1/8. Cloacal outlet obstruction with an ectopic ureter.Cloacal malformation occurs in approximately 1 in 50,000 live female births. Prenatal ultrasound may lead to the diagnosis in selected cases. We report an unusual case of prenatally detected single-system hydronephrosis with a nonvisible bladder and worsening oligohydramnios. Labor was induced at 35 weeks' estimated gestational age. On physical examination, a single perineal opening was noted consistent with cloaca. endoscopy revealed an obstructed ectopic ureter at the level of the sphincter, an undeveloped bladder and vagina, and a fistula to the rectum. A low loop cutaneous ureterostomy and right upper quadrant loop colostomy were performed. The absence of a typical fluid-filled pelvic structure may confound the prenatal diagnosis of cloaca.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/8. Retrorectal cyst: a rare tumor frequently misdiagnosed.BACKGROUND: The rarity of retrorectal cysts and their nonspecific clinical presentations often lead to misdiagnoses and inappropriate operations. In recent years, several such patients have been referred to our institutions for evaluation and treatment of misdiagnosed retrorectal cysts. A review of these patients is presented. STUDY DESIGN: medical records of the colorectal surgery divisions at two institutions were reviewed. patients found to have previously misdiagnosed retrorectal cysts were identified. Preliminary diagnoses, radiologic examinations, operative procedures, and final diagnoses were obtained. RESULTS: Seven patients with retrorectal cysts who had been misdiagnosed before referral were identified. These patients had been treated for fistulae in ano, pilonidal cysts, perianal abscesses; psychogenic, lower back, posttraumatic, or postpartum pain, and proctalgia fugax before the correct diagnosis was made. patients underwent an average of 4.1 operative procedures. physical examination in combination with CT scanning made the correct diagnosis in all patients. All patients underwent successful resection through a parasacrococcygeal approach, and six of seven did not require coccygectomy. The resected tumors included four hamartomas, two epidermoid cysts, and one enteric duplication cyst. CONCLUSIONS: Retrorectal cysts are a rare entity that can be difficult to diagnose without a high index of clinical suspicion. A history of multiple unsuccessful procedures should alert the clinician to the diagnosis of retrorectal cyst. Once suspected, the correct diagnosis can be made with physical examination and a CT scan before a definitive surgical procedure.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/8. Congenital urethral fistula with normal anus: a report of two cases.Congenital rectourethral or anourethral fistulae without imperforate anus in males are rare, representing less than 1% of anorectal malformations. We report our experience with two males with "N type" urethral fistulae. One, a 5-year-old boy, presented with recurrent urinary tract infections (UTIs) and passage of urine per anus. Investigations included a voiding cystourethrogram (VCUG), which demonstrated a fistula from the urethra to the anus. On physical examination, a small perianal opening was noted just outside the anus, which drained a small amount of urine after voiding. The fistula was excised via a perineal approach. The second patient is a 5-year-old boy with a long history of recurrent UTI requiring multiple hospitalizations since the newborn period. Chronic renal failure developed as a complication of repeated urinary tract infections. Investigations showed a single hydronephrotic pelvic kidney and a small bladder. He underwent numerous diagnostic and reconstructive procedures including cystoscopy and augmentation cystoplasty. Recurrent infections continued and an N type anourethral fistula was eventually diagnosed. The fistula was located between the anal canal and the membranous urethra. An anterior perineal approach was also used. Both fistulae were easily located, and reconstructive surgery of the urethra was not required. Postoperative VCUGs in both patients were normal. They have been free of infection with normal urinary continence since resection of the fistula. Congenital N type anourethral fistulae are rare, but should be considered in cases of recurrent urinary tract infections. The diagnosis may be missed by endoscopic procedures, but VCUG should demonstrate the fistulous tract.