Spontaneous enterocutaneous fistula in a patient with femoral hernia: a case report

Background Enterocutaneous fistula commonly occurs in the post-operative setting. However, a handful of cases have been reported to occur secondary to strangulation of hernia, mostly femoral due to the narrow femoral ring through which this type of hernia passes through. Case presentation We encountered a case of spontaneous fecal fistula, which occurred in the setting of an incarcerated femoral hernia. The patient did not develop peritonism, or obstruction, throughout the course of the disease. The hernia ruptured on day 7 of incarceration. Exploratory laparotomy under epidural anesthesia revealed a femoral hernia with ileum as content, arising approximately 20 cm from the ileocecal junction. Reduction of the contents was done, and a resection performed along with repair of the hernia. Conclusion As very few literature describe the formation of spontaneous fecal fistula, we discuss the presentation in this report.

Ileostomy in the Treatment of Typhoid Enteric Perforation Among Patients Presenting Late in The Hospital

Introduction: Typhoid enteric perforation is a communal acute emergency of abdomen in our hospital settings. Maximum patients in Pakistan come from rural zones and have a serious illness when presented in the laten final stages. Objective: To govern the importance of an ileostomy in cases of late presentation with enteric perforation. Study Design: A retrospective study. Place and Duration: In the surgical Department of Islam Medical College and Teaching Hospital Sialkot for one year duration from July 2020 to July 2021. Methods: 52 total patients of typhoid enteric perforation were included in our department. 5 to 32 years was the age range of patients with an average age of 16 years. Most of these patients have complaints of fever, abdominal pain, abdominal distension and vomiting Results: 52 patients with late presentation of typhoid perforation were alienated into 2 groups. All cases of group A underwent laparotomy and perforation exteriorization was done as loop ileostomy. In group A, when exteriorization was performed as the first procedure, fecal fistula was later developed in 12 cases. Ten of these cases had to be re-examined and the second perforation was found to be close to the original one. The mortality was observed in three cases. Conclusion: In a relatively normal-looking intestine, restoration of the margin, closure of the two layers of perforation, and ileostomy near the perforation are safer in the case of late onset of typhoid fever enteric perforation. Keywords: typhoid perforation, double-layer closure and ileostomy

Gossypiboma: A case report

This case underscores the need for clinicians to bear the possibil‑ ity of gossypiboma in mind when patients who have had abdominal surgery in the recent past present with unresolving abdominal pain. This 46 year old woman who had an elective hysterectomy done three months earlier presented with unresolving abdominal pain of three months and lower abdominal distension of a day duration. Fol‑ lowing exploratory laparotomy, an 18 cm by 18 cm towel was recov‑ ered from her peritoneal cavity. She subsequently developed fecal fistula which was successfully managed conservatively and was dis‑ charged in good condition on 20th post-operative day. Gossypiboma is a rare but grave complication of abdominal and pelvic surgeries with attendant significant morbidity or even mortal‑ ity. Adequate attention to patient care processes may reduce its oc‑ currence and high index of suspicion is needed for its diagnosis. Keywords: abdominal sponge; gossypiboma; intra‑abdominal.

EP.FRI.466 Indications and Outcome of Abdominal Re-exploration in the Pediatric Population. A Single Centre Experience

Abdominal exploration (ARE) is an important complication of abdominal surgery and has an effect on morbidity and mortality. ARE refers to exploration performed within 60 days following initial surgery. The purpose of this study is to know the grounds for performing re-exploration and its effects on the outcome. Methods This retrospective study was carried out in the pediatric surgery unit of Khyber teaching hospital from May 2017 to May 2019. All patients under the age of 16 years who underwent abdominal re-exploration within 60 days of the initial procedure were included in the study. Results A total of 55 re-exploration were done in the study duration of 2 years. The mean age of patients was 41 months (range of 0.06 to 168 months) male patients were 64%. On initial presentation, 56% of cases were emergency cases and 44% were elective. Common indications for re-exploration were, intestinal obstruction 29.1%, peritonitis 16.4%, complications of stoma 16.4%, burst abdomen 10.9%. The mean interval from initial surgery was 12.5±13.7 days. Common operative findings of re-exploration were inter-loop adhesions, anastomotic disruption, burst abdomen, anastomotic leak, intra-abdominal collection, gangrenous stoma, and para-stomal herniation. ARE resulted in 14.5% mortality. Conclusion Abdominal re-exploration is mainly indicated for intestinal obstruction and peritonitis. Inter loop adhesions and anastomotic leak are common surgical findings during re-exploration. The mortality rate is high in patients re-explored for peritonitis, fecal fistula, abdominal collection, and wound dehiscence.

Closure of the fecal fistula by bowel evagination

B-naya Cher va Maria, 57 years old, Russian, peasant woman, s. Svinogorsk, Yelabuga region, was admitted to the surgical department of Kosteneevskaya hospital on 20 / X 30 for a persistent non-healing fecal fistula in the left groin area.

