Karagjozov A, Milev I, Antovic S, Kadri E
Chirurgia (Bucur). 2014 Nov-Dec;109(6):850-4.
Retrorectal tumors are very rare but well defined pathological entities in the literature. Also, an extrasphincteric fistula is a very rare form of perianal fistula which makes our case a very unusual and rare one, especially by the fact that it was successfully treated with the first operation and without protective stoma formation. The patient was first treated in hospital for a retrorectal abscess that had spontaneously ruptured in the postanal space. Because of the constant drainage of the suppurative content from the postanal opening in the following months, MRI and fistulography were performed, registering cystic formation in the retrorectal space with fistulous communication with the rectum above and completely separate from the sphincter mechanism. After that the patient was admitted for definitive treatment. The operation was performed with the patient in a prone jack-knife position. Complete excision of the cyst with the fistulous communication was performed and the rectum was sutured in two layers with separate slowly absorbable sutures. The wound was laid open and the patient was discharged on the 5th post operative day. After about ten months the defecation is normal, the wound is sealed and there are no signs of inflammation and secretion locally.
直肠后肿瘤在文献中极为罕见，但病理特征明确。此外，括约肌外瘘是一种非常罕见的肛周瘘形式，这使得我们的病例极为特殊和罕见，特别是它通过首次手术成功治愈且未形成保护性造口。患者最初因直肠后脓肿在肛门后间隙自发破裂而入院治疗。由于在接下来的几个月里，脓性分泌物持续从肛门后开口排出，因此进行了磁共振成像（MRI）和瘘管造影检查，结果显示直肠后间隙有囊性结构，与上方直肠存在瘘管相通，且与括约肌机制完全分离。此后，患者入院接受确定性治疗。手术时患者取俯卧折刀位。完整切除囊肿及瘘管，并分两层用可缓慢吸收的缝线缝合直肠。伤口敞开，患者在术后第5天出院。大约十个月后，排便正常，伤口愈合，局部无炎症和分泌物迹象。
