65 - Preissitzung
16. Mai 2019, 13:45 - 15:15, Sopra 3, 4. OG
Perianal fistula - sometimes it's a long way to the top
T. Bächler, T. Weidinger, G. Basilicata, Presenter: T. Weidinger (Bülach)
Introduction: Perianal fistula generally arise from cryptoglandular abscesses. About 5% of cases are explained by less common causes as Crohn's disease or specific infections (tuberculosis, lymphogranuloma venereum, actinomycosis). A perianal fistula as primary presentation of a chronic diverticulitis is extremely rare.
Case report: A 70 year- old male presented in the proctological outpatient clinic for a large- volume perianal fistula. Secretion over the fistula is present since 7 years with intercurrent perianal, but no abdominal pain. Clinical and radiological examination revealed the presence of a long intersphincteric fistula, MRI and CT Imaging, were performed to evaluate the supralevatoric aspect of the fistula. The advanced imaging showed the presence of a intersphincteric and a supralevatoric abscess along the rectum reaching up to the sigmoid colon (8x3cm), where sigmo- sigmoidal fistulas were present. Repeated colonoscopy did neither show any chronic inflammatory bowel disease nor acute Inflammation of the present diverticulosis.
Results: In intention to evacuate the inflammatory collection partial fistulectomy with placement of intersphincteric and supralevatoric drainages was performed. The supralevatoric collection refilled after removal of the drainages. Due to MRI and CT imaging we postulated that the intersphincteric fistula arises from a chronic diverticulitis of the sigma we proceeded to a sigmoidal resection. The chronic inflammatory alteration of the pelvis forced us to perform a Hartmann resection and delay the re- establishment of intestinal continuity. Still 6 month after colonic resection the alterated tissue did not allow a anastomosis without protective ileostomy.
By a surgical four step procedure, which followed general surgical considerations, we achieved to heal a complex perianal fistula, proof her extraordinary origin from a fistulating chronic diverticulitis and re- establish the intestinal continuity.