Anomalies of the urethra are uncommon. Urethrorectal fistula in horses has only been reported in foals and only in conjunction with other congenital anomalies. This report describes the diagnosis, surgical management, and possible etiologies of a unique case of urethrorectal fistula in a mature gelding. (+info)
Labial fat pad grafts (modified Martius graft) in complex perianal fistulas.
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Complex perianal fistulas may at times be very difficult to treat. New vascularised tissue can reach the perineum from leg muscles and the omentum. A less well-known source is the labial fat tissue (modified Martius graft) which has a robust posterolateral pedicle and which can be useful as an adjunctive technique for high anterior anal and rectovaginal fistulas. Between November 1993 and July 1997, eight women (age range 18-55 years) underwent modified Martius grafting, six of the eight having a rectovaginal fistula and two a high complex (suprasphincteric) perianal fistula. Anorectal advancement flaps were performed in five patients and three had a transperineal approach with simultaneous anterior sphincter repair because of concurrent anal incontinence. All patients had a defunctioning stoma. The fistula healed in six of the eight patients (75%) and recurred in two patients. The stoma has been closed in five of the eight patients (one patient's fistula has healed but her stoma cannot be closed because of anal incontinence). This is a useful technique when confronted with a difficult anterior fistula in women. (+info)
Ileoanal anastomosis with reservoirs: complications and long-term results.
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OBJECTIVE: To determine the rate of complications of ileoanal pouch anastomosis, their treatment and their influence on a successful outcome. DESIGN: A computerized database and chart review. SETTING: Three academic tertiary care health centres. PATIENTS: All 239 patients admitted for surgery between 1981 and 1994 with a diagnosis of ulcerative colitis and familial adenomatosis coli. INTERVENTIONS: Sphincter-saving total proctocolectomy and construction of either S-type of J-type ileoanal reservoir. OUTCOME MEASURES: Indications, early and late complications, incidence of pouch excision. RESULTS: Of the 239 patients, 228 (95.4%) were operated on for ulcerative colitis and 11 (4.6%) for familial polyposis coli. One patient in each group was found to have a carcinoma not previously diagnosed. Twenty-eight patients had poor results: in 17 (7.1%) the ileostomy was never closed or was re-established because of pelvic sepsis or complex fistulas, sclerosing cholangitis or severe diarrhea; 11 (4.6%) patients required excision of the pouch because of anal stenosis, perirectal abscess-fistula or rectovaginal fistula. Three patients died--of suicide, and complications of liver transplantation and HIV infection. Thus, 208 patients maintained a functioning pouch. The early complication rate (within 30 days of operation) was 57.7% (138 patients) and the late complication rate was 52.3% (125 patients). Pouchitis alone did not lead to failure or pouch excision. Emptying difficulties in 25 patients with anal stenosis were helped in 2 by resorting to intermittent catheterization. Patients with indeterminate colitis had a higher rate of anorectal septic complications, and all patients having Crohn's disease after pouch construction had complicated courses. CONCLUSIONS: The complication rate associated with ileoanal pouch anastomosis continues to be relatively high despite increasing experience with this technique. Overall, however, a satisfactory outcome was obtained in 87% of patients. (+info)
Risk factors for surgery and postoperative recurrence in Crohn's disease.
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OBJECTIVE: To assess the impact of possible risk factors on intestinal resection and postoperative recurrence in Crohn's disease (CD) and to evaluate the disease course. SUMMARY BACKGROUND DATA: The results of previous studies on possible risk factors for surgery and recurrence in Crohn's disease have been inconsistent. Varying findings may be explained by referral biases and small numbers of patients in some studies. METHODS: Data on initial intestinal resection and postoperative recurrence were evaluated retrospectively in a population-based cohort of 1,936 patients. The influence of concomitant risk factors was assessed using uni- and multivariate analyses. RESULTS: The cumulative rate of intestinal resection was 44%, 61%, and 71% at 1, 5, and 10 years after diagnosis. Postoperative recurrences occurred in 33% and 44% at 5 and 10 years after resection. The relative risk of surgery was increased in patients with CD involving any part of the small bowel, in those having perianal fistulas, and in those who were 45 to 59 years of age at diagnosis. Female gender and perianal fistulas, as well as small bowel and continuous ileocolonic disease, increase the relative risk of recurrence. CONCLUSIONS: Three of four patients with CD will undergo an intestinal resection; half of them will ultimately relapse. The extent of disease at diagnosis and the presence of perianal fistulas have an impact on the risk of surgery and the risk of postoperative recurrence. Women run a higher risk of postoperative recurrence than men. The frequency of surgery has decreased over time, but the postoperative relapse rate remains unchanged. (+info)
Transperineal ultrasonography in imperforate anus: identification of the internal fistula.
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The purpose of this study was to assess the usefulness of transperineal ultrasonography in identifying the internal fistula in cases of imperforate anus. Transperineal ultrasonography was performed in 19 infants (13 neonates and 6 older infants; 13 were male and 6 were female) with imperforate anus to identify the internal fistula. Sagittal plane images were obtained through the anal dimple, and the internal connection of the rectal fistula was traced. The ultrasonographically traced internal fistula was compared with that observed on distal loopography after colostomy or with surgical findings. The internal fistula was identified as a hypoechoic linear tract, containing linear echogenicity in some cases. Of 19 patients, internal fistulas were correctly identified in 16 patients; these were rectourethral (n = 12), rectovaginal (n = 1), rectovestibular (n = 1), rectovesical (n = 1), and rectocloacal (n = 1). In three patients, internal fistulas were incorrectly defined; these cases consisted of rectovestibular (n = 2) and rectovaginal (n = 1) fistulas. Internal fistulas were correctly identified in all of the 13 male patients and in 3 of 6 female patients. Transperineal ultrasonography is an excellent diagnostic modality to define the type of the internal fistula in imperforate anus. (+info)
Clinical observations of the treatment of canine perianal fistulas with topical tacrolimus in 10 dogs.
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Tacrolimus ointment, a potent immunosuppressive medication, was evaluated for efficacy in the treatment of perianal fistulas in dogs. Ten dogs with perianal fistulas were treated with topical tacrolimus ointment once to twice daily for 16 weeks. Full healing of the fistulas occurred in 50% and was noticeably improved in 90% of dogs. (+info)
Successful closure of a recto-prostatic fistula.
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Recto-prostatic fistula is a rare complication of prostatic surgery, occurring usually because surgical planes are not appreciated. We describe a combined abdomino-perineal approach for the repair of a large recto-prostatic fistula with the interposition of omentum and gracilis without formally closing the fistula in layers. (+info)
Common anorectal conditions: Part II. Lesions.
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Patients with a wide variety of anorectal lesions present to family physicians. Most can be successfully managed in the office setting. A high index of suspicion for cancer should be maintained and all patients should be questioned about relevant family history or other indications for cancer screening. Patients with condylomata acuminata must be examined for human papillomavirus infection elsewhere after treatment of the presenting lesions. Their sexual partners should also be counseled and screened. Both surgical and nonsurgical treatments are available for the pain of anal fissure. Infection in the anorectal area may present as different types of abscesses, cryptitis, fistulae or perineal sepsis. Fistulae may result from localized infection or indicate inflammatory bowel disease. Protrusion of tissue through the anus may be due to hemorrhoids, mucosal prolapse, polyps or other lesions. (+info)