Cecocutaneous fistula diagnosed by computed tomography fistulography:A case report

BACKGROUND Enterocutaneous fistula(ECF) is an abnormal communication between the skin and the gastrointestinal tract and is associated with considerable morbidity and mortality. To diagnose ECF, X-ray fistulography and abdominal computed tomography(CT) with intravenous or oral contrast are generally used. If the anatomic details obtained from CT are insufficient, CT fistulography may help diagnose and determine the extent of the abnormal channel. However, CT fistulography is seldom performed in patients with insufficient evidence of a fistula.CASE SUMMARY A 35-year-old man with a prior appendectomy presented with purulence over the abdominal wall without gastrointestinal tract symptoms or a visible opening on the abdominal surface. His history and physical examination were negative for nausea, diarrhea, muscle guarding, and bloating. Local abdominal tenderness and redness over a purulent area were noted, which led to the initial diagnosis of cellulitis. He was admitted to our hospital with a diagnosis of cellulitis. We performed a minimal incision on the carbuncle to collect the pus. The bacterial culture of the exudate resulted positive for Enterococcus sp. ECF was thus suspected, and we arranged a CT scan for further investigation. CT images before intravenous contrast administration showed that the colon was in close contact with the abdominal wall. Therefore, we conducted CT fistulography by injecting contrast dye into the carbuncle during the CT scan. The images showed an accumulation of the contrast agent within the subcutaneous tissues, suggesting the formation of an abscess. The contrast dye tracked down through the muscles and peritoneum into the colon, delineating a channel connecting the subcutaneous abscess with the colon. This evidence confirmed cecocutaneous fistula and avoided misdiagnosing ECF without gastrointestinal tract symptoms as cellulitis. The patient underwent laparoscopic right hemicolectomy with re-anastomosis of the ileum and transverse colon.CONCLUSION CT fistulography can rule out ECF in cases presenting as cellulitis if examinations are suggestive.

High-resolution direct magnetic resonance imaging fistulography with hydrogen peroxide for diagnosing anorectal fistula: A preliminary retrospective study

BACKGROUND Fistula-in-ano is an abnormal tunnel formation linking the anal canal with the perineum and perianal skin.Multiple imagining methods are available to evaluate it,among which magnetic resonance imaging(MRI)is the most advanced nonin-vasive preoperative method.However,it is limited in its visualization function.AIM To investigate the use of intraluminal MRI for perianal fistulas via a novel direct MRI fistulography method.METHODS We mixed 3%hydrogen peroxide(HP)with gadolinium for HPMRI fistulogra-phy,retrospectively analyzing 60 cases of complex/recurrent fistula-in-ano using physical examination,trans-perineal ultrasonography(TPUS),low-spatial-reso-lution MRI,and high-resolution direct HPMRI fistulography.We assessed detec-tion rates of fistula tracks,internal openings,their relationship with anal sphinc-ters,and perianal abscesses using statistical analyses,including interobserver agreement(Kappa statistic),and compared results with intraoperative findings.RESULTS Surgical confirmation in 60 cases showed that high-resolution direct HPMRI fis-tulography provided superior detection rates for internal openings(153)and fistula tracks(162)compared to physical exams,TPUS,and low-spatial-resolution MRI(Z>5.7,P<0.05).The effectiveness of physical examination and TPUS was also inferior to that of our method for detecting perianal abscesses(54)(Z=6.773,3.694,P<0.05),whereas that of low-spatial-resolution MRI was not significantly different(Z=1.851,P=0.06).High-resolution direct HPMRI fistulography also achieved the highest interobserver agreement(Kappa:0.89,0.85,and 0.80),while low-spatial-resolution MRI showed moderate agreement(Kappa:0.78,0.74,and 0.69).TPUS and physical examination had lower agreement(Kappa range:0.33-0.63).CONCLUSION High-resolution direct HPMRI fistulography enhances the visualization of recurrent and complex fistula-in-ano,including branched fistulas,allowing for precise planning and improved surgical outcomes.

Congenital bronchobiliary fistula: A case report and review of the literature

BACKGROUND Congenital bronchobiliary fistula is a rare developmental abnormality with an abnormal fistula between the respiratory system and biliary tract. The aim of this report is to analyze and summarize the clinical features and experience of diagnosing and treating congenital bronchobiliary fistula(CBBF) occurring in the neonatal period.CASE SUMMARY The onset of symptoms was 3 d after birth in our patient with progressive cyanosis and respiratory distress, and a large amount of green fluid was noticed in her respiratory secretion. We performed computed tomography(CT),fiberoptic bronchoscopy, and cholangiography to make a diagnosis, as well as fistulography with a bronchoscope for the first time. These examinations provided us with valuable images to make a correct diagnosis. The fistula was dissected and removed with excellent results. Surgical removal of the fistula was successful, and the baby recovered well and was discharged. She has been followed for 4 mo without any signs of discomfort.CONCLUSION The main symptom of CBBF is bile-like sputum. CT, bronchoscopy,fistulography, and intraoperative cholangiography can provide important evidence for diagnosis. Surgical resection of the fistula is the first choice of treatment.