Re: Entero-vaginal fistula
From: Joanne Bulley, MD (islesannie@gmail.com)
Thu Mar 6 23:15:35 2008
Even if there is a microscopic one that you couldnt find - I bet a CT
would be even less likely to show it.
I usually do a vaginal culture also. If you get "normal vaginal flora"
or "normal urogenital flora" (instead of standard colonic bacteria) that
is also suggestive that there is not a connection to the rectum.
I have a patient who has Chron's and is convinced she has a fistula -
and her term for the vaginal flatulence is "quaffing". Vag culture is
the nml urogen flora and no sign of any tract whatsoever. We had long
discussions about more major exams and work ups but also discussed WHY
do the work up - HOW would it affect her care. Since she has no symptom
worse than the air passed per vagina she would not have anything done
about it - so we did no work up.
Joanne
At Wed, 5 Mar 2008, Rafael Haciski wrote:
>
>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.
>>>
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--
Joanne Bulley, MD, FACOG
Solo gyn
Keene, NH USA