Surgical management of perforated bowel due to typhoid infection. What are the predictive factors for pre-operative diagnosis in the endemic area

Perforated typhoid fever is a common cause of peritonitis in the endemic areas and associated with high mortality and morbidity if not managed properly. This prospective study included 75 patients with perforated bowel that operated upon in two years( 2017-2018) and other 29 cases of non-perforated typhoid enteritis presented as acute abdomen. Of 75 cases, 13 (17%) presented as local peritonitis, while 63 (87%) as general peritonitis, which was confirmed by chest X-Ray/ gas under the diaphragm in 80%. 61(81%) patients were males. The age was 15-40 years in 54 (72%) patients. White Blood Cell count [WBC] is low or normal in all cases. 35(46%) patients were presented as an acute abdomen without fever. All patients had at least one perforation in the terminal ileum. There was single perforation in 47(62%) patients. The midline incisions were complicated by dehiscence in 15 (24%) of 54 cases and by wound infection in 35(64%). Six(8%) cases were complicated by fecal fistula and 3(4%) patients unfortunately died. Wound infection complicated 4 (26%) of 15 cases of gridiron incisions, but no wound dehiscence or incisional hernia. Conclusion: WBC is helpful in the diagnosis of perforated bowel due to typhoid infection. This is important for the proper choice of an incision. Grid iron incision is associated with minimal complications and is preferred to the midline one. Acute diffuse peritonitis indicates perforation in almost all cases, but only one-third of local peritonitis caused by perforation. Early limited surgery and the proper choice of antibiotics according to local microbiologist opinion or culture decreased the mortality to 4%.

Should All Complicated Appendicitis be Treated the Same? the Answer is No

Delayed presentation of acute appendicitis is associated with increased complications. We hypothesized that the outcomes of appendectomy in delayed presentations of acute appendicitis (>72 hours of pain) were dependent on radiologic findings rather than late presentation. We reviewed records from 2009 to 2015 and analyzed delayed presentations of acute appendicitis. We divided patients into three groups based on specific CT findings: uncomplicated appendicitis (UA), phlegmon or abscess (PA), and other perforated appendicitis (PERF, signs of perforation without abscess or phlegmon). One hundred thirty-eight patients were included in this study (58 in the UA, 67 in the PA, and 13 in the PERF groups). Overall, 78 (57%) patients underwent early appendectomy (EA) and 60 (43%) underwent initial conservative management. The incidence of adverse events was lower in EA than that in initial conservative management (17% vs 42%, P = 0.005). EA in the UA group was associated with shorter hospitalization (3.2 vs 5.6 days, P < 0.001) and less adverse events (6% vs 29%, P < 0.05). Severe adverse events (two colectomies and one fecal fistula) were observed in the PA group. In conclusion, in these late presentations of appendicitis, complicated appendicitis was common. EA was safe in selected patients, however, and associated with decreased adverse events.

Treatment of Colocutaneous Fistula in the Left Thigh

Aim There are few publications on the surgical management of a colocutaneous fistula in the thigh. Here, we describe a patient who presented with a 2-year history of fecal fistula in the left thigh, following a history of drainage of a psoas abscess. This is followed by a discussion of appropriate treatment modalities for this type of fistula. Methods To determine the appropriate treatment for our patient with chronic fistula, we thoroughly reviewed the relevant literature in an Internet-based search and selected a staged operative approach for our patient. Results Using a staged surgical procedure, we were able to resolve the colocutaneous fistula without the occurrence of comorbidities. Conclusion Substantial morbidity is associated with the presence of colocutaneous fistulas. The best possible approach is prevention of its occurrence, but this is not always feasible. Measures for management of an acute fistula differ from those in patients with chronic fistula. Medical management can be more effective in acute cases, while chronic cases require surgical management. We used a staged surgical method with a few risks for our patient and he is in good health 1 year after treatment.

Assessment of the aetiology and outcome of fistulae cases (VVF RVF) operated at Shaikh Zaid woman hospital Larkana

Aims: To study etiology of fistula in patient at Shaikh Zaid Women hospital Larkana. Methods: A cross-sectional Survey was conducted at Gynecology and obstetrics wards of Shaikh Zaid Women hospital Larkana. All patients were admitted in outpatient departments along with emergency department were the part of the study. Sample was collected by universal sample technique. Total sample size was of 49 patients. Detailed history regarding fistula formation and its etiology and duration, examination and related investigation carried out in each and every patient. Young and elderly patients both were included. Results: 49 patients were selected, who were admitted and registered at the gynecological and obstetrics wards of Shaikh Zaid Women hospital, out of which 38 patients were found having urinary fistula from which 28 patients were having fistula due to obstetric causes while 10 pts were having fistula due to iatrogenic causes. Moreover, 11 patients were having fecal fistula from them 7 were again due to obstetric causes, 1 patient was having congenital fistula and remaining 3 patients were found having fistulas due to malignancy. Conclusions: Obstetrics fistula is still most common cause of fistula followed by iatrogenic cause. Urinary fistula is more common than fecal fistula.