But if the fistulous
tract is used as a conduit, this complication would be probably low or nil as tract is well vascularised due to omental covering in most cases and is of good diameter.
Also, the Programme Director, VVF Centre, Dr Sunday Lengmang, described VVF as an abnormal fistulous
tract extending between the bladder and the vagina.
"Placement of fully covered metallic stents for this kind of fistulous
tract is well recommended for adults but placement of such stents in kids is very rare in practice because of the technical difficulties underlying the procedure," said Dr.
Given concern for the respiratory flora colonization of the now atretic fistulous
tract, the patient was placed on empiric IV antibiotic therapy for six weeks.
Fistulectomy with multilayered closure involves an elliptical skin excision around the fistula followed by meticulous dissection of the entire fistulous
tract to the level of the trachea .
Following this, magnetic resonance imaging (MRI) was done which demonstrated inflammatory changes involving mucosa of the anus, rectum, and internal sphincter with no definite fistulous
tract or collection (see Figure 1).
CT scan revealed the narrowing of the bowel segment in the distal descending colon with severe inflammatory changes and an irregular fistulous
tract in the anterior abdominal wall, which appeared to communicate with the skin (figure 3).
connection between the duodenum and the kidney is a rare pathologic event.
After intense antibiotic treatment, we performed a combined endoscopic and external surgical approach with drainage of abscesses, evacuation of pus and bone sequestrate and excision of fistulous
After excising the fistulous
tract, the first layer sutured is the bladder mucosa, followed by the detrusor and/or prevesical or endopelvic fascia, and the third or fourth layer incorporates vaginal epithelium.
Splenic abscess can rarely rupture or lead to fistulous
communication with adjacent organs.
On day two of admission, she underwent balloon test occlusion followed by endovascular sacrifice of the right vertebral artery and coil embolization of the fistulous
communication (Figure 1(c)).