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Re: GYN: RV fistula From: Dr. Ainsworth (ainsron@sbcglobal.net) Wed Aug 31 10:18:19 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: William D. McIntosh, M.D: "Re: GYN: RV fistula" Previous message: Efrain Ramirez: "Re: Cervical insufficiency vs preterm uterine contractions or both??" In reply to: Garry E. Siegel, M.D.: "GYN: RV fistula" Next in thread: William D. McIntosh, M.D: "Re: GYN: RV fistula" Love those nursing home consults with not equipment available. You described my experiences to a "T." I think you are exactly right, she needs a colonoscopy, exam under anesthesia and would probably benefit from a diversion, which could be temporary if you find a repairable RV fistula and no malignancy. Inflammatory bowel disease is also a possible cause. At her age with poor surgical risks, she would more likely be a candidate for a permanent diverting colostomy. >84 YO P2002 in nursing home (unsure why) was hospitalized a local small >hospital with severe pneumonia, and is just out of ICU. My practice was >called for a consult for severe vulvar pain and a history of an RV >fistula. All things considered, the patient is a pretty good historian, >and that is pretty much where my information is from. > >She had an RV fistula diagnosed by the "nurse" at the nursing home in >March, 2005. She is incontinent of stool, had vaginal deliveries, and >never has had radiation, etc. Since March, she really hasn't had much >vulvar irritation or pain except once, and now since being in the >hospital. > >This is about all the history I took, frankly. > >On exam in the hospital bed on an inverted bedpan (no pelvic tables in >this hospital, and the only light is with a flashlight), there is stool >everywhere. After cleaning up (several nurses/aides/me), the vulva is >diffusely edematous and erythematous, and the perineal body is intact. >On a spec exam with a plastic, lighted ER speculum, stool immediately >fills it. On a digital exam, there is a hole in the vaginal floor, >around 1.5 cm., just below the cervix. > >So. . . > >Does anyone have any suggestions here? Obviously, it would be nice to >examine her properly, I suppose, and see if there is a reason >(malignancy) for the fistula. She is really not a surgical candidate, >and I have zilch experience here. There is a part of me that almost >thinks she needs a diversion. . . > >In the meantime, I made the assumption that this is probably yeast that >has gotten bad after the antibiotics killed her flora, and thus I have >given her Diflucan 150 mg. every 3 days for 3 doses, and suggested >Mycolog II cream and trying Silvadene. > >Any thoughts on comfort measures or anything else welcome. > >Garry > >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA > Next message: William D. McIntosh, M.D: "Re: GYN: RV fistula" Previous message: Efrain Ramirez: "Re: Cervical insufficiency vs preterm uterine contractions or both??" In reply to: Garry E. Siegel, M.D.: "GYN: RV fistula" Next in thread: William D. McIntosh, M.D: "Re: GYN: RV fistula"

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