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DIFFICULT FISTULAE

DIFFICULT FISTULAE. BA Taylor North Cheshire M62 Coloproctology Course. AS (17.10.47). May ’04: L ischio-rectal abscess 27.7.04: Abdominal colic & altered bowel habit: RE; fistula at 3 o’clock 13.12.04: EUA; “high” trans- sphincteric fistula ext. opening 3 o’clock

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DIFFICULT FISTULAE

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  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 o’clock • 13.12.04: EUA; “high” trans- sphincteric fistula ext. opening 3 o’clock int. opening 6 o’clock

  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 o’clock) 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 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

  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)

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