal function in >93% of patients and has reduced the need for late pouch removal.

Long-term results after colectomy and ileoanal pull-through procedure in children.

To review the clinical experience with colectomy and ileoanal pull-through procedure in children from 1 hospital. Since 1977, 116 children 18 years of age or younger underwent colectomy and ileoanal pull-through procedure at University of California-Los Angeles Medical Center. Ninety-four children had ulcerative colitis, 17 had familial polyposis coli, and 5 had Hirschsprung disease. Sixty-two children had a lateral pouch, 47 a J-pouch, and 7 a straight pull-through. A diverting ileostomy was used for 4 months for all patients except 9 with polyposis coli and 2 with Hirschsprung disease. During the same period, an additional 414 patients older than 18 years underwent the ileoanal pull-through procedure. Forty-eight children (41%) developed complications; the most common was pouchitis, which occurred in 18 patients with ulcerative colitis. Forty-two children underwent reoperation; 38 had ulcerative colitis. There were no deaths. Six children (5.2%) (3 with Crohn disease) required a permanent ileostomy. Six straight pull-throughs were converted to J-pouches because of stool frequency; 19 patients with lateral pouches underwent pouch reconstruction or spout resection because of stasis. With a mean follow-up of 7.1 years, 107 children (92.2%) were progressing well. Ulcerative colitis is a more severe disease in children. The ileoanal pull-through procedure is the preferred operation for children with ulcerative colitis, polyposis coli, and selected patients with Hirschsprung disease. The J-pouch is preferred because of simplicity of construction and scarcity of complications.

Funktionelle Schluckaktuntersuchungen mit der Elektronenstrahl- computertomographie

Functional evaluation of swallowing disorders requires rapid imaging modalities. Videofluorography and cinematography are the gold standard, but they have their limitations: no transverse plane imaging is achieved and structural resolution for exact topographic analysis is limited. Three cases preselected by videofluorography were studied to evaluate whether electron beam tomography (EBT) permits more detailed dynamic imaging of swallowing disorders focusing on the mesonasopharyngeal segment, the hypopharynx and the upper esophageal sphincter (UES). Immediately after videofluorographic examination of the oropharyngeal deglutition, EBT is performed. The patient is in a supine position and while the patient swallows a 20 ml bolus of water or diluted iodine containing contrast agent, a sequence of 20 images per level is scanned. The levels, which are determined by using the scout view, are oriented parallel to the hard palate either at the level of the hard palate to image the mesonasopharyngeal segment or just above the hyoid bone to focus on the hypopharynx or at the location of the UES. The scan technique is a single-slice cinemode with a slice thickness of 3 mm (exposure time 100 ms, interscan delay 16 ms, 130 kV, 620 mA). The following structural interactions that we have so far been unable to image can be clearly demonstrated with EBT: (1) during normal swallowing, the mesonasopharyngeal segment is completely and symmetrically closed by the soft palate and Passavant's cushion; (2) lateral hypopharyngeal pouches can be located more precisely; and (3) disorders of the UES can be differentiated into functional or morphologically caused disorders (e.g., goiter or cervical osetophytes). Videofluorography and cinematography are still the gold standard in functional evaluation of swallowing disorders. However, EBT permits dynamic imaging of pharyngeal deglutition in a preselected transverse plane and can give useful additional information concerning functional anatomical changes in the pharynx during swallowing. Further clinical evaluation is needed.

Unfertilized Oocytes in Streptocephalids: Resorbed or Released?

ABSTRACT Short interval monitoring of isolated females of Streptocephalus dichotomus Baird, S. proboscideus(Frauenfeld), and S. torvicornis (Waga) revealed no resorption of unfertilized oocytes in the lateral pouches of the oviducts or in the ovisac. Oocytes expelled by the female disintegrate in the medium. This finding is in disagreement with earlier studies on S. dichotomus and S. proboscideus, but corroborates findings on S. vitreus (Brauer) and S. rubricaudatus (Klunzinger). Light and electron microscopic studies of unfertilized and fertilized oocytes show polar-body extrusion, vitelline-membrane formation, and egg-shell deposition in fertilized oocytes only. The streptocephalids studied here differ, in this respect, from two other anostracans, Tanymastix and Artemia, where unfertilized oocytes develop a vitelline membrane, and sometimes an egg shell.

