An unusual injury resulting in a jejuno-rectal stump fistula*
*Report considered for the Adrian Tanner Prize and presented at
the President's Day and AGM (Surgical Section) on 11th June
2004. The meeting took place at King's College Hospital.
S. Banerjee, O. D. Faiz, P. A. Kane and A. J. M. Leather
King's College Hospital, London, UK
Corresponding address: Mr S Banerjee MRCS (Ed) MRCS (Eng), Clinical Research Fellow,
Colorectal Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK
E-mail: sasban@hotmail.com
We report a case where anal intercourse resulted in a jejuno-rectal stump fistula. This occurred
in a 70-year lady who had undergone formation of ileal conduit and end colostomy earlier in
the same year. Previous gynaecological surgery for cancer of the cervix, radiation and multiple
surgical procedures for dyspareunia, urinary incontinence and vesico-rectal fistula were factors
responsible for a poor quality of life. Following an unsuccessful trial of conservative therapy with
total parenteral nutrition (TPN) for the high-output fistula, a surgical procedure was planned. An
injury to the jejunum adherent to the low rectal stump following previous surgery was identified
to be the cause. Resection of a short segment of jejunum and anastomosis was performed at
laparotomy. Histology of the specimen of jejunum revealed post-irradiation changes. The patient
was discharged following uneventful postoperative recovery. There are no reported instances of
such injury resulting in a fistula.
Key words
Anal intercourse; fistula; injury.
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