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Neuroradiology 1985The authors report a new case of intraspinal extra-medullary meningeal arteriovenous fistula draining through medullary veins. Discovered in a 33-year-old black man...
The authors report a new case of intraspinal extra-medullary meningeal arteriovenous fistula draining through medullary veins. Discovered in a 33-year-old black man suffering from a cauda equina syndrome, this malformation suspected in myelography was confirmed by a selective angiographic procedure of both internal iliac arteries. This investigation specified the sacral site of the fistula as well as its feeding arteries from several branches of the left and right internal iliac arteries and its posterior and intra-meningeal venous medullary drainage. An embolization procedure followed by a surgical approach and a second embolization session brought a fair improvement to this young patient who could walk again. The acquired traumatic origin of the fistula is discussed for this patient who had been previously operated at his L5-S1 level.
Topics: Adult; Angiography; Arteriovenous Malformations; Cauda Equina; Humans; Male; Myelography; Nerve Compression Syndromes; Spinal Cord
PubMed: 4010923
DOI: 10.1007/BF00344494 -
Pediatric Surgery International May 2015Seventeen years have passed since the first description of the laparoscopic approach for anorectal malformation and approximately 68 articles have been published on the... (Review)
Review
Seventeen years have passed since the first description of the laparoscopic approach for anorectal malformation and approximately 68 articles have been published on the subject. In this review article, we aim to describe the advantages as well as the indications and contraindications of this approach when dealing with each specific type of anorectal malformation, according to what has been described in the literature and to our own experience. The ideal and undisputable indication for laparoscopy remains for cases in which the abdomen needs to be entered to repair the malformation. Only 10% of male patients with anorectal malformation are born with a recto-bladder neck fistula that requires an abdominal approach, this represents an ideal indication for laparoscopy. In females, only the complex cloacae with a common channel length greater than 3 cm are the ones that require a laparotomy; they represent about 30% of the cloacae. However, the repair of this type of cloacae also requires sophisticated and technically demanding maneuvers that have never been done laparoscopically. In cases of recto-urethral prostatic fistulas the malformation can be repaired either way: laparoscopically or posterior sagitally. In all other malformations: recto-perineal fistula, recto-urethral bulbar fistula, anorectal malformation without fistula, rectal atresia, recto-vestibular fistula; no justification for laparoscopy could be found; and in some cases, laparoscopy is contraindicated. In the published reports, there is no evidence supporting the idea that laparoscopic repair results in better functional results when compared with non-laparoscopic operation; there is a tendency to omit information relevant to bowel control such as the characteristics of the sacrum and the presence or absence of tethered cord; and most authors do not compare results between comparable malformations.
Topics: Anal Canal; Anorectal Malformations; Anus, Imperforate; Female; Humans; Infant; Laparoscopy; Male; Rectum
PubMed: 25725614
DOI: 10.1007/s00383-015-3687-y -
Stem Cells International 2019To report our experience in a compassionate use program for complex perianal fistula.
AIM
To report our experience in a compassionate use program for complex perianal fistula.
METHODS
Under controlled circumstances and approved by European and Spanish laws, a compassionate use program allows the use of stem cell therapy for patients with nonhealing diseases, mostly complex fistula-in-ano, who do not meet criteria to be included in a clinical trial. Candidates had previously undergone multiple surgical interventions that had failed. The intervention consisted of surgery (with closure of the internal opening or a surgical flap performance), followed by stem cell injection. Three types of cells were used for implant: stromal vascular fraction, autologous expanded adipose-derived, or allogenic adipose-derived stem cells. Healing was evaluated at 6 month follow-up. Outcome was classified as partial response or healing. Relapse was evaluated 1 year later. Maximum follow-up period was 48 months.
RESULTS
45 patients (24 male) were included; the mean age was 45 years, which ranged from 24 to 69 years. Since some of them received repeated doses, 52 cases were considered (42 fistula-in-ano, 7 rectovaginal fistulas, 1 urethrorectal fistula, 1 sacral fistula, and 1 hidradenitis suppurativa). Regarding fistula-in-ano, there were 18 Crohn's-associated and 24 cryptoglandular. 49 cases (94.2%) showed partial response starting 6.5 weeks of follow-up. 24 cases (46.2%) healed in a mean time of 5.5 months. A year later, all patients cured remained healed. No adverse effects related to stem cell therapy were reported.
CONCLUSION
Stem cells are safe and useful for treating anal fistulae. Healing can be achieved in severe cases.