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/8. Anorectal agenesis with a rectourethral fistula diagnosed in an adult: report of a case.We report an unusual case of anorectal agenesis with a rectourethral fistula diagnosed in a 48-year-old man. The patient presented after noticing hematuria, although he had been aware of urinary leakage from his colostomy with occasional fecal urine for about 4 years. He had had a double-barrel colostomy created soon after birth for an imperforate anus, with revision at the age of 4 years to correct a prolapse of the stoma, but his malformation had never been repaired. We performed a physical examination, which did not reveal a perineal fistula, but urethrocystography demonstrated high anorectal agenesis with a rectourethral fistula. Thus, we resected the rectourethral fistula and created an end-colostomy. The patient had an uneventful postoperative course, and was discharged in good health on postoperative day 19. To our knowledge, this is the oldest patient to be diagnosed with anorectal agenesis and undergo resection of a rectourethral fistula.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/8. Mucinous adenocarcinoma associated with chronic anal fistula reconstructed by gracilis myocutaneous flaps.Mucinous adenocarcinoma associated with chronic anal fistula is extremely rare, and such tumors have often reached an advanced stage at the time of presentation. Here we report a case of mucinous adenocarcinoma associated with chronic anal fistula that involved repair with gracilis myocutaneous flaps and review other reported cases. A 67-year-old man with an approximate 30-year history of an anal fistula was referred to our hospital due to enlargement of the perianal induration accompanied by mucinous secretion and pain. physical examination of the perianal region revealed an ulcerated and discharging lesion on the buttocks. Histologic examination of a biopsy specimen of the ulcerated lesion revealed mucinous adenocarcinoma. An abdominoperineal resection was performed with resection of the ischiorectal fossa, coccyx, part of the gluteus maximus, and the obturator internus. The extensive defect was repaired with bilateral gracilis myocutaneous flaps. The patient did not experience a decrease in the strength of hip adduction and survived for 58 months without recurrence until he died of pneumonia. The repair using myocutaneous flaps was considered to contribute to a physically active life without recurrence.- - - - - - - - - - ranking = 0.056042049035913keywords = physical (Clic here for more details about this article) |
6/8. Anterior sacral meningocele. A presentation of three cases.Anterior sacral meningoceles are congenital lesions that consist of a spinal fluid-filled sac in the pelvis communicating by a small neck with the spinal subarachnoid space through a defect in the sacrum. The three patients with this disorder presented here had characteristic symptoms snd physical findings: chronic constipation, a pelvic mass, and almost unmistakable roentgenographic changes, but diagnosis was delayed from 11 months to 21 years in all three. After prolonged and complicated treatment, the primary lesions have been surgically eradicated and function is generally satisfactory.- - - - - - - - - - ranking = 0.056042049035913keywords = physical (Clic here for more details about this article) |
7/8. Crohn's disease with fistulae involving joints.Two cases of Crohn's disease with unusual manifestations of fistulae involving joints are reported. One case with a fistula from the rectum through the pelvis presented with an abscess adjacent to the left hip joint. The second presented acutely with inflammation and swelling of the right thigh suggesting thrombophlebitis. This patient died from septicaemia and was found at postmortem to have ileal Crohn's disease with fistulae into the thigh, producing septic arthritis of the knee. The possibility of underlying Crohn's disease should be considered in patients who develop abscesses adjacent to the pelvis, or physical signs suggesting thrombophlebitis of the thigh.- - - - - - - - - - ranking = 0.056042049035913keywords = physical (Clic here for more details about this article) |
8/8. Anorectal fistula: an unusual presentation in a Crohn's disease patient.An unusual case of an anorectal fistula presenting with hip pain and extensive lower limb muscle wasting in a patient with Crohn's disease is reported. This report emphasizes the important role of a thorough history, a complete physical examination, and a thorough search for evaluating such cases. Any progressive local irritation and pain in a Crohn's disease patient may indicate possible fistulous involvement. Nonspecific laboratory findings such as leukocytosis, anemia, decreased albumin level, and thrombocytosis may be considered as supportive indicators. barium contrast studies and enhanced computed tomography scan may be helpful but can be falsely negative in the presence of a fistula, as in this case. These findings illustrate that the clinician must not be dissuaded from the diagnosis simply based on negative radiological findings because the presence of a fistula may be impossible to determine preoperatively.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |