1/5. Embolization--an optional treatment for intractable hemorrhage from a malignant rectovaginal fistula: report of a case.PURPOSE: patients rarely have intractable hemorrhage from rectovaginal fistulas, which usually require surgical intervention. This report presents our experience with nonsurgical treatment of a high-risk patient with uncontrolled hemorrhage originating from a malignant rectovaginal fistula. methods: A 74-year-old female developed uncontrolled hemorrhage from a malignant rectovaginal fistula. Because of her poor physical condition, an embolization with metal clips of the right and left hypogastric arteries was performed, distal to the superior gluteal artery. RESULTS: Embolization was successful in controlling the rectovaginal bleeding, allowing the patient to live 12 months. She refused adjuvant radiotherapy or chemotherapy. CONCLUSIONS: Selective angiography and embolization is a worthwhile alternative in patients with uncontrolled bleeding from a malignant rectovaginal fistula who are poor candidates for surgical intervention.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Congenital H-type anovestibuler fistula.The congenital H-type fistula between the anorectum and genital tract besides a normal anus is a rare entity in the spectrum of anorectal anomalies. We described a girl with an anovestibuler H-type fistula and left vulvar abscess. A 40-day-old girl presented symptoms after her parents noted the presence of stool at the vestibulum. On the physical examination, anus was in normal location and size, and had normal sphincter tone. A vestibuler opening was seen in the midline just below of the hymen. A fistulous communication was found between the vestibuler opening and the anus, just above the dentate line. There was a vulvar abscess which had a left lateral vulvar drainage opening 15 mm left lateral to the perineum. After the management of local inflammation and abscess, the patient was operated for primary repair of the fistula. A protective colostomy wasn't performed prior the operation. A profuse diarrhea started after 5 hours of postoperation. After the diarrhea, a recurrent fistula was occurred on the second postoperative day. A divided sigmoid colostomy was performed. 2 months later, and anterior sagital anorectoplasty was reconstructed and colostomy was closed 1 month later. Various surgical techniques with or without protective colostomy have been described for double termination repair. But there is no consensus regarding surgical management of double termination.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/5. Rectovestibular fistula with vaginal malformations.Anorectal malformations are associated with other anomalies among which vaginal malformations are occasionally encountered and may go unnoticed by the primary physician. Between January 1998 and December 2003, 563 cases of anorectal malformations were managed in Pediatric Surgery Department, Chittagong Medical College & Hospital, Chittagong, bangladesh. Among these, five cases of rectovestibular fistula were associated with vaginal malformations. In this retrospective study age, physical findings, operative findings and procedures, outcome of operation and postoperative follow-up were evaluated. Mean age at presentation was 8.67 years (range 2 months to 17 years). All cases referred as rectovaginal fistula and vaginal anomalies (atresia to agenesis) were detected after thorough examination. Initial pelvic colostomy was done in all patients. Cases 1, 3 and 4 had distal vaginal agenesis and underwent posterior sagittal anorectovaginoplasty. In case 5, atretic vaginal duplication was found with didelphic hypoplastic uterus and absent left kidney. Case 2 (vaginal atresia) operated elsewhere is waiting for definitive surgery. colostomy closure was done in four cases. The third patient had already married and conceived. Bowel habits are regular in all except the second patient. In females, a thorough understanding of anorectal malformations is necessary to identify the association with vaginal anomalies and awareness of this association will lead to earlier diagnosis and appropriate operative measures.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/5. 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 = 1keywords = physical (Clic here for more details about this article) |
5/5. Imperforate anus, delayed presentation in a 7-year-old girl.Most of the cases of imperforate anus should be discovered at birth, during the initial physical examination. This case represents the status of Third World rural perinatal care, wherein delivery of an infant by a midwife in poverty stricken area of mountainous Jipijapa, ecuador, failed to reveal the anomaly during the cursory examination. Moreover, the cultural taboos of the Jipijapan agricultural community further delayed the diagnosis. A 7-year-old girl with imperforate anus presenting with a rectovaginal fistula is reported. Specific findings in the case, therapy, and an approach to the diagnosis are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |