You were asked for you opinion about this distal colostogram. What is the diagnosis and what would be the surgical approach for this patient?

 

 

 

a- rectoprostatic fistula, posterior sagittal approach only

 

b- no fistula, posterior sagittal approach only

 

c- recto-bladder neck fistula, posterior sagittal approach only

 

d- rectoprostatic fistula, laparotomy/ laparoscopy and posterior sagittal approach

 

e- recto-bladder neck fistula, laparotomy/ laparoscopy and posterior sagittal approach

D

E

correct answer

e- recto-bladder neck fistula, laparotomy/ laparoscopy and posterior sagittal approach

 

This high-pressure distal colostogram shows a recto-bladder neck fistula with plenty of distal bowel left for the pull-though. The colon is above the sacrum (as always occurs in recto-bladder neck fistulas), so a laparotomy/laparoscopy will be needed in order to reach the rectum and mobilise it. After the mobilisation, a small posterior sagittal incision and anoplasty is performed.