DIFFICULT FISTULAE

1
DIFFICULT FISTULAE

• BA Taylor
• North Cheshire
• M62 Coloproctology Course

2
AS (17.10.47)

• May 04 L ischio-rectal abscess
• 27.7.04 Abdominal colic altered
• bowel habit RE fistula at 3 oclock
• 13.12.04 EUA high trans- sphincteric
  fistula
• ext. opening 3 oclock
• int. opening 6 oclock

3
AS (17.10.47)
4
AS (17.10.47)

• 13.12.04 EUA
• ext. sphincter skeletonized
• mucosa/int. sphincter divided
• tight (cutting) Seton
• 4.1.05 well
• 10.2.05 EUA minimal residual division
• 29.3.05 well

5
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 oclock)
• No obvious fistula
• 9.3.04 Healed discharged
• Histology non-specific

6
KC (4.7.55)

• 27.9.04 Recurrent R ischio-rectal abscess
• EUA ? int. opening at 6 oclock
• 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

7
KC (4.7.55)
8
KC (4.7.55)
9
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!)

10
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

11
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

12
KH (21.12.84)
13
KH (21.12.84)

• 22.3.04 Mucosectomy, direct closure of
  fistula and pouch advancement Hand-sewn,
  endo-anal re- anastomosis.
• June 04 Pouchogram ve
• July 04 EUA ileostomy closure
• Sept 04 Well

14
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

15
VB (29.8.75)