Rectovaginal Fistula Research Articles

Treatment of Rectovaginal Fistula.

Rectovaginal fistula (RVF) is a challenging complication with unsatisfactory success and a significant burden for the patients. With insufficient clinical data due to the rare entity, the present state of treatments for RVFs was reviewed especially form the point of factors to determine management, classifications, principle of treatment, conservative and surgical treatments with outcomes. Size, fistula localization and etiology, type of fistula; "simple" or "complex," status of anal sphincter complex and surrounding tissue, presence or absence of inflammation, presence of diverting stoma, previous attempted repair and radiation therapy, patient's condition with co-morbidities, and surgeon's experience are important factors to determine the management of RVF. The inflammation should initially subside in cases with infection. Starting with conservative surgical options and interposing healthy tissue for complex or recurrent fistulas, invasive procedures will be performed if conservative treatment failed. Conservative treatment may be effective in RVFs with minimal symptoms and should be done for small RVFs for a 36 months usual period. Anal sphincter damage might need a repair of sphincter muscles along with RVF repair. Diverting stoma can initially be constructed in patients with severe symptoms and larger RVFs to relief the patient's pain. Simple fistula is usually indicated for local repair. Local repairs to transperineal and transabdominal approaches can be used for complex RVFs. Interposition of healthy, well-vascularized tissue can be required for more complex fistulas and abdominal procedures for high RVFs.

Successful omental flap coverage repair of a rectovaginal fistula after low anterior resection: a case report

BackgroundRectovaginal fistula (RVF) is a troublesome and refractory complication after low anterior resection (LAR) for rectal cancer. An omental flap repair was performed for the RVF caused due to Crohn’s disease and childbirth trauma. However, there are few cases of an omental flap repair for RVF after LAR. Herein, we present a successfully repaired case of RVF by omental flap coverage after LAR for rectal cancer.Case presentationA 50-year-old female patient with advanced rectal cancer underwent laparoscopic LAR with double-stapling technique anastomosis and achieved curative resection. She complained of a stool from the vagina and was diagnosed with RVF on the postoperative day (POD) 18. Conservative therapy was ineffective. We performed laparoscopic fistula resection and direct closure of the vagina and rectum, designed the omentum that could reach the pelvis, repaired RVF by omental flap coverage, and performed transverse colostomy on POD 25. She was discharged on initial POD 48. Seven months after the initial operation, colostomy closure was administered. There was no recurrence of RVF found 1 year after the initial operation.ConclusionsThe patient achieved an omental flap coverage for RVF. We successfully performed the omental flap coverage repair in patients with RVF after the leakage of LAR. An omental flap may become an alternative treatment for muscle flap or an effective treatment for RVF.

Dehydrated human amniotic membrane and amniotic fluid allograft for the treatment of complex rectovaginal fistulas: A novel technique.

SynopsisUsing a dehydrated human amniotic membrane along with an amniotic suspension allograft, an effective therapy for complex rectovaginal fistula is demonstrated.

