Vesicocutaneous Fistula Following Radiation and Surgery for the Treatment of Rectal Cancer

Ridha, Mustafa; Honeywill, Conor; Diab, Jason; Badiani, Sarit; Berney, Christophe R

doi:10.7759/cureus.16219

Cited by 3 publications

(2 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Chronic radiation proctitis is characterized by mucosal fragility, pallor, spontaneous bleeding, telangiectasias, mucosal edema, strictures, fistulas, and ulceration [ 16 ]. Although we could not find any previous reports regarding anal fistula associated with neoadjuvant CRT, radiation therapy can lead to fistula formation as a late complication [ 17 ], and a previous report has shown that preoperative CRT is significantly associated with postoperative fistulous complications [ 18 ]. We assumed that radiation therapy might induce chronic injury to the corresponding anorectal mucosa, and malignant cells could have been delivered from the proximal large intestine and implanted into the anal fistula.…”

Section: Discussionmentioning

confidence: 81%

Anal fistula metastasis of rectal cancer after neoadjuvant therapy: a case report

et al. 2022

View full text Add to dashboard Cite

Background Anal metastasis of colorectal cancer is very rare and may present synchronously or metachronously, regardless of pre-existing anal diseases. We report a case of anal fistula metastasis after completion of neoadjuvant therapy for rectal cancer, followed by surgical resection of the primary tumor and metastatic lesion. Case presentation A 50-year-old man was diagnosed with rectal cancer located 5 cm from the anal verge, with a clinical stage of cT3N0M0. He denied any medical or surgical history, and physical examination revealed no perianal disease. He underwent preoperative chemoradiation therapy (CRT) consisting of a tegafur/gimeracil/oteracil potassium (S-1)-based regimen with 45 Gy of radiation. After completion of CRT, computed tomography (CT) revealed the primary tumor’s partial response, but a liver mass highly suggestive of metastasis was detected. This mass was later diagnosed as cavernous hemangioma 3 months after CRT initiation. He then underwent and completed six cycles of consolidation chemotherapy with a capecitabine-based regimen. Subsequent colonoscopy revealed the complete response of the primary tumor, but CT showed thickening of the edematous rectal wall. Therefore, we planned to perform low anterior resection as a radical surgery. However, he presented with persistent anal pain after the last chemotherapy, and magnetic resonance imaging revealed a high-intensity mass behind the anus, suggestive of an anal fistula. We considered the differential diagnosis of a benign anal fistula or implantation metastasis into the anal fistula. Fistulectomy was performed, and a pathological diagnosis of tubular adenocarcinoma, suggestive of implantation metastasis, was made. Thereafter, we performed laparoscopic abdominoperineal resection. Histopathological examination revealed well-differentiated adenocarcinoma, ypT2N0, with a grade 2 therapeutic effect. Subsequent immunohistochemistry of the resected anal fistula showed a CDX-2-positive, CK20-positive, CK7-negative, and GCDFP-15 negative tumor, with implantation metastasis. There was no cancer recurrence 21 months after the radical surgery. Conclusions This is the first report of anal fistula metastasis after neoadjuvant therapy for rectal cancer in a patient without a previous history of anal disease. If an anal fistula is suspected during or after neoadjuvant therapy, physical and radiological assessment, differential diagnosis, and surgical intervention timing for fistula must be carefully discussed.

show abstract

Section: Discussionmentioning

confidence: 81%

Anal fistula metastasis of rectal cancer after neoadjuvant therapy: a case report

et al. 2022

View full text Add to dashboard Cite

show abstract

“…A fistula is an abnormal communication between two epithelial lined surfaces [4]. Vesicocutaneious fistula (VCF) can be acquired or congenital characterized by an abnormal tract formed between the urinary bladder and cutaneous surface of the body [5]. Diagnosis can sometimes be challenging due to the obscure clinical history and presentation hence higher modality contrast studies like CT-scan or MRI should be done, as will also facilitate in the plan of management.…”

Section: Introductionmentioning

confidence: 99%

An unusual presentation of penetrating bladder injury with vesicocutaneous fistula: a case report

et al. 2023

View full text Add to dashboard Cite

Background Blunt trauma to the urinary bladder is common with penetrating injury being a rare occasion. Most common entry pint for penetrating injuries includes buttock, abdomen and perineum with thigh being rare. There are a number of complications that may develop as a result of penetrating injury with vesicocutanous fistula being a rare occurrence that usually presents with typical sign and symptoms. Case presentation We present a rare case of penetrating bladder injury through medial upper thigh as an entry point that had complicated into vesicocutaneous fistula with atypical presentation of long-standing pus discharge that had been managed by incision and drainage several times with no success. MRI demonstrated a presence of fistula tract and a foreign body (piece of wood) in-situ confirmed the diagnosis. Conclusion Fistulas are a rare complication of bladder injuries and can cause negative impact on the quality of life of patients. Delayed urinary tract fistulations and secondary thigh abscesses are uncommon therefore a high index of suspicion is needed for early diagnosis. This case emphasizes the importance of radiological tests in aiding the diagnosis and ultimately proper management.

show abstract

A Vesicocutaneous Fistula Treated With Urinary Diversion, Negative Pressure Wound Therapy, and Time

Al-Hajj,

Hamze,

El Koubayati

et al. 2024

Cureus

View full text Add to dashboard Cite

A 38-year-old motor vehicle accident victim presented for acute urinary retention due to a clogged Foley catheter, which was inserted two weeks prior during surgery for pelvic and spine fixation and extraperitoneal bladder rupture. Imaging studies revealed persistent bladder leaks despite primary and, later, secondary surgical repair. A combination of novel non-surgical techniques, that is, urinary diversion, negative pressure dressings, and waiting proved beneficial in our case, and led ultimately to complete clinical and radiological resolution of the fistula.

show abstract

Vesicocutaneous Fistula Following Radiation and Surgery for the Treatment of Rectal Cancer

Cited by 3 publications

References 8 publications

Anal fistula metastasis of rectal cancer after neoadjuvant therapy: a case report

Anal fistula metastasis of rectal cancer after neoadjuvant therapy: a case report

An unusual presentation of penetrating bladder injury with vesicocutaneous fistula: a case report

A Vesicocutaneous Fistula Treated With Urinary Diversion, Negative Pressure Wound Therapy, and Time

Contact Info

Product

Resources

About