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Ileo vaginal fistula management.pptx
- 1. A case of Ileo- vaginal fistula Dr Mohit Gangwal
- 2. • 63 year old female • Presented to emergency department • Complaints- passing faecal matter per vaginum, weakness, tiredness – 3 months • Previous history- Diabetic/ Hypertensive • Surgical history- k/c/o Endometrial carcinoma • Open Radical hysterectomy with BSO with pelvic lymphadencetomy ~ 7 months back • Followed by radiation and chemotherapy
- 3. Examination • P/A – scar from the previous surgery, otherise normal • P/R – no significant finding • P/V- feculent smell, induration in the posterior vaginal wall • Dx - ? Rectovaginal fistula
- 6. • Diagnosis- Ileo vaginal fistula • Optimisation- Antibiotics and fluids • Surgery – Diagnostic Laparoscopy with adhesiolysis with dismantling of fistula with closure of vault with limited right colectomy with ileotransverse anastomosis Finding ➢ Omental adhesions to anterior abdominal wall ➢ Dense interloop small bowel adhesions ➢ Loop of terminal ileum forming fistula with vaginal vault ➢ Rectum adherent to vagina without fistulous communication
- 7. • video
- 8. • The World Health Organization (WHO) estimates that 50,000 to 100,000 women worldwide develop vaginal fistulas every year. Aetiology • Prolonged labor during childbirth. • Vaginal tears during childbirth or an episiotomy. • Abdominal or pelvic surgery, including C- sections and hysterectomies. • Cancer in the pelvic area, such as cervical cancer or colorectal cancer. • Inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis. • Colon infections like diverticulitis. • Radiation therapy to the pelvic region.
- 9. Symptoms • Skin irritation in vagina, vulva or perineum • Dyspareunia • Recurrent urinary tract infections, or vaginal infections (vaginitis). • Abdominal pain. • Foul-smelling vaginal discharge. • Gas, pus or stool (fecal incontinence) leaking from the vagina. • Nausea and vomiting or diarrhea. • Rectal bleeding or vaginal bleeding. • Unexplained weight loss.
- 10. • Complete blood counts and urinalysis to look for infections. • Dye test, inserting dye in rectum and checking for signs of leakage from vagina. • Fistulogram/ Vaginogram X-ray to determine the number and size of fistulas. • CT scans • Pelvic MRI (More complex cases like crohn’s) • Cystoscopy • Flexible sigmoidoscopy to view rectum and colon. • Colonoscopy
- 11. Management • Optimization • The basic principle of the surgical approach is to excise the involved segment of the bowel and the fistula • Limited conservative excision of the involved intestinal segment and the fistula is recommended • Diversion wherever necessary • Radical excision is recommended in an operable malignancy. • The fistulous tract is debrided and drained as part of the intra- abdominal adhesiolysis and debridement. • Debriding all unhealthy tissue and closing with viable, healthy tissue edges is essential for successful healing and fistula closure.