MP02-19 MANAGEMENT AND OUTCOMES OF RECTAL INJURIES DURING GENDER AFFIRMING VAGINOPLASTY

You have accessJournal of UrologyCME1 Apr 2023MP02-19 MANAGEMENT AND OUTCOMES OF RECTAL INJURIES DURING GENDER AFFIRMING VAGINOPLASTY Talia Stark, Kenan Celtik, Jess Ting, Miroslav Djordjevic, and Rajveer Purohit Talia StarkTalia Stark More articles by this author , Kenan CeltikKenan Celtik More articles by this author , Jess TingJess Ting More articles by this author , Miroslav DjordjevicMiroslav Djordjevic More articles by this author , and Rajveer PurohitRajveer Purohit More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We describe incidence, management and outcomes of rectal injuries (RI) during gender affirming vaginoplasty (GAV) and revision vaginoplasty (RV) at a high volume center. METHODS: All intra-operative RI during GAV and RV are reported to a quality control committee for evaluation at our institution. We performed a retrospective review of pre-operative, intra-operative and post-operative findings of all patients with RI during GAV. RESULTS: RI occurred in 9 of 1011 (incidence 0.89%) primary GAV and during 1 RV for vaginal stenosis from January 2016-September 2022. Preoperative data are summarized in Table 1, and injury and repair characteristics in Table 2. Colorectal surgery (CRS) evaluation included sigmoidoscopy in 4 cases, an air leak test in 2, and with temporary bowel diversion in 3 (2 concomitant and 1 delayed). In 7/10 full depth GAV was completed; 3 were converted to minimal depth vaginoplasty. 3 cases had unusual adhesions, obliterated planes, or fibrosis from prior silicone implant surgery during the vaginal canal dissection. 2 had bulbospongiosus muscle interposition over the repair site. No patient had a concomitant urethral injury, 2 (20%) developed a rectovaginal fistula (RVF). Both RVF occurred in patients with prior perineal surgery, including prior vaginoplasty. Neither patient had intra-operative sigmoidoscopy done by CRS. 3 patients (43%) with full depth GAV developed vaginal stenosis postoperatively. CONCLUSIONS: Rectal injuries occur even in experienced hands with an incidence of <1% in our series of 1011 patients undergoing primary GAV. Unusual tissue dissection planes were a risk factor. If injuries were identified intra-operatively, repaired with multilayer closure and evaluated by CRS, patients did well without the development of RVF despite completion of full depth GAV. It is reasonable to complete the full depth vagina, but patients have a significant risk of post-operative vaginal stenosis. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e19 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Talia Stark More articles by this author Kenan Celtik More articles by this author Jess Ting More articles by this author Miroslav Djordjevic More articles by this author Rajveer Purohit More articles by this author Expand All Advertisement PDF downloadLoading ...

North-central Nigerian women’s experiences of obstetric fistula risk factors and their perceived treatment services: An Interpretive Description

BackgroundAn obstetric fistula also known as vesico vaginal fistula (VVF), or recto-vaginal fistula (RVF) is an abnormal opening between the urogenital tract and intestinal tract caused by prolonged obstructed labour; when the head of the baby presses on the soft tissues in the pelvis leading to loss of blood flow to the women’s bladder, vagina, and rectum. This can cause necrosis of the soft tissues resulting in debilitating fistula formations. AimThis study aimed to uncover North-central Nigerian women’s experiences of obstetric fistula and their perceived treatment services. DesignQualitative, interpretive descriptive methodology underpinned by symbolic interactionism involving face-to-face semi-structured interviews was used to explore North-central Nigerian women’s experiences of obstetric fistula and their perceived treatment services. SampleA purposive sample of 15 women who had experienced obstetric fistula at a repair Centre in North-central Nigeria were eligible. ResultsFour themes emerged from North-central Nigerian women’s experiences of obstetric fistula and their perceived treatment services i) I was left alone in the room ii) Waiting for the one vehicle in the village iii) I never knew about labour until that very day iv) and We kept following the native doctors and sorcerers. ConclusionThe findings from this study highlighted the depth of women’s experiences from the devastating complication of childbirth injury in North-central Nigeria. Analysis of insights from women’s voices directly affected by obstetric fistula demonstrated that in their views and experiences the themes identified were majorly responsible for their fistula status. Thus women need to raise their collective voices to resist oppressive harmful traditions and demand empowerment opportunities that will improve their social status. Government should improve primary healthcare facilities, train more midwives and subsidise maternal care for antenatal education and birth services spending for childbirth women may result in improved childbirth experiences for women in rural and urban communities. Tweetable AbstractReproductive women call for increased accessibility to healthcare services and the provision of more midwives to mitigate obstetric fistula in North-central Nigerian communities.

Three-Port Laparoscopic Splenic Flexure Colectomy for Descending Colon Cancer with Intracorporeal Colocolic Anastomosis and Transvaginal Natural Orifice Specimen Extraction

