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Suggest Treatment For Abdominal Sinus And A Vaginal Fistula
Question: Hello - I'm female aged 55 - in January I had a hysterectomy and my bowel perforated. This wasn't as a result of neglect - it was down to years of endometriosis which had been treated by repeatedly draining cysts on my ovaries - the area at the top of my vagina was very stuck. I had already had an Ileostomy 30 years ago for ulcerative colitis. Anyway I spent 3 months in hospital - they didn't operate to repair the perforation, they wanted it to heal spontaneously. I am now 7 moths post surgery - I have abdominal sinus and a vaginal fistula which depress me greatly, that said I am well with good appetite, I am actually overweight, my stoma works well but I have to wear dressings on the abdomen although the output is quite low. There is no evidence of chrons disease. At the moment I feel my life is ruined and feel so depressed, I am afraid it will never heal or further surgery will make matters worse. I find it hard to deal with the uncertainty of it all. My first grandchild is due in a few months and I feel this is spoiling everything. Have you any advice or reassurance please.
Brief Answer:
correction of Deficiencies & few investigations please.
Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
I can understand the plight you must have gone in the past and going through now.
Noted all the history you have provided about ileostomy 30 years ago for ulcerative colitis, endometriosis, hysterectomy with perforation of the intestine - 7 months post-op, have abdominal sinus and a vaginal fistula - fear of not healing or further surgery make matter worse -
After reading and re-reading your history I have some points to make and may help us to find a solution:
- First of all I would like to know your Hemoglobin and serum protein values, particularly albumin. Anemia and Hypo-proteinemia are one of the commonest reasons for delayed healing or non-healing.
If corrected properly may help for spontaneous healing.
- Correction of deficiency of Vitamins and mineral- particularly Vitamin A and D; these are very important for healing and you might lack them due to enteric fistula not allowing proper absorption.
- The dictum of intestinal fistula is: if the distal passage is patent the proximal fistulas must heal.
This can be studies by Barium study done by pitting a catheter through the fistula to visualize the distal bowel loop to if there is any kinking, stricture and so on. If present and corrected this will make the fistula heal.
- The vaginal fistula: if is just a sinus or connected to any other passage like bowel or bladder? Above factors will help to get this heal too. If this is just a sinus the diseased part excision can help the healing.
- Surgery is required only if needed.
I hope this insight will help you to recover fully.
Please give me the feedback and we shall discuss further till you are healed well. I shall be very happy to assist you.
correction of Deficiencies & few investigations please.
Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
I can understand the plight you must have gone in the past and going through now.
Noted all the history you have provided about ileostomy 30 years ago for ulcerative colitis, endometriosis, hysterectomy with perforation of the intestine - 7 months post-op, have abdominal sinus and a vaginal fistula - fear of not healing or further surgery make matter worse -
After reading and re-reading your history I have some points to make and may help us to find a solution:
- First of all I would like to know your Hemoglobin and serum protein values, particularly albumin. Anemia and Hypo-proteinemia are one of the commonest reasons for delayed healing or non-healing.
If corrected properly may help for spontaneous healing.
- Correction of deficiency of Vitamins and mineral- particularly Vitamin A and D; these are very important for healing and you might lack them due to enteric fistula not allowing proper absorption.
- The dictum of intestinal fistula is: if the distal passage is patent the proximal fistulas must heal.
This can be studies by Barium study done by pitting a catheter through the fistula to visualize the distal bowel loop to if there is any kinking, stricture and so on. If present and corrected this will make the fistula heal.
- The vaginal fistula: if is just a sinus or connected to any other passage like bowel or bladder? Above factors will help to get this heal too. If this is just a sinus the diseased part excision can help the healing.
- Surgery is required only if needed.
I hope this insight will help you to recover fully.
Please give me the feedback and we shall discuss further till you are healed well. I shall be very happy to assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr Chandrakant for your reply. To answer your questions -
I have regular bloods and have been assured they are all normal. I know my haemoglobin is 135 and my White blood count is 7.1 - hope this makes sense. We are not given out blood test results in the UK but my GP tells me they are all good with the inflammatory markers all good. The plasma viscosity was slightly abnormal and a swab of one of the sinus holes showed a stap? Infection so I am now on antibiotics. The discharge from the fistula / sinus is low requiring coverage with gauze plus the wearing of a pad. My surgeon tells me there is a pocket of inflammation at the top of the vagina and this is where the perforation occurred. It is assumed a small leak remains but this did not show up on CT. I had a small bowel MRI which also did not show a definit leak just a pocket of inflammation. It also confirmed my bowel shows no evidence of any chrons disease or strictures. This inflammation has created the fistula / sinus holes. I have no fever or stomach pain. I take a multi vitamin tablet daily . I eat a high protein diet which is based in chicken, fish and eggs. I am however psychologically traumatised and afraid of more surgery in case it too goes wrong. My first grandchild is due in a few months and I so want to be well. Thank you for your reply - most fistula stories on line are very depressing. I don't understand though how there can be anything major going on as I am well and actually gaining weight not losing it. Thanks again Doctor.
