Re: Entero-vaginal fistula
From: FRANCES WREN (fwren@shaw.ca)
Thu Mar 6 09:54:09 2008
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rachael I would agree with you ...I guess the internist just thinks that general surgeons know more!!!!
concerning the vagina I think not.
waste of money the CT I think.
frances wren
>----- Original Message -----
From: Rafael Haciski <haciski@earthlink.net>
Date: Wednesday, March 5, 2008 9:08 pm
Subject: Re: Entero-vaginal fistula
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net>
> Bernard had it right - there was absolutely nothing.
>
> She was not fat, the vagina was not overly large, but no
> fistulous
> tract of any kind was seen, no discharge (beyond scant usual
> white
> discharge).
> Since she had no symptoms (beyond the occasional vaginal
> flatulence
> upon arising from sitting position).
>
> Thus:
> .. being very unlikely that a fistula should spontaneously
> appear 5
> years after her surgery
> .. not seeing any significant symptoms (vaginal irritation,
> odor,
> discharge, etc)
> I saw no reason to subject her to any radiographic tests. And
> she
> concurred.
>
> Well, the internist who sent her to me, was not convinced, and
> then
> referred her to a general surgeon who in turn ordered a CT
> scan. No
> results yet.
>
> Rafael Haciski MD FACOG
> Anchor Health Centers GYN
> 800 Goodlette Rd #360
> 239-643-8780 office
> 239-571-0292 cell
> Naples, FL.
>
> On Mar 5, 2008, at 5:28 PM, D. Glen Elrod, MD wrote:
>
> > Rafael,
> >
> > Have you seen this patient yet? I have this exact patient
> coming to
> > see
> > me tomorrow. I'm curious if anything that was listed
> actually
> > worked on
> > this patient.
> >
> > Mine has known diverticular disease as her risk factor for
> her
> > fistula.
> >
> > Glen
> >
> > At Wed, 20 Feb 2008, Raymond Stephen wrote:
> >>
> >> First question should be, what in the history could have
> caused a
> >> fistula? They don't arise spontaneously. Then
> look for the
> >> hole. If
> >> you don't see it, the "gas" is probably entrapped air.
> If you still
> >> think there is a hole even though you haven't seen it, then
> an EUA
> >> with
> >> a finger stretching the rectovaginal septum from the rectal side.
> >> Usually the fistulous tract is scarred and contracted and
> that
> >> deformity
> >> can be felt even if not seen.
> >>
> >> Steve
> >>
> >> ________________________________
> >>
> >> ________________________________
> >> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On
> Behalf Of
> >> Rafael
> >>
> >> --
> >> ________________________________
> >> Haciski
> >> ________________________________
> >> Sent: Wednesday, 20 February 2008 3:28 AM
> >> To: Multiple recipients of list OB-GYN-L
> >> Subject: Entero-vaginal fistula
> >>
> >> I am having a pt referred to me for evaluation of "passing
> gas per
> >> vagina"
> >>
> >> Not having seen a fistula since residency days, I am looking
> for
> >> advice
> >> on which diagnostic modalities may be best suited to
> confirming
> >> such a
> >> fistula (beyond the physical exam at which time one may see
> the
> >> actual
> >> fistula, stool etc)., to delineate it's source, course etc.
> >>
> >> Rafael Haciski MD FACOG
> >>
> >> Anchor Health Centers GYN
> >>
> >> 800 Goodlette Rd #360
> >>
> >> 239-643-8780 office
> >>
> >> 239-571-0292 cell
> >>
> >> Naples, FL.
> >>
> >> CONFIDENTIALITY NOTICE AND DISCLAIMER
> >>
> >> The information in this transmission may be confidential
> and/or
> >> protected by legal professional privilege, and is intended
> only
> >> for the person or persons to whom it is addressed. If you are
> not
> >> such a person, you are warned that any disclosure, copying
> or
> >> dissemination of the information is unauthorised. If you
> have
> >> received the transmission in error, please immediately
> contact
> >> this office by telephone, fax or email, to inform us of the
> error
> >> and to enable arrangements to be made for the destruction of
> the
> >> transmission, or its return at our cost. No liability is
> accepted
> >> for any unauthorised use of the information contained in
> this
> >> transmission. If the transmission contains advice, the advice
> is
> >> based on instructions in relation to, and is provided to
> the
> >> addressee in connection with, the matter mentioned
> above.
> >> Responsibility is not accepted for reliance upon it by any
> other
> >> person or for any other purpose.