Introduction: Transanal and transvaginal natural orifice specimen extraction (NOSE) are viable alternatives to transabdominal specimen retrieval after laparoscopic colorectal surgery in selected patients without increasing morbidity or compromising oncologic outcomes.1 Conventional laparoscopic colorectal surgery is performed using one camera port, two operator ports, and one or two assistant ports. Three-port surgery is feasible2 and complementary to NOSE for laparoscopic colorectal cancer surgery to reduce surgical trauma to the abdominal wall.3 Transanal NOSE avoids an additional vaginal incision, however, the transvaginal route is preferable for larger tumors because of the elasticity of the vagina.3 Although dyspareunia and rectovaginal fistulae are theoretical concerns following transvaginal NOSE, these fears are thus far unfounded.1,3 Placement of a transvaginal wound protector protects against the risk of tumor seeding. Transvaginal NOSE following three-port laparoscopic D3 right hemicolectomy4 and three-port laparoscopic anterior resection5 have been previously demonstrated. Compared with other locations within the large bowel, cancers of the splenic flexure are relatively uncommon.6 Splenic flexure colectomy preserves bowel and is safe and oncologically comparable with a subtotal colectomy or formal left hemicolectomy.7,8 However, segmental resection and anastomosis for tumors in this area can be technically challenging. Methods: A 69-year-old patient with a descending colon cancer and body mass index of 29.2 kg/m2 presented for resection. Preoperative bowel preparation with 2 L polyethylene glycol was administered. A 12-mm transumbilical camera port was used, with a 12- and 5-mm right iliac fossa and right flank working ports, respectively. The splenic flexure was mobilized from medial to lateral. The inferior mesenteric artery was identified, and the left colic artery was ligated at its origin, with adequate distal mesenteric division to ensure satisfactory lymph node harvest. Proximal and distal bowel transection were performed intracorporeally with a linear stapler. An isoperistaltic side-to-side colocolic anastomosis was fashioned, with a two-layer closure of the colonic defect. The uterus was hitched to the anterior abdominal wall with a transabdominal suture. The vagina was cleansed before a posterior vaginotomy was created with the help of a transvaginal sizer. A double ring wound protector was inserted transvaginally with one ring completely within the abdominal cavity and the other ring opened against the perineum to shorten the channel for specimen delivery. The wound protector was removed and the vaginotomy was closed using a barbed suture. Results: Operative time was 3 hours 15 minutes, with 20 mL intraoperative blood loss. There was minimal postoperative pain with return of gastrointestinal function on the first postoperative day. The patient was discharged uneventfully on postoperative day 2. Histology was pT4N1 and 27 lymph nodes were harvested. Adjuvant chemotherapy was administered, with no evidence of disease recurrence at 6 months follow-up. Conclusion: The reduced port technique is feasible and synergistic with NOSE for splenic flexure colectomy in selected patients, augmenting the minimally invasive nature of laparoscopy. No competing financial interests exist. Runtime of video: 5 mins 49 secs Patient Consent: The authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

Surgical Correction of Recto-Umbilicus Fistula by Diverting the Rectum to the Lower Right Abdominal Wall in a Cross-Breed Calf

The congenital disability, atresia ani or atresia ani et recti or recto-vaginal fistula, is one of the most common types of congenital malformation disability. A 45-day-old male cross-breed calf was admitted to Patuakhali Science and Technology University's Veterinary Teaching Hospital with complaints of leaking feces through the umbilicus and was clinically confirmed as a recto-umbilicus fistula. This congenital condition was corrected successfully by making an artificial opening in the lower right abdominal wall. Corrective surgery was the only successful technique for repairing the recto-umbilicus fistula. The prognosis for surgical correction of the recto-umbilicus fistula in a cross-breed calf was indicated to be good.

Conservative surgery versus colorectal resection for endometriosis with rectal involvement: a systematic review and meta-analysis of surgical and long-term outcomes.

The optimal surgical approach for removal of colorectal endometrial deposits is unclear. Shaving and discoid excision of colorectal deposits allow organ preservation but risk recurrence with associated functional issues and re-operation. Formal resection risks potential higher complications but may be associated with lower recurrence rates. This meta-analysis compares peri-operative and long-term outcomes between conservative surgery (shaving and disc excision) versus formal colorectal resection. The study was registered with PROSPERO. A systematic search was performed on PubMed and EMBASE databases. All comparative studies examining surgical outcomes in patients that underwent conservative surgery versus colorectal resection for rectal endometrial deposits were included. The two main groups (conservative versus resection) were compared in three main blocks of variables including group comparability, operative outcomes and long-term outcomes. Seventeen studies including 2861 patients were analysed with patients subdivided by procedure: colorectal resection (n = 1389), shaving (n = 703) and discoid excision (n = 742). When formal colorectal resection was compared to conservative surgery there was lower risk of recurrence (p = 0.002), comparable functional outcomes (minor LARS, p = 0.30, major LARS, p = 0.54), similar rates of postoperative leaks (p = 0.22), pelvic abscesses (p = 0.18) and rectovaginal fistula (p = 0.92). On subgroup analysis, shaving had the highest recurrence rate (p = 0.0007), however a lower rate of stoma formation (p < 0.00001) and rectal stenosis (p = 0.01). Discoid excision and formal resection were comparable. Colorectal resection has a significantly lower recurrence rate compared to shaving. There is no difference in complications or functional outcomes between discoid excision and formal resection and both have similar recurrence rates.

