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[Temporary total fecal diversion--ultimate solution for complex recurrent anal fistula]
M Oniţa1, A Dumnici, E Hornung
1Clinica Chirurgie, Spitalul Clinic Municipal Arad. Marcelonita@yahoo.com
Chirurgia (Bucharest, Romania : 1990)
|March 2, 2010
Summary
Complex anal fistulas are challenging. A temporary fecal diversion followed by extensive tissue removal offers a potential solution for recurrent cases, achieving remission in a severe case.
Area of Science:
- Colorectal Surgery
- Gastroenterology
Background:
- Anal fistulas are common, but complex cases pose significant treatment challenges.
- Current treatment strategies for complex anal fistulas remain debated globally.
Observation:
- A 55-year-old male presented with a 15-year history of recurrent perianal fistulas and abscesses, having undergone over 40 operations.
- The complex fistula had spread throughout the perineal and gluteal regions, with numerous external and internal orifices, leading to patient debilitation, anemia, and chronic sepsis.
Findings:
- A terminal fecal diverting stoma was created as a last resort, followed by extensive debridement of affected tissues, skin grafting, and flap coverage.
- After 12 months, the perineal region healed, allowing for the restoration of colonic continuity. Follow-up showed no recurrence.
Implications:
- Temporary fecal diversion combined with wide excision of fistulous tissues may be an effective ultimate treatment for complex, recurrent perianal fistulas.
- This approach can lead to successful disease resolution and improved patient outcomes in challenging cases.
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