Length Of Fistula Research Articles

Clinical characteristics and MRI-based phenotypes of perianal abscess formation in children with fistulizing Crohn's Disease.

The aim of this study was to explore potential correlation of the MR imaging features and clinical characteristics with formation of perianal abscess in children with Crohn's perianal fistulas (CPF). From 2010 to 2020, pediatric patients with CPF diagnosis on their first pelvic MRI were identified retrospectively. All patients were divided into two groups based on the presence or absence of perianal abscess. Baseline clinical and MRI characteristics were recorded for each patient. All the statistical calculations were performed using R (version 3.6.3). A total of 60 patients [F:M 17:43, median age 14 years (IQR 10-15), ranging 3-18 years] were included in this study. Forty-four abscesses were identified in 36/60 children (mean volume 3 ± 8.6 ml, median 0.3 ml). In 24/60 patients with perianal disease, no abscess was detected on the MRI. Ten patients (28%) showed perianal abscess on pelvic MRI at the initial diagnosis. The rate of active disease on colonoscopy (visible ulcerations/aphthous ulcers) was similar in both groups (95% vs. 94%). With regards to disease location, the majority of patients (40/60, 66.6%) in both groups had ileocolonic CD. All patients without abscess had a single perianal fistula (n = 24; 3 simple and 21 complex fistulae), however, patients with perianal abscess tended to have >1 fistulous tracts (n = 50 fistulas; all complex, 27 single, 10 double and 1 triple). Intersphincteric fistula was the most common fistula type in both groups (79% and 66%, p = 0.1). The total length of fistula (3.8 ± 1.7 vs. 2.8 ± 0.8 cm, p = 0.006) and presence of multiple external openings (n = 25 vs. 7, p = 0.019) were significantly higher in patients with abscesses, and fistula length >3.3 cm showed 80% specificity and 83% PPV for the presence of perianal abscess. Fistulas were symptomatic (pain, bleeding or drainage) at similar rates in both groups (68% and 70%, p = 0.1). Pediatric patients with CPF who develop perianal abscess have a distinct imaging phenotype defined by longer fistula length (>3.3 cm), multiple skin openings and multiple fistulous tracts (≥2) on MRI. Patients who have these features but does not have an abscess on imaging may merit more aggressive treatment (and close monitoring) to prevent the development of an abscess.

Labyrinthine Fistula-Our Experience at a Tertiary Hospital.

This study has aimed to determine the anatomical site of labyrinthine fistula in patients of chronic suppurative otitis media at our centre. Labyrinthine fistulae (LF) are caused by abnormal communications between the inner ear and surrounding structuresresulting in perilymph leakage and hearing loss. Labyrinthine fistula represents as erosive loss of the enchondral bone overlying the semicircular canals without loss of perilymph. The manifestations of fistula like vertigo, hearing loss vary in severity and complexity, commonly ranging from very mild to incapacitating. Cholesteatoma induced fistula most commonly involves lateral semicircular canal probably because of its close proximity to the middle ear, but can involve other semicircular canals and rarely cochlea. This is a retrospective analysis of 36 patients of chronic suppurative otitis media with history of vertigo undergoing tympanomastoid surgery in whom there was an evidence of labyrinthine fistula on HRCT scan of temporal bone. The incidence of patients with labyrinthine fistula presenting with vertigo, nystagmus, sensorineural hearing loss, history of vertigo were analysed. The anatomical location of the fistula was supported by Radiological evidence. Patients underwent either canal wall down mastoidectomy or cortical mastoidectomy. The anatomical site and length of the labyrinthine fistula were analysed. Amongst the 36 patients of chronic suppurative otitis media with labyrinthine fistula 22 (61.1%) patients had atticoantral disease, 4 (11.1%) patients had chronic otitis media with extensive granulation, 2 (5.5%) patients had Tubotympanic disease with polyps, 4 (11.1%) patients had Tuberculous otitis media, 1 (2.77%) patient had Tubotympanic disease with extensive tympanosclerosis eroding the dome of lateral semicircular canal, 1 (2.77%) patient had extensive cholesteatoma with cerebellar abscess, 1 (2.77%) patient had fistula in the promontory following trauma, 1 (2.77%) patient had extensive tympanosclerosis with erosion of promontory. It was noticed that, in 14 (38.88%) patients the fistula was at the centre, in 17 (47.22%) patients the fistula is towards the ampullary end of horizontal semicircular canal and in 5 (13.88%) patients the fistula was towards the non ampullary end of lateral semicircular canal. The maximum length of fistula noticed was 6mm and the minimum length of the fistula noticed was 2mm. Labyrinthine fistula are most commonly noticed in the ampullary end of the lateral semicircular canal. The average length of the fistula was found to be 4mm. Careful elevation of the cholesteatoma matrix over the endosteal membrane and immediate placement of temporal fascia over the exposed fistula is important to avoid injury to the inner ear. Maximum number of fistula were seen in the atticoantral type of Chronic suppurative otitis media. Prior knowledge of anatomical location of the fistulous tract in HRCT temporal bone is important to address the fistula.

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.

The resection with methylene blue notation for the treatment of children congenital lacrimal duct fistula

Objective To investigate the treatment of children congenital lacrimal duct fistula. Methods From February 2013 to January 2015, 16 eyes of 16 cases of children congenital lacrimal duct fistula in our hospital were diagnosed and treated. Sex proportion was 9: 7(male: female), age group was 0.5-8 years, average (3.0±0.6) years, eye proportion was 6: 10 (right: left). The distance from fistula to inner canthus were≤5 mm in 13 cases, >5 mm in 3 cases. After irrigation of lacrimal passage and dacryocystography, the fistula was connected with dacryocyst in 12 cases, with common canaliculus in 3 csaes and with inferior lacrimal ductile in 1 case. All patients underwent fistula resection by methylene blue notation. Results The lacrimal duct fistula was successful resected in all 16 cases, the length of the fistula removed was 5 - 8 mm, <7 mm in 10 cases, ≥7 mm in 6 cases. After 6 months follow-up, the lacrimal duct were flushed unobstuctably, the scar of skin was not obvious. Conclusion The resection for the treatment of children congenital lacrimal duct fistula by methylene blue notation is effective. Key words: Lacrimal duct fistula, congential, children; Resection, methylene blue notation

Transperitoneal laparoscopic ureteric reimplantation for lower ureteric strictures and ureterovaginal fistulas: A study from north India

IntroductionIncidence of lower ureteric injuries has increased due to proliferation of complex pelvic laparoscopic and ureteroscopic procedures. ObjectiveTo describe our experience of laparoscopic ureteric reimplantation for lower ureteric strictures and ureterovaginal fistulas due to different aetiologies. Patients and methodsA total of 42 patients underwent laparoscopic ureteric reimplantation from January 2007 to December 2013 after preoperative evaluation by intravenous urography or CT urogram to delineate the site and length of stricture or ureterovaginal fistula. All the patients were followed up with ultrasonography and micturating cystourethrogram at 3 months. Out of the total 42 patients, 22 patients (group 1) underwent laparoscopic ureteric reimplant for lower ureteric stricture and 20 patients (group 2) underwent laparoscopic ureteric reimplant for ureterovaginal fistula. ResultsThere were 5 male and 37 female patients. The mean patient age was 43.5±12 (range 24–62yrs), mean operating time was 129±11 (range 110–160) minutes, mean hospital stay was 2.8 (range 2–6) days and mean follow up period of 16 months (range 6–70). Two procedures had to be converted to open (one each in both groups). There were no major (Clavien grade III and above) intra-operative or post-operative complications. One of the failures in lower ureteric stricture group was managed by open reconstruction with boari flap. ConclusionLaparoscopic ureteric reimplantation is an excellent modality for both lower ureteric strictures and ureterovaginal fistulas with long term good outcomes in addition to the advantage of lesser hospital stay and lesser comorbidities.

Preoperative Risk Factors and Radiographic Findings Predictive of Laparoscopic Conversion to Open Procedures in Crohn’s Disease