Outcomes of gracilis muscle interposition for rectourethral fistulas caused by treatment of prostate cancer.

Gracilis muscle interposition (GMI) has been associated with favorable outcomes in treating complex perianal fistulas. Outcomes of GMI may vary according to the fistula etiology, particularly between rectovaginal fistulas in women and rectourethral fistulas (RUF) in men. The aim of this study was to assess the outcome of GMI to treat RUF acquired after prostate cancer treatment. This retrospective cohort study included male patients treated with GMI for RUF acquired after prostate cancer treatment between January 2000 and December 2018 in the Department of Colorectal Surgery, Cleveland Clinic Florida. The primary outcome was the success of GMI, defined as complete healing of RUF without recurrence. Secondary outcomes were length of hospital stay and postoperative complications. This study included 53 male patients with a median age of 68 (range, 46-85) years. Patients developed RUF after treatment of prostate cancer with radiation (52.8%), surgery (34%), or transurethral resection of the prostate (TURP) (13.2%). Median hospital stay was 5 (IQR, 4-7) days. Twenty (37.7%) patients experienced 25 complications, the most common being wound infection and dehiscence. Primary healing after GMI was achieved in 28 (52.8%) patients. Fifteen additional patients experienced successful healing of RUF after additional procedures, for a total success rate of 81.1%. Median time to complete healing was 8 (range, 4-56) weeks. The only significant factor associated with outcome of GMI was wound dehiscence (p = 0.008). Although the initial success rate of GMI was approximately 53%, it increased to 81% after additional procedures. Complications after GMI were mostly minor, with wound complications being the most common. Perianal wound dehiscence was significantly associated with failure of healing of RUF after GMI.

Predictors and outcomes of surgical repair of obstetric fistula at Mekelle Hamlin Fistula Center, Northern Ethiopia.

Obstetric fistula is a medical condition that involves an opening between vagina and bladder or vagina and rectum. From 2010 to 2013, on average, around 2000 women each year had surgery for obstetric fistula in Ethiopia. The success and failure rate of obstetric fistula repair varies from center to center and is determined by many factors. Thus, this study aimed to assess the predictors and outcomes of surgical repair of obstetric fistula at Mekelle Hamlin Fistula Center (MHFC). A retrospective reviewed medical records of 328 patients with obstetric fistula were carried out at MHFC. Multivariable logistics regression analysis was conducted, a significant association was declared when the p-value was less than 0.05, and the strength of the association was determined by computing the odds ratio at 95% CI. The analysis was done using SPSS version 24. Obstetrics fistula patients who had formal education were 13% more likely to be successfully repaired than obstetrics fistula patients who had no formal education. Additionally, obstetrics fistula patients who had a live birth were 32.325 (exp (β) = 32.325) times more likely to have had a successful repair than those who had a stillbirth. Fistula closure was achieved in 89.3% of cases. The success rate for VVF (vesico-vaginal fistula) and RVF (recto-vaginal fistula) surgical repair was 86.9% and 100% respectively, which is higher than the WHO target. Body mass index between 18.5-24.9kg/m2, formal education, antibiotic use, live birth, large fistula size, and home and cesarean delivery were predictors of successful closure of obstetric fistula.

Principles and outcomes of gender-affirming vaginoplasty.

