Thursday 6 March 2008

Fecal fistula

Fecal fistula

[Summary]



Fecal fistula (fecal fistula) is formed between the genital and intestinal abnormalities channel. In obstetrics and gynecology clinic is the most common rectovaginal fistula. Lag-formed fecal fistula sometimes complicated by urinary fistula. In addition there are also the small intestine, colon fistula. Genital fistula is a very painful injury disease. The urine and feces was not able to control long-term immersion in the perineum, urine, not only for women suffering physical, but for fear of patients with the masses close to not participate in productive work, the spirit of the burden is also very strong. Strengthening maternal health, to clean delivery, correctly handle the delivery and improve the quality of surgery, the injury could have been avoided genital mutilation, genital fistula will greatly reduce the incidence.



[Diagnosis]




Rectovaginal fistula simple comparison of the symptoms, so diagnosis of a urinary fistula easy. Big hole in the vaginal fistula Kuiqi exposure see or touch, in terms of attendance; fistula hole less difficult to see, or only in the posterior wall of the vagina to see a bright red flag of the small granulation tissue, such as from here with uterine probe exploration, while the other hand fingers to enter into the anus, and deep finger needle encounter can be definite diagnosis. If suspected small bowel or colon fistula, with the exception of the history of surgery, could be considered barium irrigation anal or barium meal examination.


[Treatment]




For the treatment of fecal fistula repair surgery. Urinary fistula repair effect than good. Its self-healing injury to more than urinary fistula. Fresh trauma (such as surgery or trauma) should be immediately repaired. Old fecal fistula, such as a higher position rectovaginal fistula, according to the principle of urinary fistula repair methods and operation requirements, from fistula hole peripheral organizations, vaginal mucosa and wall separation, first slit straight wall (not mucosal permeability ), the suture after vaginal wall. If rectal vaginal wall near the anus, the first cut from the median between the anal and vaginal fistula hole at the rectum so that the three-perineal laceration, re-patch (Figure 1).



Figure 1 rectovaginal fistula repair low cut before the anal and vaginal fistula holes at the rectum

If fecal leakage of urine leakage and the two co-exist at the same time to repair. If fecal fistula larger, or more scar tissue, it is estimated that surgery can be difficult to make abdominal ostomy colon and urinary fistula repair, the question urinary fistula healing, spacing four weeks and then fecal fistula repair, after the success of ostomy reduction of the colon. Although fewer such cases, the methods and procedures required to carefully consider the light of the specific circumstances.

Rectovaginal fistula fistula huge hole, excessive scar tissue (mostly sitting vagina corrosion caused by the drug), fistula repair hole after numerous failures, repair it without discussions that are successful, consideration could be given to permanent artificial anus surgery .

Diagnosis of the small intestine or colon to the abdominal vaginal fistula repair or visit bowel resection anastomosis.

Fecal fistula preoperative preparation and postoperative treatment of fecal fistula repair healing relations larger. Therefore, preoperative 3 to 5 days into a semi-liquid slag, and to metronidazole 0.2 g, 3 to 4 times daily; served a total of three to four days, gentamicin 80,000 U, intramuscular injection, 1 2 , with 3 to 4 days, or a few days ago of serving 1 g neomycin, streptomycin or daily oral 1 g, 3 to 4 days, the opportunity to reduce intestinal infection. Of the day before serving Senna 15 g (Chong Yin), or anus of the evening washing clean, and wash the vagina. Continue to slag after a semi-liquid diet and control defecation 3 to 5 days, give five percent of opium tincture 5 ml, three times a day; Further to the prevention of infection, such as metronidazole, and promote wound healing. Since the operation, a night service on the 4th of liquid paraffin 30 ~ 40 ml or 15 g daily service senna, feces-thinning or softening from easy (excessive defecation may stop serving). In addition, after also maintain genital cleansing.


[Etiology:




Fecal the causes of fistula and urinary fistula basically the same, in addition, because many of perineal laceration suture three surgical failure, or incision of the perineum to suture, through the intestinal mucosa caused by sutures. Small intestine, colon fistula Although rare, but more from surgery or injury caused by postoperative adhesions.

[Clinical]




If fistula large hole near the vagina mouth, forming or semi-forming stool can be vaginal discharge, and beyond the control of exhaust symptoms, when the stool dilute more serious symptoms. If fistula small hole, dry manure than can be no faeces from the vagina, just dilute it by the time of vaginal excess manure, but the exhaust control. If fecal fistula and urinary fistula coexist, often leak or exhaust mixture of feces. Often because of the vagina and vulva with the faecal droppings and secretions of genital stimulation and chronic dermatitis.


[Prevention]




Fecal fistula in the same basic prevention of urinary fistula. In addition, midwifery should be correct, to avoid severe perineal laceration; perineal incision suture attention should be paid to suture not penetrate mucosa. After conventional suture attention to the perineum DRE found Rectal a timely suture removal. For abdominal surgery, stripping of the pelvic floor, and had to review by the sigmoid colon cover, and pots of peritoneal closure should also pay attention to not penetrate walls. Peritoneal suture in the pelvic floor, the attention not exposed rough surface to avoid adhesion, infection, necrosis, overcast vaginal fistula formation.

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