Terry Morgan, Ng Mitchell K, Ma Truong, Stein Sharon L
Surgery, Case Western Reserve University School of Medicine, Cleveland, USA.
Internal Medicine, Case Western Reserve University School of Medicine, Cleveland, USA.
Cureus. 2020 Feb 15;12(2):e7001. doi: 10.7759/cureus.7001.
A rectoperineal fistula (RPF) is a relatively rare, non-life-threatening form of anorectal malformation that nevertheless causes significant physical discomfort, and remains technically challenging for surgeons to treat. We present a case of a 72-year-old female with a history of a recurrent perianal fistula with multiple approaches including endorectal advancement flap previously attempted. Our procedure involved laparoscopic loop ileostomy with transversus abdominis plane (TAP) block, and RPF repair through the perineal approach with primary repair involving Martius flap and house advancement flaps. The patient tolerated the procedure well with no known peri-operative complications and resolution of stool incontinence at subsequent post-operative visits, the first within a month of the procedure. This case was used to demonstrate and highlight the surgical technique of the RPF repair by Martius flap. Informed consent was obtained from the patient for video recording for educational purposes.
直肠会阴瘘（RPF）是一种相对罕见的、不危及生命的肛门直肠畸形，尽管如此，它会引起严重的身体不适，并且在技术上仍然给外科医生的治疗带来挑战。我们报告一例72岁女性病例，该患者有复发性肛周瘘病史，此前曾尝试多种治疗方法，包括直肠内推进皮瓣术。我们的手术包括腹腔镜袢式回肠造口术联合腹横肌平面（TAP）阻滞，以及通过会阴途径进行RPF修复，一期修复包括Martius皮瓣和改良推进皮瓣。患者对手术耐受良好，无已知围手术期并发症，术后随访时大便失禁症状消失，首次随访在术后一个月内。本病例用于展示和突出Martius皮瓣修复RPF的手术技术。已获得患者的知情同意，以便为教育目的进行视频录制。