Vaginoplasty is the most frequently performed gender-affirming genital surgery for gender-diverse people with genital gender incongruence. The procedure is performed to create an aesthetic and functional vulva and vaginal canal that enables receptive intercourse, erogenous clitoral sensation and a downward-directed urine stream. Penile inversion vaginoplasty (PIV) is a single surgical procedure involving anatomical component rearrangement of the penis and scrotum that enables many patients to meet these anatomical goals. Other options include minimal-depth, peritoneal and intestinal vaginoplasty. Patient quality of life has been shown to improve drastically after vaginoplasty, but complication rates have been documented to be as high as 70%. Fortunately, most complications do not alter long-term postoperative clinical outcomes and can be managed without surgical intervention in the acute perioperative phase. However, major complications, such as rectal injury, rectovaginal fistula, and urethral or introital stenosis can substantially affect the patient experience. Innovations in surgical approaches and techniques have demonstrated promising early results for reducing complications and augmenting vaginal depth, but long-term data are scarce.

P538 Suboptimal disease control is common in patients with Crohn’s perianal fistulas with capacity to optimise medical and surgical treatment in real-world experience: A cross-sectional analysis of baseline disease characteristics in the FINESS study

Abstract Background Crohn’s perianal fistula treatment is often challenging, requiring combined medical and surgical treatment with heterogeneity in real-world practice. We herein evaluate disease activity and management history of patients with Crohn’s perianal fistulas, identifying those with active disease amenable for treatment optimisation. Methods We present the results of a cross-sectional study of disease characteristics among patients with Crohn’s perianal fistulas at a single specialist Inflammatory Bowel Disease service. Patients with Crohn’s perianal fistulas seen in clinic from February 2021 to June 2022 (new and review appointments) were sequentially enrolled. Patients were excluded based on rectovaginal or rectovesical fistulas, proctectomy, pregnancy or breastfeeding. Baseline disease activity was defined as active (stage A/B: sepsis, actively draining), optimised with a chronic seton in situ (stage C), or remission (stage D: no discharge from fistula tract external opening). Radiologic disease activity was assessed with magnetic resonance imaging using the Van Assche Index (VAI), VAI-inflammatory sub-score (VAIinfl; derived from T2-hyperintesnity, collections &amp;gt;3mm diameter, and rectal wall involvement), and Magnetic Resonance Novel Index for Fistula Imaging in Crohn’s Disease (MAGNIFI-CD) score. Results Sixty patients were included with a median age of 39 years (IQR 17.7), 52% male, median clinic attendance of 6 years (IQR 7.9), median Crohn’s and perianal disease duration of 13 (IQR 16.8) and 8 (IQR 13.5) years, respectively. Majority were on anti-tumour necrosis factor-α therapy (28% infliximab, 40% adalimumab) and an immunomodulator (55% thiopurine, 5% methotrexate). Forty-two percent had undergone perianal surgical intervention within the preceding 12 months, see Table 1. Forty-eight percent (n=29), 7% (n=4), and 45% (n=27) had stage A/B, C, and D disease activity, respectively. Radiologic disease activity scoring indices were lower between stage D and A/B (VAI 4 vs 12; VAIinfl 0 vs 8; MAGNIFI-CD 2 vs 6, respectively), see Table 2. Of those with stage A/B disease activity, 31% were not on a biologic (63% new diagnosis, 25% prior remission, 13% comorbidities precluding), 52% were infliximab naïve (71% new diagnosis, 14% prior remission, 14% contraindications), 85% who were on a biologic had potential for initial or further dose escalation, and 31% did not undergo perianal surgical intervention in the preceding 12 months. Conclusion In a single specialist centre, almost half the patients with Crohn’s perianal fistulas have clinically active disease, with capacity to optimise medical and/or surgical treatment in the majority. Prospective assessment of a model of care directed towards optimising treatment in these patients is needed.