UNFERTILIZED OOCYTES IN STREPTOCEPHALIDS: RESORBED OR RELEASED?

ABSTRACT Short interval monitoring of isolated females of Streptocephalus dichotomus Baird, S. proboscideus(Frauenfeld), and S. torvicornis (Waga) revealed no resorption of unfertilized oocytes in the lateral pouches of the oviducts or in the ovisac. Oocytes expelled by the female disintegrate in the medium. This finding is in disagreement with earlier studies on S. dichotomus and S. proboscideus, but corroborates findings on S. vitreus (Brauer) and S. rubricaudatus (Klunzinger). Light and electron microscopic studies of unfertilized and fertilized oocytes show polar-body extrusion, vitelline-membrane formation, and egg-shell deposition in fertilized oocytes only. The streptocephalids studied here differ, in this respect, from two other anostracans, Tanymastix and Artemia, where unfertilized oocytes develop a vitelline membrane, and sometimes an egg shell.

Barnett continent intestinal reservoir

Since 1988, surgeons at five hospitals have been performing the Barnett continent intestinal reservoir (BCIR). The BCIR includes modifications to the original Kock pouch, designed to reduce the incidence of valve slippage and fistula formation. Principle modifications include an intestinal collar, an isoperistaltic valve, and a lateral pouch design. This unique collaborative study includes 510 ulcerative colitis or familial polyposis patients, with a follow-up time from one to five years postoperatively. Ninety-two percent still have functioning reservoirs. Six and one-half percent have had their pouches removed and replaced with conventional Brooke ileostomies. Reoperation rate for major pouch-related complications (other than pouch removal) was 12.8 percent. These complications included slipped valve (6.3 percent), valve fistulas (4.5 percent), and pouch fistulas (6.3 percent). Several questions were administered to patients whose responses revealed a significant improvement in general quality of life, state of mind, and overall health. The BCIR represents a successful alternative to patients with a conventional Brooke ileostomy or those who are not candidates for the ileal pouch-anal anastomosis.

Limnobiophyllum Krassilov — a fossil link between the Araceae and the Lemnaceae

Limnobiophyllum Krassilov includes fossil free-floating stoloniferous plants each with one or two sessile suborbicular to reniform leaves of different size as well as numerous simple and one or two longerbranched roots on a reduced main stem. The venation consists of campylodromous curved primaries, up to 14 in number, among which irregular reticulate veins of higher orders can be preserved. There are no signs of lateral pouches characteristic of the Lemnaceae. However, aerenchyma and pigment cells are well developed in Limnobiophyllum. Two species are recognized - Limnobiophyllum scutatum (Dawson) Krassilov (latest Cretaceous to Oligocene of western North America and Palaeocene of East Asia) and Limnobiophyllum expansum (Heer) Kvaček, comb. n. (Miocene of Europe). Turion-like bodies are associated with L. scutatum. No fruits have been found in connection, but numerous isolated ribbed seeds are associated with L. expansum. They resemble some Araceae and also Lemna L. and Spirodela Schleid. Such seeds are known as Lemnospermum Nikitin from the Tertiary of Eurasia. Limnobiophyllum resembles in some respects Spirodela, but it is larger and the roots and the habit are more like young plants of Pistia L. (Araceae). It differs from Hydromystria Mey. (i.e. Limnobium Rich.) by venation, root system and habit; the Lemnaceae, although similar, differ by lateral pouches of leafy fronds and the lack of branched roots and higher-order veins. Limnobiophyllum is considered as an extinct link related to Pistia (Araceae), from which Spirodela (Lemnaceae) may have evolved by reduction.

A revision of the genus Prionospio Malmgren, with special emphasis on species from the Atlantic Ocean, and new records of species belonging to the genera Apoprionospio Foster and Paraprionospio Caullery (Polychaeta, Annelida, Spionidae)

