An acquired recto-perineal fistula as the outcome of sacrococcygeal teratoma treatment

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Abstract

Introduction. An acquired recto-perineal fistula in childhood is a quite rare pathology. One of its main causes is trauma of the perineal part of the rectum and anal canal. That is why, acquired rectoperineal fistulas most often develop after the correction of Hirschsprung’s disease and anorectal malformations.

Material and methods. The publication presents a rare case of a newborn child with recurrent course of an acquired rectoperineal fistula which developed after sacrococcygeal teratoma treatment. The teratoma was removed when the child was 3 days old. The surgery was complicated with suture dehiscence in the rectal wall defect. After suturing, a separate sigmostoma was placed. At the age of 6 months, the sigmostoma was closed, but after a few days, fistulas were found in the area of drainage and postoperative scar, which required sigmostoma restoration. After the prescribed therapy, the fistulas were obliterated; the stoma was closed again. In 2 weeks, child’s general condition deteriorated, and newly appeared fistulas were noted. It was decided to perform demucosation of the disconnected rectum above the level of anal sphincter and to make fistula through drainage via the rectum lumen.

Conclusion. Acquired recto-perineal fistulas in childhood is a rare recurrent disease. Though postoperative complications were detected in time, authors could not get independent closure of the fistula, despite numerous interventions. In fact, only the rectum extirpation allowed to separate the fistulous tract from the intestinal lumen. This type of intervention is considered a quite rare one; usually, such complication can be eliminated in a less radical way.

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About the authors

Victoria V. Kholostova

Pirogov Russian National Research Medical and Surgical Center; Filatov Children’s City Clinical Hospital

Author for correspondence.
Email: vkholostova@yandex.ru

associate professor, department of pediatric surgery, Pirogov Russian National Research Medical and Surgical Center

Россия, Moscow, 117997; Moscow, 123001

A. N. Smirnov

Pirogov Russian National Research Medical and Surgical Center; Filatov Children’s City Clinical Hospital

Email: vkholostova@yandex.ru
Россия, Moscow, 117997; Moscow, 123001

S. A. Vojna

2Filatov Children’s City Clinical Hospital

Email: vkholostova@yandex.ru
Россия, Moscow, 123001

V. S. Shumikhin

Pirogov Russian National Research Medical and Surgical Center; Filatov Children’s City Clinical Hospital

Email: vkholostova@yandex.ru
Россия, Moscow, 117997; Moscow, 123001

M. M. Gorokhova

Pirogov Russian National Research Medical and Surgical Center

Email: vkholostova@yandex.ru
Россия, Moscow, 117997

References

  1. Groom J.S., Nicholls R.J., Hawley P.R., Phillips R.K. Pouch-vaginal fistula. Br J Surg. 1993; 80: 936–40.
  2. Ашкрафт К.У., Холдер Т.М. Детская хирургия. СПб.: Пит – Тал; 1997. Т. 2. Ashkraft K.U, Holder T.M. Pediatric surgery [Detskaya khirurgiya]. St. Petersburg: Pit – Tal; 1997. V. 2. (In Russian)
  3. Ионов А.Л., Щербакова О.В. Послеоперационные осложнения в колоректальной хирургии у детей. Российский вестник детской хирургии, анестезиологии и реанематологии. 2013; (4): 58–8. Ionov A.L., Shcherbakova O.V. Postoperative complications in colorectal surgery in children. Rossijskij vestnik detskoj khirurgii, anesteziologii i reanematologii. 2013; (4): 58–8. (In Russian)
  4. Горелова: Е.М. Крестцово-копчиковая тератома (ККТ). Детская хирургия. 2016; 20(4): 194–9. Gorelova E.M. Sacrococcygeal teratoma. Detskaya khirurgiya (Russian Journal of Pediatric Surgery). 2016; 20(4): 194–9. (In Russian)
  5. Holschneider A.M., Hutson J.M. Anorectal Malformations in Children. Embryology, Diagnosis, Surgical Treatment, Follow-up. Berlin – Heidelberg: Springer Verlag; 2006.

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Patient K., 4th day of life. Asymmetric type teratoma, shifted to the right: a – appearance of the pelvic area; б – CT examination: type IV teratoma.

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3. Fig. 2. Fecal discharge through drainage on the 6th day after surgery.

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4. Fig. 3. Appearance of the patient at the age of 3 months, wound healing against the background of stomatology.

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5. Fig. 4. Fecal fistula in the wound area 5 days after closure colostomy.

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6. Fig. 5. Formation of chronic pararectal fistula and abscess of the buttock at the age of 1 year.

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7. Fig. 6. CT-fistulography – the cavity of the abscess is contrasted.

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8. Fig. 7. Diagram of the pararectal fistula and drainage.

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9. Fig. 8. Intraoperative photo: curettage (а) and drainage (б) of the pararectal fistula.

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10. Fig. 9. Operation diagram: а – the colostomy and the left half of the colon have been mobilized; б – the blind end of the rectal stump has been opened; в – the augmentation and formation of the anal canal; г – the reduction of the colon and the creation of a colo-rectal anastomosis.

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11. Fig. 10. Irrigation of the patient at the end of treatment – the contours and patency of the colon are not changed.

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12. Fig. 11. Appearance of the patient at the age of 6 years.

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Copyright (c) 2023 Kholostova V.V., Smirnov A.N., Vojna S.A., Shumikhin V.S., Gorokhova M.M.

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