EFFICACY AND SAFETY OF HYPERBARIC OXYGEN THERAPY IN FISTULIZING CROHN'S DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract BACKGROUND Hyperbaric oxygen therapy (HBOT) delivers 100% oxygen in a pressurized chamber, increasing tissue oxygen levels and regulating inflammatory pathways. Despite significant expansion of the inflammatory bowel disease (IBD) therapeutics, there remains a significant gap in achieving fistula healing. Mounting evidence suggests that HBOT may be effective for IBD. Our systematic review and meta-analysis aimed to quantify the efficacy and safety of HBOT in fistulizing Crohn’s disease (CD). METHODS A systematic review was conducted using the EMBASE, Web of Science, Pubmed, and Cochrane Library databases according to PRISMA criteria. Study bias was assessed using the Cochrane handbook guidelines. Published articles and abstracts were included for analysis if they met study design criteria, evaluated HBOT efficacy in patients with fistulizing CD, and reported sufficient outcome data. Outcome data were considered sufficient when measured clinically, radiographically, and/or endoscopically. Randomized controlled trials, case-controlled studies, and case-series were included in the analysis. Our primary outcome of interest was overall clinical response with HBOT. Overall clinical response was defined as either clinical remission or partial response. Clinical remission was defined as closure of fistula and complete cessation of drainage. Partial response was defined as improvement in fistula drainage. RESULTS Sixteen studies with 164 patients who underwent 5,125 HBOT sessions were included in the analysis. For all fistula subtypes, the pooled overall clinical response was 87% (95% CI 0.70-0.95, I2=0) (Figure) and the pooled clinical remission was 59% (95% CI 0.35-0.80, I2=0). The overall clinical response was 89%, 84%, and 29% for perianal, enterocutaneous, and rectovaginal fistulas, respectively. (Table) On meta-regression, hours in the chamber and number of HBOT sessions were not found to correlate with a clinical response. The pooled number of adverse events was low at 51.7 per 10,000 HBOT sessions for all fistula types (95% CI 16.8-159.3, I2=0). DISCUSSION With a pooled overall clinical response rate of 87% and low adverse event rate, our review emphasizes the potential clinical benefit and safety of adjunctive HBOT in refractory cases of fistulizing CD. Rectovaginal fistulas were the fistula subtype least responsive to HBOT. Data limitations include study design heterogeneity and lack of control group presence. Randomized control trials are needed to substantiate the benefit of HBOT in fistulizing CD.

Gracilis muscle transposition in complex anorectal fistulas of diverse types and etiologies: long-term results of 60 cases

PurposeComplex fistulas often require several attempts at repair and continue to be a challenging task for the surgeon, but above all, a major burden for the affected patient. This study is aimed at evaluating the potential of gracilis muscle transposition (GMT) as a therapeutic option for complex fistulas of diverse etiologies.MethodsA retrospective study was conducted over a period of 16 years with a total of 60 patients (mean age 50 years). All were treated for complex fistula with GMT at St. Josef’s Hospital in Regensburg, Germany. Follow-up data were collected and analyzed using a prospective database and telephone interview. Success was defined as the absence of fistula.ResultsA total of 60 patients (44 women, 16 men; mean age 50 years, range 24–82 years) were reviewed from January 2005 to June 2021. Primary fistula closure after GMT was achieved in 20 patients (33%) and 19 required further interventions for final healing. Overall healing rate was 65%. Fistula type was heterogeneous, with a dominant subgroup of 35 rectovaginal fistulas. Etiologies of the fistulas were irradiation, abscesses, obstetric injury, and iatrogenic/unknown, and 98% of patients had had previous unsuccessful repair attempts (mean 3.6, range 1–15). In 60% of patients with a stoma (all patients had a stoma, 60/60), stoma closure could be performed after successful fistula closure. Mean follow-up after surgery was 35.9 months (range 1–187 months). No severe intraoperative complications occurred. Postoperative complications were observed in 25%: wound healing disorders (n = 6), gracilis necroses (n = 3), incisional hernia (n = 2), scar tissue pain (n = 2), suture granuloma (n = 1), and osteomyelitis (n = 1). In 3 patients, a second gracilis transposition was performed due to fistula recurrence (n = 2) or fecal incontinence (n = 1).ConclusionBased on the authors’ experience, GMT is an effective therapeutic option for the treatment of complex fistulas when other therapeutic attempts have failed and should therefore be considered earlier in the treatment process. It should be seen as the main but not the only step, as additional procedures may be required for complete closure in some cases.