PubMed: 31191678
DOI: 10.1155/2019/6132340 -
European Journal of Pediatric Surgery :... Oct 2022Posterior or anterior sagittal anorectoplasty (ASARP) is the mainstream for correcting rectovestibular fistula (RVF). However, the intermediate RVF has the potential...
BACKGROUND
Posterior or anterior sagittal anorectoplasty (ASARP) is the mainstream for correcting rectovestibular fistula (RVF). However, the intermediate RVF has the potential risk of wound complications when applying ASARP due to its high rectal pouch, long fistula tract, and difficulty separating the rectum and vagina. We developed laparoscopic-assisted anorectoplasty (LAARP) for surgical correction of RVF, which has acceptable preliminary outcomes. The purpose of this study is to evaluate the safety and efficacy of LAARP in comparison with ASARP for patients with RVF.
MATERIALS AND METHODS
Twenty-five patients with RVF who underwent LAARP between October 2017 and December 2020 were retrospectively reviewed. The outcomes were compared with 43 patients who underwent ASARP between April 2015 and August 2018. The age, weight at operation, sacral ratio, operative time, and postoperative hospital stay were evaluated. The results were assessed for complications, perineum appearance, and bowel function.
RESULTS
The two groups were comparable in terms of demographics. The median operative time of the LAARP group was significantly longer than that of the ASARP group (113 vs. 95 minutes; = 0.015). The mean length of the resected rectum in the LAARP group was also longer than that in the ASARP group (6.75 ± 5.07 vs. 3.31 ± 3.06 cm; = 0.001). Compared with the LAARP group, complications in the ASARP group were more frequent (4.0 vs. 27.9%, = 0.036). No intraoperative or postoperative wound-related complications occurred in the LAARP group. However, in the ASARP group, one patient had an intraoperative vaginal injury and four had postoperative anastomosis-related complications. The incidence of redo operation in the ASARP group was significantly higher than that in the LAARP group ( = 0.000). Cosmetic satisfaction was higher in the LAARP group (96.0 vs. 76.7%; < 0.05). In terms of voluntary bowel movement, soiling, and constipation, the LAARP group had similar results compare with the ASARP group.
CONCLUSION
The LAARP technique has shown several unique strengths in treating intermediate type RVF, including lower risks of complications, and minimal muscular injury, with a comparable bowel function.
Topics: Anal Canal; Anorectal Malformations; Female; Humans; Infant; Laparoscopy; Postoperative Complications; Plastic Surgery Procedures; Rectal Fistula; Rectum; Retrospective Studies
PubMed: 34852385
DOI: 10.1055/s-0041-1740157 -
Journal of Surgical Case Reports Dec 2012Fistula formation after restorative proctocolectomy poses a challenge to the surgeon and sometimes can lead to the excision of the pouch. While pouch-vaginal fistulas...
Fistula formation after restorative proctocolectomy poses a challenge to the surgeon and sometimes can lead to the excision of the pouch. While pouch-vaginal fistulas are more common, pouch-sacral fistulas are a rare event and treatment is still controversial. The authors report a case of pouch-sacral fistula which was treated successfully with a novel approach comprising pouch revision, debridement of sacrum and placement of a human acellular dermal matrix (Alloderm) mesh to patch the residual large sacral defect. This is the first report of the use of Alloderm under this rare condition.
PubMed: 24968393
DOI: 10.1093/jscr/rjs006 -
Interventional Neuroradiology : Journal... Mar 2002A patient with a spinal intradural arteriovenous malformation (AVM) at the conus medullaris concomitant with a sacral dural arteriovenous fistula (AVF) of the filum...
A patient with a spinal intradural arteriovenous malformation (AVM) at the conus medullaris concomitant with a sacral dural arteriovenous fistula (AVF) of the filum terminale is reported. A 44-year-old-male presentied with bilateral leg weakness and urinary incontinence for several months. Spinal angiography demonstrated two lesions: one was spinal intradural AVM at the conus medullaris supplied by the anterior spinal artery; the other was sacral dural AVF of the filum terminale supplied by the middle sacral artery. Although multifocal spinal cord AVMs have been reported, this is the first case report of two different types of vascular malformations coexisting in one patient. The arterial supply of the dural AVF of the filum by the middle sacral artery is also first demonstrated in the literature. The patient was treated successfully by surgical approach for both lesions in the same operation.
PubMed: 20594512
DOI: 10.1177/159101990200800109 -
Journal of Pediatric Surgery Sep 2010Transanal anorectoplasty was developed through the 1980s by the senior author (AB) as an alternative approach to posterior sagittal anorectoplasty for the management of...
