Transcript DIFFICULT FISTULAE

DIFFICULT FISTULAE
BA Taylor
North Cheshire
M62 Coloproctology Course
AS (17.10.47)
May ’04:
27.7.04:
13.12.04:
L ischio-rectal abscess
Abdominal colic & altered
bowel habit: RE; fistula at
3 o’clock
EUA; “high” transsphincteric fistula
ext. opening 3 o’clock
int. opening 6 o’clock
AS (17.10.47)
AS (17.10.47)
13.12.04:
4.1.05:
10.2.05:
29.3.05:
EUA
ext. sphincter skeletonized
mucosa/int. sphincter divided
tight (“cutting”) Seton
well
EUA; minimal residual
division
well
KC (4.7.55)
30.9.01: R ischio-rectal abscess
1.11.01: Discharged (no fistula apparent)
7.8.03: Recurrent R ischio-rectal abscess
Drained; horseshoe (5-9 o’clock)
No obvious fistula
9.3.04: Healed; discharged
Histology: non-specific
KC (4.7.55)
27.9.04: Recurrent R ischio-rectal abscess
EUA; ? int. opening at 6 o’clock
2.10.04: Further (posterior) collection
9.11.04: Fully healed; offered EUA
6.12.04: EUA; high complex supra-levator
fistula. Int. opening at dentate; X2
ext. openings in scar. MR scan
KC (4.7.55)
KC (4.7.55)
KC (4.7.55)
Jan ’05: EUA; external openings cored out
Fistula track curetted
Fibrin glue to track
Overnight stay
March ’05:
Healed (so far!)
KH (21.12.84)
19.2.03: Abdominal colectomy & ileostomy
Severe CUC
20.5.03: Adhesiolysis, proctectomy, double
stapled J pouch-anal anastomosis
4.6.03: EUA; tiny pouch-vaginal fistula
5.6.03: laparotomy, adhesiolysis, stoma
KH (21.12.84)
16.9.03: EUA; no fistula
Oct ’03: pouchogram; no fistula
11.11.03: EUA (air insufflation/
methylene blue); no fistula
Pouchoscopy; normal
Jan ’04: Admission for ileostomy closure
EUA; obvious pouch-vaginal
fistula at anastomosis
KH (21.12.84)
KH (21.12.84)
22.3.04: Mucosectomy, direct closure of
fistula and pouch advancement
Hand-sewn, endo-anal reanastomosis.
June ’04: Pouchogram –ve
July ’04:
EUA; ileostomy closure
Sept ’04:
Well
VB (29.8.75)
6.10.04: 4th degree obstetric injury
Levators mobilized & overlapped
Perineal muscles closed
Mucosa /skin closed
28.2.05: Excellent bowel function/flatus PV
15.3.05: EUA; small ano-vaginal fistula
VB (29.8.75)