Surgical Management of Atresia Ani and Associated Congenital Malformations in Three Calves

Background: Congenital malformation leads to perinatal mortality, decreases maternal productivity and reduces the value of the neonates. Atresia is the most common anomaly of the anus and rectum of calves and pigs. It may occur either alone or associated with other congenital defects like atresia recti, rectovaginal fistula, vagino-urethral agenesis. The present study reports surgical management atresia ani and associated malformationsin three animals. Methods: All three animals (1 female and 2 with undefined sex) were presented on first day of life with near normal physiological parameters. After clinical examination, all neonates were prepared for surgery and the resulting complications were managed accordingly. Result: Essential surgical interventions were done to correct atresia ani and the associated anomalies. One calf succumbed to death due to postoperative complications and other two survived.

Persistent urogenital sinus with recto-vaginal fistula: the new variant in which the anus is normally positioned and literature review

BackgroundPersistent urogenital sinus is a rare cloacal anomaly in which the urinary and genital tracts cannot be differentiated during embryonic development. However, the presence of concomitant recto-urogenital sinus or recto-vaginal fistula is much rarer. In the literature, only two cases with accompanying fistula have been presented so far.Case presentationWe present the diagnosis and treatment management of a persistent urogenital sinus case with recto-vaginal fistula. We also aimed to reveal the difference between our patient, who is the 3rd case in the literature, and the other two and the described cloacal anomalies. By performing total urogenital sinus mobilization and fistula repair, the three systems were separated from each other, and both a functional and cosmetic appearance was obtained.ConclusionIt should be kept in mind that there may be different variants other than the defined cloacal malformations. In patients with cloacal malformation, cystoscopy and rectoscopy should be performed to reveal the anatomy before reconstructive surgery in order to avoid any unexpected situation.

Recto-vaginal fistulas of obstetrical origin: Epidemiological aspects and therapeutic approaches in the general surgery department of the Idrissa POUYE general hospital

Introduction: The recto-vaginal fistula is a pathological communication between the posterior wall of the vagina and the anterior wall of the rectum, through the recto-vaginal septum. Fistulas of obstetric origin remain common in developing countries. Aim: To describe the epidemiological aspects of obstetric rectovaginal fistulas in our department and discuss the results of treatment.Patients and methods: Retrospective multicentre study from January 1, 2014 to December 31, 2022, collecting 13 cases of obstetrical rectovaginal fistula treated in the general surgery department of the Idrissa POUYE general hospital. Results: The median diameter of the fistula was 12 mm. The treatment had consisted́ of a suture excision in 1 patient. A perineotomy with simultaneous reconstruction in 2 cases; a perineotomy and two-stage reconstruction according to Musset in 10 cases. Complete healing after the first operation was found in 10 cases, complete healing but at the cost of dyspareunia was noted in 1 case. A definitive failure was found in 2 cases. Conclusion: Obstetric RVFs are rare but they have not completely disappeared in Senegal despite the efforts made. The 2-stage surgical treatment according to MUSSET gives good results but the best treatment remains preventive because of the serious socio-economic repercussions of this pathology.

Rectovaginal fistulas. Is there an optimal method of surgical treatment?

Rectovaginal fistulas. Is there an optimal method of surgical treatment?

Minocycline-Induced Hyperpigmentation: Importance of Early Diagnosis

A 75-year-old woman on hemodialysis for end-stage renal failure due to polycystic kidney disease developed dark spots on her limbs. She had been treated for extended spectrum beta-lactamase–producing Escherichia coli bacteremia by a rectovaginal fistula and was on long-term oral minocycline (cumulative dose 45 g). Physical examination revealed dark patches on her forearms and lower legs but no trunk hyperpigmentation or visual impairment. Blood tests were normal. Skin biopsy confirmed minocycline-induced hyperpigmentation. Minocycline-induced pigmentation is categorized into types I–IV, each with unique clinical and histopathological features. Types I and II are reversible upon discontinuing minocycline, whereas types III and IV are permanent. The patient was diagnosed with type II pigmentation, generally occurring with a cumulative dose exceeding 70–100 g; however, her lower dose (45 g) led to pigmentation, possibly influenced by her vitamin D deficiency. Clinicians should evaluate the antimicrobial indication and treatment period, considering not only the benefits but also the side effects and antimicrobial resistance. If minocycline is used, attention should be paid to minocycline-induced hyperpigmentation, and this possibility should be communicated to patients to enable early detection.

Radiation-induced rectovaginal fistula surgical treatment: a case report

Radiation-induced rectovaginal fistula surgical treatment: a case report