medical notes

Apr 17th, 2015
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FISTULASIntroduction: Fistulas in gynecologic surgery are associated with malignancy;prior radiation therapy; intraoperative bowel, bladder, or ureteralinjury; and obstetric trauma (e.g. fourth-degree lacerations,breakdown of episiotomy repairs). Vesicovaginal, rectovaginal, and enterocutaneous fistulas are themost commonly seen of this rare complication. Rectovaginal fistulas occur after obstetric trauma or vaginalsurgery. Primary transvaginal repair has an approximately 90% success ofclosure. Larger, recurrent, or irradiated defects may require divertingcolostomy while the repair heals Enterocutaneous fistulas may present initially with wounderythema, followed by feculent drainage from the incision site. Treatment of enterocutaneous fistulas consists of keeping thepatient from oral intake over a period of 2-4 weeks,supplementation with total parenteral nutrition, and nasogastricdecompression. If spontaneous closure does not occur, surgical repair will benecessary.Vesicovaginal fistulaDefinition Vesicovaginal fistula (VVF) is a subtype of female urogenitalfistula (UGF). A VVF is an abnormal communication between the urinarybladder and the vagina that results in the continuousinvoluntary discharge of urine into the vaginal vaultEpidemiology In developing countries, the predominant cause of VVF isprolonged obstructed labor (97%). VVFs are associated with marked pressure necrosis, edema,tissue sloughing, and

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