UROVAGINAL FISTULA IN TERTIARY HOSPITAL OF WEST JAVA INDONESIA

Objective: This study was conducted to find out the frequency and characteristics of urovaginal fistula patients. Material & Methods: This study design used a retrospective descriptive research design conducted at a tertiary hospital in West Java, Indonesia (Hasan Sadikin General Hospital) from 1 January 2010 to 31 December 2016. Results: Of all 22 urovaginal fistula patients, the majority in the age range of 41-50 years, and there was one patient in the age range of 61-70 years. Fourteen patients (63.6%) had defects in the bladder, and 36.5% of patients had defects in the ureters. There were nine patients (40.9%) who had urovaginal fistula after undergoing a hysterectomy procedure. The other causes were cervical carcinoma (40.9%), difficult labor (9.1%), radiotherapy (4.5%), carcinoma rectum (4.5%), cesarean section procedure (9.1%), and other gynecological procedures such as myomectomy or cystectomy (9.1%). Based on the type and location of the fistula, the majority of patients had vesicovaginal fistula/VVF (59%), ureterovaginal fistula/UVF (36%), and a combination of ureterovesicovaginal fistula (5%). The causes of VVF and UVF are different from each other. In patients with VVF, the most common cause is cervical carcinoma (35.7%). Meanwhile, the most common cause of UVF is hysterectomy (75%). Conclusion: Of the various types of urovaginal fistulas, vesicovaginal fistulas are the most frequently encountered. In general, the characteristics of urovaginal fistula patients in Hasan Sadikin General Hospital is slightly different from the literature, especially the cause of fistula. At Hasan Sadikin General Hospital, vesicovaginal fistulas are mostly caused by cervical cancer, not a hysterectomy. For ureterovaginal etiology, the characteristics of patients in Hasan Sadikin General Hospital are caused mainly by hysterectomy.

Chronic Fistulas of Thigh Presenting Unusually in an Operated Patient of Carcinoma Rectum. More Than What Meets the Eye!

Chronic skin lesions of the thigh (wounds, fistulas etc) are relatively uncommon, vis-à-vis, their notorious cousins over the distal limb. Even when present, the cause is usually obvious, mostly as trauma or a systemic affliction. We present an unusual case of chronic fistulas over the right thigh in a patient of carcinoma rectum for which anterior resection and an end colostomy was done 4 years earlier. Postsurgical pelvic abscesses finding their way into the thigh are a known entity, but they are usually accompanied by systemic/local features and their presentation is within a shorter time span. The novelty of our case lies in its manifestation (as a cluster of chronic fistulas and not a frank abscess), its late presentation as well as in the absence of any systemic/local inflammatory signs. Our primary objective is to educate wound physicians about the origin of such fistulas whenever they deal with patients who have had a preceding surgical intervention of the abdomen. In our humble opinion, this will ease out many diagnostic and management dilemmas, that such patients can potentially pose.

A retrospective analysis of cancers in a rural tertiary care centre

Background: In the last couple of decades, cancer incidence has been raising heavily, probably due to our changing lifestyle, habits, and increased life expectancy. The situation is so alarming that every fourth person is having a lifetime risk of cancer.Methods: The study was conducted as a retrospective study among the various cancer patients admitted in our tertiary care centre for a period of 10 years from 2011 to 2020. The data and the case sheets from the hospital records were obtained from the MRD department. The case sheets were reviewed by the investigators on the variables viz age, gender, diagnosis, cancer site, investigations and treatment aspects. The data were entered in the MS excel sheet and analyzed using Statistical package for social sciences (SPSS) software version 21. The data were expressed in terms of frequencies and percentages.Results: Total cases reported were 121 of which in the year 2014 and 2015, the cancer cases reported were 32% and 26% respectively. Then again there was a peak in 2018 and 2019 with 8% and 31% with one case each in the year 2017 and 2020. High prevalence is seen with Breast cancer, which showed 60% followed by carcinoma stomach which is 18% and carcinoma rectum which is 9%. The cancers showed low prevalence, which is 1% include carcinoma prostate, carcinoma larynx, gastro intestinal stromal tumor and retro peritoneal lipo sarcoma.Conclusions: Our study revealed that the cancer cases are high and it showed increasing trend which suggests that the population based cancer registries to be made at all levels of health care to identify the time trends so that prevention measures can be implemented at the community level.

Carcinoma Rectum with Prostate and Urinary Bladder Metastasis- A Rare Case Report

Tumours of the colon and rectum are one of the most common malignancies worldwide. In India, its incidence is less compared to the developed countries however,recently it has increased from past few decades due to sedentary lifestyle and more consumption of animal fats with less dietary fibre intake. The liver and lungs are most common sites of metastasis from colorectal carcinoma; however, it occasionally metastasised to atypical sites by making diagnosis difficult. Due to the high frequency of colorectal carcinoma, even infrequent metastatic sites are important to diagnose as early as possible. Hereby, authors present a case of 53- year-old male, with history of carcinoma rectum and treated with Abdominoperineal Resection (APR) with permanent colostomy three years back. Three years after the diagnosis of carcinoma rectum, the patient was diagnosed with metastasis of colorectal adenocarcinoma to prostate and urinary bladder which was proven histopathologically. Despite the fact that this condition is uncommon in clinical practice, the possibility of metastatic involvement of prostate and urinary bladder should always be considered when the diagnosis of other primary carcinoma is made.

Carcinoma of the Rectum: A Clinicopathological Evaluation of Patients in Tertiary Care Hospitals

Background: Colorectal carcinoma is the fourth most commonly diagnosed cancer and the third leading cause of cancer deaths worldwide. The rectum is the most frequent site involved. The disease is no less common in our country in comparison to western world. The aim of this study was to determine the incidence and to review the clinicopathological aspects of carcinoma rectum in different ages in our country. Methods: This is a prospective observational study which includes 50 cases of carcinoma rectum which were admitted under different surgical units of Dhaka Medical College Hospital and Bangabandhu Sheikh Mujib Medical University during the period of November 2007 to December 2008. Results: The present study showed maximum incidence of carcinoma rectum in the age group 21-30 years. Next common age group was 31-40 years. Incidence declined after 60 years. Majority of victims were male giving a male to female ratio of 1.17:1. As regards the mode of clinical presentation, most patients presented with bleeding per rectum. Majority of patients in this study was moderately anaemic. Curative resection was possible in 54% cases, palliative resection in 38% and palliative end colostomy was done in 4% cases. Only 2% mortality was reported in this study. Histopathological grading showed that poorly differentiated adenocarcinoma of rectum was more common in younger age group. Conclusion: Younger patients with carcinoma rectum have several distinct clinicopathological features. Since early diagnosis is essential to improve the cure rate for carcinoma rectum, all known procedure tools must be used to detect carcinoma of the rectum in an early stage, in addition to periodic selective investigations of high-risk group. Journal of Surgical Sciences (2020) Vol. 24 (1) : 15-20