Closure of rectal-bladder fistula

This is an automatically translated article.

The article is professionally consulted by Master, Doctor Nguyen Thai Binh - Gastroenterologist - Department of General Surgery - Vinmec Ha Long International General Hospital.

1. The main cause of rectal-bladder fistula

Patients with rectal-bladder fistula are the consequences of diseases:
Patients with trauma in obstetrics. Patients with Crohn's disease or other inflammatory bowel diseases. Patients with cancer or after radiation therapy for pelvic disease. Complications after surgery related to vagina, perineum, rectum, anus...

2. Who is not indicated for surgery to close the rectal-bladder fistula?

When examined, the patient found:
The fistula was broken, the infection was severe... Rectal-bladder fistula due to Crohn's disease, tuberculosis... was progressing. The patient's general condition is seriously ill (heart failure, lung failure, shock, ..), the body is too weak, it is not safe for surgery.

3. Procedure to perform rectal-bladder fistula closure surgery

3.1 Doctor The person performing the rectal-bladder fistula surgery includes: 1 Gastrointestinal surgeon and may need the cooperation of a urologist. The surgery usually takes about 120 minutes to perform rectal-bladder fistula closure. 3.2 The patient has had necessary tests related to the surgery, such as the results of basic blood and urine tests, etc., and is eligible for surgery. The patient was diagnosed based on clinical symptoms (fecal and gas leakage through the bladder, urine flow through the anal opening), cystoscopy - rectal examination, examination with blue dye, endoscopy. bladder, computed tomography, magnetic resonance, endoscopic ultrasound,... Other tests were done to diagnose the cause of the rectal-colon fistula such as: Colonoscopy and colonoscopy. biopsy in Crohn's disease... The patient needs to clean the colon before surgery by giving an intestinal bleach (fortrans,...). The patient finished taking medication 2 hours before surgery. Patients will be given anesthesia with spinal anesthesia or endotracheal general anesthesia.

3.3 Carry out surgery to close the rectal-bladder fistula. Open the abdomen to the midline below the navel. Dissect into the sac with douglas, dissect the rectum from the posterior wall of the bladder, find the fistula. Bladder stage: Filter out the fistula, sew up 2 layers: Mucous membrane suture, sphincter separate. If the fistula is narrow, wide, and the bladder is infected, a combined bladder drainage is required. Rectal stage: Filter the fistula, suture 2 layers of mucosa and muscle. If the fistula is large and thin, then cut the rectum with the fistula. The colon is not well prepared, the rectum wall is inflamed, thick, mushy, ... must be protected by an artificial anus. 3.4 After surgery to close rectal-bladder fistula After finishing surgery to close rectal-bladder fistula, the patient will be taken to the recovery room for post-operative monitoring by nurses. Give the patient a metronidazole, a urinary tract antibiotic such as quinolone, or a combination of another antibiotic for 7 days. Parenteral nutrition. The bladder catheter was placed for about 7 days because the patient had to undergo spinal anesthesia during surgery, causing urinary retention. Urine culture is suspected when the patient has a urinary tract infection.

4. Caring for patients after surgery to close rectal-bladder fistula

Use pain relievers, antibiotics if necessary For patients to use laxatives, sedatives at night. Usually 500ml - 1000ml of intravenous fluids after surgery. Give the patient a light meal and early light exercise. Care of the incision: change the dressing every day, when there is an abnormal phenomenon such as bleeding, a lot of fluid, the incision must be checked. Soak the anus in warm water during certain surgeries as prescribed by the surgeon. Closure of rectal-bladder fistula is a rather complicated and time-consuming surgery. Patients need to go to reputable medical centers and treatment facilities to perform and ensure safety.

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