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      Rectovaginal Fistula as a Complication of Fecal Management System

      case-report

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          Abstract

          We report a rare complication of the use of an intrarectal catheter. An 18-year-old female with T-cell acute lymphoblastic leukemia post-matched unrelated donor allogeneic stem cell transplantation (auto-SCT) developed hepatic encephalopathy secondary to hepatic sinusoidal obstructive disease. A fecal management system was used to contain and divert fecal matter in this immobilized patient. Approximately 1 month after placement of an intrarectal catheter, stool was noted in the vaginal vault. Speculum examination confirmed development of a rectovaginal fistula.

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          Rectovaginal fistulas.

          J Bohl, T Debeche (2010)
          Rectovaginal fistulas are abnormal epithelial-lined connections between the rectum and vagina. They can be quite bothersome to both the patient and the surgeon due to their irritating and embarrassing symptoms and high failure rate after repair. An individualized, systematic approach to these fistulas based on their size, location, and etiology provides a more concise treatment plan. Treatment options of medical therapy, advancement flaps, plugs, fistula ligation, and tissue interposition are discussed.
          Article 0 comments Cited 19 times – based on 0 reviews     Review now
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            Clinical evaluation of a flexible fecal incontinence management system.

            Mary DeSane, J Wishin, Andrew M Stern … (2007)
            Management of fecal incontinence is a priority in acute and critical care to reduce risk of perineal dermatitis and transmission of nosocomial infections. To evaluate the safety of the Flexi-Seal Fecal Management System in hospitalized patients with diarrhea and incontinence. A prospective, single-arm clinical study with 42 patients from 7 hospitals in the United States was performed. The fecal management system could be used for up to 29 days. The first 11 patients (all from critical care) underwent endoscopic proctoscopy at baseline; 8 of these had endoscopy again after treatment. The remaining 31 patients (from critical or acute care) did not have endoscopy. Rectal mucosa was healthy after use of the device in all patients who had baseline and follow-up endoscopy. Physicians and nurses reported that the system was easy to insert, remove, and dispose of; its use improved management of fecal incontinence; and it was practical, caregiver- and patient-friendly, time-efficient, and efficacious. Skin condition improved or was maintained in more than 92% of patients. Patients' reports of discomfort, pain, burning, or irritation were uncommon. Adverse events were reported for 11 patients (26%). Death (considered unrelated to study treatment) occurred in 5 patients, 2 patients had generalized skin breakdown, and 1 patient had gastrointestinal bleeding after 4 days of treatment. The fecal management system can be used safely in hospitalized patients with diarrhea and fecal incontinence. Additional well-designed, controlled clinical trials may help to measure clinical and economic outcomes associated with the device.
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              The natural history and management of radiation induced injury of the gastrointestinal tract.

              J W REAGAN, Daniel Rhodes, W B WENTZ … (1969)
              Article 0 comments Cited 13 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Investig Med High Impact Case Rep
                Journal ID (iso-abbrev): J Investig Med High Impact Case Rep
                Journal ID (publisher-id): HIC
                Journal ID (hwp): sphic
                Title: Journal of Investigative Medicine High Impact Case Reports
                Publisher: SAGE Publications (Sage CA: Los Angeles, CA )
                ISSN (Electronic): 2324-7096
                Publication date (Electronic): 17 August 2019
                Publication date Collection: Jan-Dec 2019
                Volume: 7
                Electronic Location Identifier: 2324709619869368
                Affiliations
                [1 ]Augusta University Medical Center, Medical College of Georgia, Augusta, GA, USA
                Author notes
                [*]Sandeep Anand Padala, MD, Department of Medicine, Nephrology, Augusta University, Medical College of Georgia, 1120 15th Street, Augusta, GA 30912, USA. Email: spadala@ 123456augusta.edu
                Article
                Publisher ID: 10.1177_2324709619869368
                DOI: 10.1177/2324709619869368
                PMC ID: 6698988
                PubMed ID: 31423842
                SO-VID: 4b7237fc-0c00-4327-9b5f-4d20716de1c1
                Copyright © © 2019 American Federation for Medical Research
                License:

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 5 June 2019
                Date revision received : 16 July 2019
                Date accepted : 18 July 2019
                Categories
                Subject: Case Report
                Custom metadata
                cover-date January-December 2019

                Keywords: fecal management system,intrarectal catheter,rectovaginal fistula,veno-occlusive disease,fecal incontinence
                Data availability:
                Keywords: fecal management system, intrarectal catheter, rectovaginal fistula, veno-occlusive disease, fecal incontinence

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