> >>
> >
>
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<DIV>rachael I would agree with you ...I guess the internist just thinks that general surgeons know more!!!!</DIV>
<DIV>concerning the vagina I think not.</DIV>
<DIV>waste of money the CT I think.</DIV>
><DIV>frances wren<BR><BR>----- Original Message -----<BR>From: Rafael Haciski <haciski@earthlink.net><BR>Date: Wednesday, March 5, 2008 9:08 pm<BR>Subject: Re: Entero-vaginal fistula<BR>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net><BR><BR>> Bernard had it right - there was absolutely nothing.<BR>> <BR>> She was not fat, the vagina was not overly large, but no <BR>> fistulous <BR>> tract of any kind was seen, no discharge (beyond scant usual <BR>> white <BR>> discharge).<BR>> Since she had no symptoms (beyond the occasional vaginal <BR>> flatulence <BR>> upon arising from sitting position).<BR>> <BR>> Thus:<BR>> .. being very unlikely that a fistula should spontaneously <BR>> appear 5 <BR>> years after her surgery<BR>> .. not seeing any significant symptoms (vaginal irritation, <BR>> odor, <BR>> discharge, etc)<BR>> I saw no reason to subject her to any radiographic tests. And <BR>> she <BR>> concurred.<BR>> <BR>> Well, the internist who sent her to me, was not convinced, and <BR>> then <BR>&
gt; referred her to a general surgeon who in turn ordered a CT <BR>> scan. No <BR>> results yet.<BR>> <BR>> <BR>> Rafael Haciski MD FACOG<BR>> Anchor Health Centers GYN<BR>> 800 Goodlette Rd #360<BR>> 239-643-8780 office<BR>> 239-571-0292 cell<BR>> Naples, FL.<BR>> <BR>> <BR>> On Mar 5, 2008, at 5:28 PM, D. Glen Elrod, MD wrote:<BR>> <BR>> > Rafael,<BR>> ><BR>> > Have you seen this patient yet? I have this exact patient <BR>> coming to <BR>> > see<BR>> > me tomorrow. I'm curious if anything that was listed <BR>> actually <BR>> > worked on<BR>> > this patient.<BR>> ><BR>> > Mine has known diverticular disease as her risk factor for <BR>> her <BR>> > fistula.<BR>> ><BR>> > Glen<BR>> ><BR>> > At Wed, 20 Feb 2008, Raymond Stephen wrote:<BR>> >><BR>> >> First question should be&
#044; what in the history could have <BR>> caused a<BR>> >> fistula? They don't arise spontaneously. Then <BR>> look for the <BR>> >> hole. If<BR>> >> you don't see it, the "gas" is probably entrapped air. <BR>> If you still<BR>> >> think there is a hole even though you haven't seen it, then <BR>> an EUA <BR>> >> with<BR>> >> a finger stretching the rectovaginal septum from the rectal side.<BR>> >> Usually the fistulous tract is scarred and contracted and <BR>> that <BR>> >> deformity<BR>> >> can be felt even if not seen.<BR>> >><BR>> >> Steve<BR>> >><BR>> >> ________________________________<BR>> >><BR>> >> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On <BR>> Behalf Of <BR>> >�
38;gt; Rafael<BR>> >><BR>> >> --<BR>> >> ________________________________<BR>> >> Haciski<BR>> >> Sent: Wednesday, 20 February 2008 3:28 AM<BR>> >> To: Multiple recipients of list OB-GYN-L<BR>> >> Subject: Entero-vaginal fistula<BR>> >><BR>> >> I am having a pt referred to me for evaluation of "passing <BR>> gas per<BR>> >> vagina"<BR>> >><BR>> >> Not having seen a fistula since residency days, I am looking <BR>> for <BR>> >> advice<BR>> >> on which diagnostic modalities may be best suited to <BR>> confirming <BR>> >> such a<BR>> >> fistula (beyond the physical exam at which time one may see <BR>> the <BR>> >> actual<BR>> >> fistula, stool etc)., to delineate it's source, course etc.<BR>> >&g
t;<BR>> >> Rafael Haciski MD FACOG<BR>> >><BR>> >> Anchor Health Centers GYN<BR>> >><BR>> >> 800 Goodlette Rd #360<BR>> >><BR>> >> 239-643-8780 office<BR>> >><BR>> >> 239-571-0292 cell<BR>> >><BR>> >> Naples, FL.<BR>> >><BR>> >> CONFIDENTIALITY NOTICE AND DISCLAIMER<BR>> >><BR>> >> The information in this transmission may be confidential <BR>> and/or <BR>> >> protected by legal professional privilege, and is intended <BR>> only <BR>> >> for the person or persons to whom it is addressed. If you are <BR>> not <BR>> >> such a person, you are warned that any disclosure, copying <BR>> or <BR>> >> dissemination of the information is unauthorised. If you <BR>> have <BR>> >> received the transmission in error, please immediately <BR>>
; contact <BR>> >> this office by telephone, fax or email, to inform us of the <BR>> error <BR>> >> and to enable arrangements to be made for the destruction of <BR>> the <BR>> >> transmission, or its return at our cost. No liability is <BR>> accepted <BR>> >> for any unauthorised use of the information contained in <BR>> this <BR>> >> transmission. If the transmission contains advice, the advice <BR>> is <BR>> >> based on instructions in relation to, and is provided to <BR>> the <BR>> >> addressee in connection with, the matter mentioned <BR>> above. <BR>> >> Responsibility is not accepted for reliance upon it by any <BR>> other <BR>> >> person or for any other purpose.<BR>> >><BR>> ><BR>> <BR>> </DIV>
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