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Re: RV fistulaFrom: Raymond Stephen (stephen.raymond@dhhs.tas.gov.au)Wed Aug 31 20:31:39 2005
Your thought about a malignancy is probably number one to be excluded. Carcinoma rectum would explain the history and findings very well. A rectal examination with a finger would be useful. Management? Your favourite colorectal surgeon! Steve -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Wednesday, 31 August 2005 1:17 PM To: Multiple recipients of list OB-GYN-L Subject: GYN: RV fistula 84 YO P2002 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
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