Fistulas

Fistulas caused by pelvic tumours or post-radiotherapy include:-

♦ Rectovaginal

♦ Enterovaginal

♦ Colovesical

♦ Vesicovaginal

♦ Combination of above

Pre-operative assessment to determine the exact type is important. A proximal end sigmoid colostomy, which can usually be performed without a formal laparotomy, is the treatment of choice for most rectovaginal fistulas. Patients with combined rectovaginal and vesico-vaginal fistulas may need an end colostomy and ileal conduit. A covered stent, delivered endoscopically or at X-ray, should be considered for patients with a colovesical fistula. Patients with an entero-vesical fistula will require laparotomy resection of small bowel segment and anastomosis.

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