Treatment of fistula-in-ano by lift procedure: a preliminary report

Fistulization of the large intestine with the female genital organs is a frequent complication of diverticular disease complicated, and occurs mostly in patients who have previously undergone hysterectomy. Patients typically present with loss of material fecaloid or gas from the vagina, preceded by abdominal pain that resolved with the release of material vaginal. The percentage of fistulas after an episode diverticulitis is less than 5% (1-2%): of these, less than a quarter develops fistulas with the female genital tract, in fact in most cases the fistulization occurs with the bladder. Other possible causes of fistula between the intestinal tract and the genital are: irradiation of the pelvis, neoplasms of colon cancer, inflammatory bowel disease (especially Crohn’s disease). Traditionally, the treatment of fistulas article-genital surgical-type “multi-step”: there are several treatment options guided by the “degree” of diverticular disease and basic organ involved (fallopian tubes, uterus, vagina). Typically using a three-step approach: proximal colostomy followed at a later time by resection and anastomosis tract affection and finally closing the colostomy; or two-step approach with Hartmann’s procedure (resection with colostomy proximal and subsequent restoration of the continuity digestive). Key words: Diverticulitis - Vasovasostomy - Fistula. La creazione di una fistola cologenitale è un evento molto raro, le cause più frequenti possono essere una malattia diverticolare del colon sinistro, una neoplasie dell’utero, postchirurgica negli interventi di isterectomia, post irradiazione della regione pelvica, una malattia infiammatoria cronica intestinale o causata da traumi da corpi estranei. La sintomatologia è caratterizzata soprattutto da dolori addominali, con presenza di uno stato febbrile e perdite fecali dalla vagina. Caso clinico Paziente donna di anni 70, con anamnesi patologica remota positiva per ipertensione arteriosa, HBV positiva, malattia diverticolare del colon ed isterectomia per leiomiosi (circa 20 anni prima). Viene riferita da circa un anno la presenza di improvvisi dolori addominali