Uterine Fistula

About: Uterine Fistula is a research topic. Over the lifetime, 131 publications have been published within this topic receiving 931 citations.

Spontaneous healing in a vesico-uterine fistula following labor: report of case

Abstract: The patient here discussed was first seen by me after she had been in labor for sixty hours, with the bag of waters ruptured at the onset of the pains. In the interim an ampule of pituitary extract had been administered and had given rise to intense pain. During this time numerous vaginal examinations had been made without attention to asepsis. The patient was sent to the hospital, where vaginal examination revealed a long, soft, cuff-like cervix with an os of 5 cm. The head was not engaged, and the sagittal suture was in the transverse diameter. A number 3 Voorhees bag, which was inserted and ballooned, was expelled after fifty minutes and the cervix was almost completely dilated but not wholly effaced. On account of the rapidity of fetal heart tones, the atonicity of the uterine musculature and the weakened condition of the mother, labor was terminated at once.

Surgical management of sigmoidovesical and sigmoido-uterine fistula complicating diverticulitis

Abstract: FISTULAS between the siganoid flexure and the bladder or the uterus are uncommon. T h e most frequent cause of fistulas of this type is diverticulitis involving the sigmoid flexure. Carcinoma of the sigmoid is the second most common cause. Al though diverticulitis is the usual causative factor in sigmoidovesical or sigmoido-uterine fistulas, this complicat ion is encountered rarely. Surgical management of these complicated conditions is frequently difficult and the choice of t reatment often presents a perplexing problem to the surgeon. Our purpose in prepar ing this review is to repor t our experience with sigmoidovesical and sigmoido-uterine fis'ulas as complications of diverticulitis. Material for this review was obtained from records of a series of patients treated consecutively in the Depar tment of Proctology of Temple University Medical Center f rom September 1940 to May 1960. Dur ing that period of time 253 patients with diverticulitis of the colon were treated. There were 114 males and 139 females. T h e ages of these patients ranged f rom eight to more than 80 years. T h e majori ty of cases occurred dur ing the sixth and seventh decades. Of this group of 253 patients, fistulas were encountered in 21 (8.3 per cent). Various authors report a similar incidence. T h e preponderance of sigmoidovesical fistulas occurs in males. Of our 21 cases, 17 were males. This high incidence in males is due, undoubtedly, to the protection which the uterus affords the bladder in females. Only two of the four women in this series had sigmoido-uterovesical fistulas, one had a sigmoido-uterine fistula and one, who had had a previous hysterectomy, had a sigmoidovesical fistula (Table 1). Surgical T r e a t a m e n t : In this group of 21 patients single-stage procedures were employed in ten. These were patients with chronic diverticulitis and chronic sigmoidovesical fistulas wi thout evidence of acute abscess or suppurat ion. In these ten patients resection of the sigmoid flexure and part ial cystectomy was pe r fo rmed in one stage without colostomy. T h e other 11 patients underwent stage procedures. These included prel iminary transverse colostomy, resection of the sigmoid with concomitant part ial cystectomy and occasional cystostomy, or hysterectomy, and subsequent closure of the colostomy. T h e r e was no mortality in either group (Table 2). Th ree cases are repor ted to i l lustrate the type of problem encountered in these complicated conditions.