IntroductionLaparoscopy is accepted as a standard surgical approach for Crohn’s disease. However, the rate of conversion is high, ranging from 15 to 70 % depending on the population. There are also concerns that conversion results in worsened outcomes versus an initial open procedure. MethodsThis study evaluated preoperative radiographic findings to determine who is at increased risk of conversion and may therefore benefit from an initial open approach. A case-matched study included patients from 2004 to 2013 with preoperative CTE/MRE who underwent laparoscopic surgery converted to an open approach, and compared them to laparoscopically completed controls with similar age, same surgeon, and number of previous abdominal operations. Studies were reviewed by two blinded radiologists. Variables included abdominal AP diameter, amount of subcutaneous fat, peritoneal versus pelvic location of disease (greater or lesser hemipelvis or abdomen), intestinal location of disease (colon, TI, ileum, jejunum), and presence, length, and location of strictures, simple or complex fistula, phlegmon, or abscess. Conditional logistic regression evaluated relationships between radiographic variables and conversion. Twenty-seven patients meeting study criteria were compared with 81 controls. ResultsA negative association between conversion and disease in the left lesser pelvis was found (p = 0.019) and neared significance for left abdomen (p = 0.08). Positive correlations were found with pelvic fistulas (p = 0.003), complex fistulas (p = 0.017), and pelvic abscesses (p = 0.009) and neared significance for Society of Abdominal Radiology classification (p = 0.058). ConclusionPreoperative imaging in patients with Crohn’s disease can help in selecting the most suitable cases to approach laparoscopically and reduce conversion rates and should be evaluated in conjunction with other preoperative factors.

Comparison of Binary Models for the Associated Factors Affecting Recovery Status of Vesico-vaginal Obstetrics Fistula Patients: A Case of Mettu Hamlin Fistula Center, South West Ethiopian

Background: Obstetric fistula or vaginal fistula is a medical condition in which a fistula (hole) develops between either the rectum or vagina or between the bladder and vagina after severe or failed childbirth, when adequate medical care is not available. It is the most tragic of preventable childbirth complications in the developing world, as affected women are often abandoned by their husbands and family, and forced to live in shame. Objective: The main objective the study was to determine an appropriate binary model for the recovery status of the vesico-vaginal patients. Furthermore, the study explores factors affecting the recovery status of the patients during the time period of the study. Methods: The study consists of 206 vesico-vaginal fistula patients having all required information who were taking treatment at Mettu Hamlin Fistula center from November 2010 to June 2014. The chi-square test of association was employed to explore the association between the recovery status and categorical independent variables. After exploring the association between the variables, different binary models were employed to have an appropriate model for the recovery status of the patients based on Akaki information criteria of the model. Results: The chi-square test of association showed that width of fistula length of fistula and bladder size categories were significantly associated with recovery status of the patients at 5% of level of significance. The study showed among the candidate binary models logistic model was considers an appropriate model. Furthermore, the fitted model showed width, length of fistula and bladder size categories were the factors that have significant effect on the recovery status of the patients at 5% level of significance. Conclusion: Logistic regression model was the better fit of the data whereas the fistula patients with width and length fistula category group between three up to five centimeter were less likely to be recovered comparison with the fistula patients group with width and length of fistula less than or equal to two centimeters. Similarly, the none bladder size category patients where less likely recover in comparison with fair bladder size fair bladder size group patients.

Survival Analysis of Time to Recovery from Obstetric Fistula: A Case Study at Yirgalem Hamlin Fistula Hospital, Ethiopia

Kaplan-Meier estimation method, Cox proportional hazard model and parametric regression model were applied. The Cox proportional hazard analysis indicated that older ages at first marriage, weight 150 cm, follow up of antenatal care, delivery at health center, duration of labour for 150 cm (Adjusted HR=1.00), follow up of antenatal care (adjusted HR=0.263), delivery at health center (adjusted HR=1.00), duration of labour (adjusted HR=0.127 for <2 day), vaginal delivery (adjusted HR=0.241), length of fistula (adjusted HR=0.342 for <2 cm, HR=0.426 for 3-5 cm), width of fistula (adjusted HR=0.147 for <2 cm, HR=0.356 for 3-5 cm) and intact of urethra (adjusted HR=0.439) significantly contribute to a shorter recovery time of a patient. In conclusions: The finding of this study showed that age at first marriage, height, antenatal care, weight, place of delivery, mode of delivery, duration of labour, length and width of fistula, and status of urethra were major factors affecting recovery time of obstetric fistula patient at Yirgalem Hamlin Fistula Hospital. It is recommended to make interventions based on these risk factors.

Axillary Fistula and Scar Contracture due to Uncontrolled Chronic Infection after Trans-Axillary Augmentation Mammaplasty.

Axillary Fistula and Scar Contracture due to Uncontrolled Chronic Infection after Trans-Axillary Augmentation Mammaplasty.

John Marshall's first description of surgical electrocautery

John Marshall's first description of surgical electrocautery