Search This Blog

Sunday, April 22, 2012

CASE: RECURRENT FECAL FISTULA

Old aged male with h/o trauma 8 months back and operated for resection of 3.5 feets of ileum due to mesenteric tare..developed low level fistula from wound....discharging pus...

Was not subsided even after 6 months of surgery...worked up again and fistulogram suggested communication with bowel..taken up Unfortunately scrapping...and biopsy...and some resection was done (exact data not available)  Bx was sent from the fistula site: s/o tuberculosis!!

Following this surgery presented after 20 days of hospital stay with bile discharging from main wound

TLC:  22,000 , And hypotension with tachycardia and distension

CECT : plain and oral contrast demonstrated leak near terminal ileum....



surgery: exploration and removal of of dead omentum, lump, debridment of obscess, Rt quarter colectomy and ileostomy and mucus fistula...wound healed and pt discharged on POD 7 to home.


on exploration, with chronic fistulous tracts and dirty abscesses...

after clearing , lavage and resection...the relatively healthy looking bowel

HPE: s/o  atypical tuberculosis with granuloma p/o M. Kansasi

pt now started on COMBINATION AKT.