Several generic schemes used in classifying species belonging to Prionospio Malmgren, 1867 sensu lato have been reviewed; three taxa have been retained at the generic level, and three additional taxa at the subgeneric level. The following genera and subgenera are recognized: Prionospio Malmgren, 1867, including the subgenera Minuspio Foster, 1971, Aquilaspio Foster, 1971 and Prionospio Malmgren (sensu striclo); Apoprionospio Foster, 1969, and Paraprionospio Caullery, 1914. Prionospio sensu lata includes species with various combinations of branchiae which are smooth (apinnate), wrinkled, or with digitiform pinnules, beginning on setiger 2. Apoprionospio includes species having branchiae from setiger 2, with at least one pair having plate-like pinnules. Paraprionospio includes species with branchiae from setiger 1, with all pairs having platelike pinnules. Fifteen species, including seven new species, belonging to the genus Prionospio are described. Prionospio (Prionospio) steenstrupi Malmgren, 1867 is described from the syntype series, and is newly synonymized with P. fallax Soderstrom, 1920. The validity of P. bocki Soderstrom, 1920 as a separate species is discussed, as is the indeterminable nature of P. malmgreni Claparede, 1869. Prionospio (Prionospio) dubia Day, 1961 originally described as a new variety of P. malmgreni from S Africa, is raised to full species status. Prionospio (P.) cristata Foster, 1971 and P. (P.) heterobranchia Moore, 1907 are redescribed. Prionospio (P.) tripinnata, a new species with three pairs of pinnate branchiae, is described from the Mediterranean Sea and compared with P. plumosa Sars, 1872. A new synonymy is proposed for P. lobulata Fauchald, 1972 with P. (P.) ehlersi Fauvel, 1928. Two new species, P. (Minuspio) fauchaldi and P. (M.) laciniosa, are described in which the apinnate branchiae are distinctly wrinkled or sculptured, rather than smooth. P. (M.) laciniosa is also distinguished by dorsal crests modified into semicircular flaps. Several species previously referred to Prionospio (Minuspio) cirrifera Wiren, 1883 are reviewed and described. The seven species recognized by Foster in the genus Minuspio are considered; several are retained, and new species and new synonymies are proposed. Because the types are apparently lost, a description of P. (M.) cirrifera is given based on specimens from near the type locality. Prionospio (M.) aluta new species is separated from P. (M.) cirrifera on the basis of the presence of lateral pouches in P. aluta and their absence in P. cirrifera. Prionospio (M.) delta Hartman, 1965 is retained as a valid species; P. (M.) longibranchiata Reish, 1968 and P. (M.) minor Fauchald & Hancock, 1981 are newly synonymized with P. delta. P. (M.) multibranchiata Berkeley, 1927 is also retained as a valid species, and P. (M.) perkinsi, P. (M.) lighti and P. (M.) wireni are newly described from shallow water. Two species are recognized as belonging to Apoprionospio Foster: A. pygmaea (Hartman, 1961) and A. dayi Foster, 1969. New records and range extensions are given for both species. New records are also presented for Paraprionospio pinnata (Ehlers, 1901). The specimens examined as part of this study are based primarily on deep-sea materials collected in the Atlantic Ocean, but also include shallow-water specimens from the east, west, and gulf coasts of N America.

Studies On the Oviductal Secretion and Ovulation in Streptocephal Us Dichotomus Baird, 1860 (Anostraca)

In Streptocephalus dichotomus, the oviductal cells show the existence of a secretory cycle corresponding to each ovulation cycle. This secretory activity coincides with the passage of eggs from the lateral pouch of the oviduct into the ovisac. During ovulation the glandular cells of the oviduct become flattened and produce large numbers of secretory granules in the form of globules. Various phases of the secretory cycle are also described. The possible function and the type of secretion have been discussed with available information on other anostracans.

Pharyngeal pouch as a cause of difficult intubation

The presence of a lateral pharyngeal pouch may cause difficulty in recognising the glottis when awake intubation is undertaken. This is mainly because the orifice may open and close during phonation and therefore be mistaken for the glottis. A case is described and some aspects of relevance to the anaesthetist are discussed.

Intestino-vaginal fistulae.

Abstract Fourteen fistulae were recorded from approximately 7,000 barium examinations seen over the past six years, an incidence of 0·2 per cent. These were six vaginal fistulae, five vesical. one ileocolic, and two gastro-colic. The incidence of intestino-vaginal fistula is 0·08 per cent. These six cases are described. The radiological investigations and findings are discussed, and the value of water-soluble contrast examinations is stressed. It is important to appreciate the high incidence of associated fistulae. The finding of a “lateral pouch” beside the rectum in the frontal projection is an indication of vaginal filling, and to the author's knowledge has not previously been described. The early recognition of the “lateral pouch” will allow the examiner to delay further filling and take appropriate early films so as to prevent overfilled loops obscuring the origin of the fistula.