PPT Jurnal Tubacutaneus Fistula-dr Johan M.H Sp.og

Case Report Tubacutaneus Fistula

Presentant: Kevin Ardiansyah NIM : 11-2013-265 Consulant: dr. ohan M !uta"arat #$.%& '#() *A'AKAN )+PA'*M+N* %, %#*+*' AN) &N+C%/%& 

Introduction  &yneoloist is a4iliar ith : vesiovainal uretrovainal and retovainal istulae.  ,istula *u"autaneus is rare ase  no ase is re$orted reardin tu"outaneus istula.  In this ase  the istula tu"autaneus is develo$ed ater treatin the $elvi a"sess.  *he istula e7tended ro4 the riht allo$ian tu"e to the riht roin alon the anato4ial $ath o the round

Case Report   A 80 years old o4an ith 2 $revious nor4al deliveries $resented to sureon at Kin9s Mill !os$ital in a$ril 2013 :   3-year history o inter4ittently disharin $ersistent riht roin sinus.  *he dishare is $urulent

 Past 4edial history  /a$aroto4y or ru$tured $yosal$hin7 in 2000  'eurrent a"do4inal $ain in 200; and 2011 &ive antio"ioti and o$tion to $elvi learane and 

Case Report  +7a4ination  #ureon noted

 )isharin sinus o the riht roin < d : !idraadenitis.



 C* #inora4  +7tendin ro4 the riht roin rease to the riht adne7a ith the ontrast tra=in "ehind uterus and the u$$er vaina 

 *hen the $atient reerred to the yneoloy tea4

 &yneoloial asses4ent and e7a4ination  !istory sinus.

 'iht illia ossa $ain and onstant dishare ro4 the riht roin



  A"do4inal Pelvi

 Midline la$arato4y sar and disharhin riht roin sinus.



 'edued 4o"ility o the $elvi oran and thi=enin o riht adne7al

Case Report   Ater liaisin ith the sureon  *he $lan 4ade or la$aroto4y riht sal$hinoooore=to4i and e7ition o istulous trat  *he $atient as inor4ed reardin the ris= to ad>eent  vasular strutures due to $ro7i4ity o the trat to the 4a>or  "lood vessels.

 May 2? 2018  the $atient had la$aroto4y under the >oint are o the yneoloist and sureon.  'esult :   Nor4al let tu"e and ovary hih as attahed to let $elvi side all. *he uterus as nor4al and she had nor4al riht ovary and

Case Report  'esult  *he istulous trat as o44uniatin to the ornual end o the allo$ian tu"e $osterior to the round lia4ent@ it then olloed the $ath o the round lia4ent  o$enin at the level o the inuinal rin in the riht roin 

Case Report  %$eration $roedure  'iht sal$hine=to4i as $eror4ed  'iht round lia4ent as divided near the riht ornual end o the uterus@ a riht roin istulous trat o 3 4 as e7ised.

 !isto$hatoloy  Pyosal$hin7 ith the eatures o hroni and aute inla44ation ith 4iroa"sesses and istulous trat shoin inla44atory ranulation tissue  ithout evidene o 4alinany.

 *he $atient as dishared ho4e on the 3rd $ost

Case Report  *hen the $atient as read4itted on the o$erative day ith headache.

6th

$ost

 *hen she as seen "y anesthetist ho treated her  ith a "lood $ath or $ostdural headahe.  *he $atient 4ade ood $osto$erative reovery olloed "y the "lood$ath and she as dishared ho4e on the ;th $osto$erative day.  ; ee=s later  the $atient revieed in lini  she had 4ade a ood reovery ith o4$letely healed riht 

Discussion  *he o44uniation "eteen the allo$ian tu"e and s=in is very rare.  +tioloy      



%"stetri surial Pelvi inla44atory disease +ndo4etriosis *u"erulosis Pelvi irradiation Inla44atory "oel disease  And $elvi surery 

Discussion  In our ase  *he istulous trat : olloin the $ath o the round lia4ent and it has develo$ed ater reurrent e$isodes o $elvi inla44atory disease

 !#&  ultrasound C* and M'I are investiation 4odalities o hoie  *he treat4ent de$ends on the ae o the $atient and the ertility o$tion o the o4en. ,istulas to the allo$ian tu"e are rare and their

Discussion  Most studies advoate istula resetion and sal$ine=to4y as the only easi"le 4ethod o treatin this rare disease to $revent the ourene o eto$i $renany.

Conclusion  *u"outaneus istule is rare  their 4anae4ent is not ell desri"ed in the literature.  #al$ineto4y resetion o istulous trat and treatin the underlyin ause are the treat4ent o hoie.  +arly dianosis and treat4ent o these $atient are

Conflict of interest  *he authors delare that they have no onlit o interests.

TERIMA KASIH