I have regular bloods and have been assured they are all normal. I know my haemoglobin is 135 and my White blood count is 7.1 - hope this makes sense. We are not given out blood test results in the UK but my GP tells me they are all good with the inflammatory markers all good. The plasma viscosity was slightly abnormal and a swab of one of the sinus holes showed a stap? Infection so I am now on antibiotics. The discharge from the fistula / sinus is low requiring coverage with gauze plus the wearing of a pad. My surgeon tells me there is a pocket of inflammation at the top of the vagina and this is where the perforation occurred. It is assumed a small leak remains but this did not show up on CT. I had a small bowel MRI which also did not show a definit leak just a pocket of inflammation. It also confirmed my bowel shows no evidence of any chrons disease or strictures. This inflammation has created the fistula / sinus holes. I have no fever or stomach pain. I take a multi vitamin tablet daily . I eat a high protein diet which is based in chicken, fish and eggs. I am however psychologically traumatised and afraid of more surgery in case it too goes wrong. My first grandchild is due in a few months and I so want to be well. Thank you for your reply - most fistula stories on line are very depressing. I don't understand though how there can be anything major going on as I am well and actually gaining weight not losing it. Thanks again Doctor.
Brief Answer:
You surely heal have a best healing.
Detailed Answer:
Thanks again for your elucidate feedback.
Hemoglobin of 135 is absolutely fine.
Well, antibiotics will take care of the staph infection.
I was just wondering to know- whether there is just a leakage of some fluid or feces too from either of the wounds.
If the wound on the abdominal wall is not discharging feces/stool, it should have healed by this time. One can go for exploration of the tract removed the debris / unhealthy tissues like the fat and such tissues and the tract may just heal well.
This is the simplest surgery that can cure the problems.
It is good that you are taking proper supplements and hope that both the things will heal by the time the grand-child will be borne.
Please stop reading the fistula stories on internet as the ones those heal up are never bothered to share on internet but everyone who is not befitted will share and make others to get bothered.
I am sure you will heal up very fast.
Please request your Doctor for Serum proteins, albumin test.
You surely heal have a best healing.
Detailed Answer:
Thanks again for your elucidate feedback.
Hemoglobin of 135 is absolutely fine.
Well, antibiotics will take care of the staph infection.
I was just wondering to know- whether there is just a leakage of some fluid or feces too from either of the wounds.
If the wound on the abdominal wall is not discharging feces/stool, it should have healed by this time. One can go for exploration of the tract removed the debris / unhealthy tissues like the fat and such tissues and the tract may just heal well.
This is the simplest surgery that can cure the problems.
It is good that you are taking proper supplements and hope that both the things will heal by the time the grand-child will be borne.
Please stop reading the fistula stories on internet as the ones those heal up are never bothered to share on internet but everyone who is not befitted will share and make others to get bothered.
I am sure you will heal up very fast.
Please request your Doctor for Serum proteins, albumin test.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you doctor - the sinus holes and vagina do discharge a liquid but it is not faecal. It is a sort of creamy colour and does not make my skin sore or anything. Most of the swabs taken have not shown anything but as I say the last one did show a staph infection.
I think the internet horror stories have not helped and have made me very depressed so I will stop seeking out these horror stories. If the holes are not leaking faeces - where could this liquid be coming from? I suppose that is the answer I am seeking - I know my surgeon is reluctant to do any more surgery until at least a year has passed.
Think this is the last question I am allowed now.
Thank you
I think the internet horror stories have not helped and have made me very depressed so I will stop seeking out these horror stories. If the holes are not leaking faeces - where could this liquid be coming from? I suppose that is the answer I am seeking - I know my surgeon is reluctant to do any more surgery until at least a year has passed.
Think this is the last question I am allowed now.
Thank you
Brief Answer:
This is curable in very small exploration Surgeon
Detailed Answer:
You may further carry on if you like to or contact me on the link below:
http://bit.ly/askdrtchandrakant
...
Yes, please stop searching internet.
As per the history you have given: the sinus holes and vagina do discharge a liquid but it is not faecal. It is a sort of creamy colour and does not make my skin sore or anything
If the holes are not leaking faeces - where could this liquid be coming from?
This means these are just sinuses that have not healed. Blind loops without any connection to any of the internal structures.
These should really heal the best by exploration and removal of the sinus tracts and the unhealthy tissue.
I have a feeling that if these procedures are done nicely, there is a chance of cure before you become grandmother.
Go for it.
You may take a second opinion of another XXXXXXX Surgeon.
This is curable in very small exploration Surgeon
Detailed Answer:
You may further carry on if you like to or contact me on the link below:
http://bit.ly/askdrtchandrakant
...
Yes, please stop searching internet.
As per the history you have given: the sinus holes and vagina do discharge a liquid but it is not faecal. It is a sort of creamy colour and does not make my skin sore or anything
If the holes are not leaking faeces - where could this liquid be coming from?
This means these are just sinuses that have not healed. Blind loops without any connection to any of the internal structures.
These should really heal the best by exploration and removal of the sinus tracts and the unhealthy tissue.
I have a feeling that if these procedures are done nicely, there is a chance of cure before you become grandmother.
Go for it.
You may take a second opinion of another XXXXXXX Surgeon.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Thank you again for your reassuring reply. It is a lonely journey but I must be more positive,
No searching Internet as all stories are horrible,
Many thanks again,
No searching Internet as all stories are horrible,
Many thanks again,
Brief Answer:
You will be cured.
Detailed Answer:
Thanks for your appreciation.
You are never alone although you feel so.
Please follow the guidelines and the outcome will be positive.
Please maintain nice hemoglobin, proteins, the positive attitude.
Please give me feedback.
Wishing you all the best for complete recovery.
You will be cured.
Detailed Answer:
Thanks for your appreciation.
You are never alone although you feel so.
Please follow the guidelines and the outcome will be positive.
Please maintain nice hemoglobin, proteins, the positive attitude.
Please give me feedback.
Wishing you all the best for complete recovery.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Sonia Raina
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