BACKGROUND
Transanal anorectoplasty was developed through the 1980s by the senior author (AB) as an alternative approach to posterior sagittal anorectoplasty for the management of imperforate anus. This study evaluates this surgical approach and its longer-term results.
METHODS
Case notes of all patients treated from 1984 to 2005 were reviewed. Operative procedures, colostomy requirement, complications, and long-term outcome were recorded. Patients were grouped according to the status of the pelvic floor, the location of the rectal fistula, and the sacral ratio.
RESULTS
A total of 245 patients (175 male, 70 female) underwent transanal anorectoplasty. The perineum was well formed in 208 patients (85%), moderately formed in 15 (6%), and poorly formed in 22 (9%) patients. Two hundred three patients (82.8%) had a visible perineal or vulval fistula, 24 (9.8%) had a prostatic urethral fistula, whereas 18 (7.4%) had a bulbourethral fistula. Overall, 6 patients (2.5%) had wound infection or breakdown. As continence is age related, 32 patients were excluded from the study. Of the remaining 212 patients, 182 are continent with no soiling or only minimal staining. Thirty patients born with a poor perineum are incontinent.
CONCLUSION
Transanal anorectoplasty is a safe procedure with limited morbidity. It is sphincter sparing and permits accurate placement of the rectum with its internal sphincter within the anal canal. The anus lies accurately placed at the center of the external anal sphincter muscle complex. Given a well-performed surgical intervention, eventual continence relates to the original anatomy and neurology of the pelvic floor. Transanal anorectoplasty should be regarded as an alternative rather than as a substitute to posterior sagittal anorectoplasty for reconstruction of most forms of imperforate anus.
Topics: Anal Canal; Anus, Imperforate; Female; Follow-Up Studies; Humans; Infant, Newborn; Male; Plastic Surgery Procedures; Rectum
PubMed: 20850646
DOI: 10.1016/j.jpedsurg.2010.05.005 -
International Journal of Surgery Case... 2018Spinal tuberculosis (TB) is the most common manifestation of extra-pulmonary TB. TB of the lumbosacral junction is rare and occurs in only 1 to 2% of all cases of spinal...
INTRODUCTION
Spinal tuberculosis (TB) is the most common manifestation of extra-pulmonary TB. TB of the lumbosacral junction is rare and occurs in only 1 to 2% of all cases of spinal TB. Moreover, isolated sacrococcygeal TB is extremely rare. Herein, we report a rare case of sacrococcygeal TB, which was difficult to distinguish from complex anal fistula.
CASE PRESENTATION
A 93-year-old man presented with sacral pain and peri-anal discharge. He had pulmonary TB at 25 years of age. Fistulography revealed an abnormal tract that connected to the pre-sacrococcygeal area, which was not connected to the rectum. Computed tomography scan showed fluid collection in front of the sacrum, with a lytic destruction of the lower sacrum and coccyx. Cold abscess aspiration cytology was negative for acid-fast bacilli. However, real-time polymerase chain reaction was positive for Mycobacterium tuberculosis. His symptoms resolved immediately after the initiation of anti-TB chemotherapy.
CONCLUSION
This case highlights the importance of considering tuberculosis as a diagnosis if the unusual sites are involved.
PubMed: 29966953
DOI: 10.1016/j.ijscr.2018.05.033 -
British Medical Journal May 1910
ON IMPIANTATION OF THE URETERS INTO THE RECTUM BY THE SACRAL ROUTE, Illustrated by a Case of Inveterate Vesico-vaginal Fistula in which the Left Ureter was Implanted and the Right Kidney Removed.
PubMed: 20765100
DOI: 10.1136/bmj.1.2577.1224 -
Medicina (Kaunas, Lithuania) Nov 2023The occurrence of pneumorrhachis (PR), defined as the presence of air within the spinal canal, presents a complex clinical picture with diverse etiological factors. We... (Review)
Review
The occurrence of pneumorrhachis (PR), defined as the presence of air within the spinal canal, presents a complex clinical picture with diverse etiological factors. We report an exceedingly rare case of PR arising from locally advanced rectal cancer accompanied by a pre-sacral abscess. This report aims to enhance awareness and understanding of rare causes of PR within the medical community, particularly among surgeons engaged in emergency procedures. The patient survived the acute phase of the disease through multiple surgical interventions and admission to the intensive care unit, but succumbed to cardiovascular complications three weeks later. We also offer a brief review of the literature concerning PR originating from the colorectal lumen.
Topics: Humans; Pneumorrhachis; Abscess; Spinal Canal; Rectal Neoplasms
PubMed: 38138179
DOI: 10.3390/medicina59122076