And so what happens is that one month back she starts having loose motions and can feel stool in vagina and smells of stool.So they give her antidiarrhoeal but get her to Delhi.Visit quite a few big hospitals in Delhi and Gurgaon and are diagnosed with big Rectovaginal fistula,,,,,,,a hole between vagina and rectum developed due to radiotherapy done years back.She is told that she has got a RVF which I don't think this Lady understands much considering her uneducated background where her whole life she might have depended on her father,husband or Sons to take decision for her.She is told and also is written on her prescription.....RVF,nothing can be done,onservative management.What does that mean??To sit in a puddle of puff.
Her sons get her to me.They have heard that I deal with such cases.And ofcourse I do.These case are not so difficult if one knows the pelvic anatomy well and can dissect in correct plain.So I say a yes to her.Yes I will operate you.Then I tried to rule out a recurrence of her cancer by getting a MRI done.Take a biopsy with great difficult from the fistula tract which is quite hard and stenosed and avascular due to her radiotherapy.Both rule out a recurrence.
And Then time to get a fitness certificate from anaesthetist.Yes and we find that she had a recent Myocardial infarction as per ECG.So we need to get an angiography done.So,we arrange for that.And yup......2 vessels are involved.Will need a plasty and then blood thinners.So????? So then what.......try to repair her RVFunder high risk consent now as after angioplasty no surgery can be done for 6 months.Ask the Lady.....her opinion.She leaves it on me.Her sond they trust me blindly.
I am scared of such patients who don't question you and leave all the decision on you.You feel so weighed down by the trust they put on you unlike people who are oh so well educated as to know medicine just too well.Who have so many questions and those who take informed decisions.
Now I and Dr Shalabh decide a plan.Temporary diversion colostomy for sure to give sometime for repaired fistula to heal.then fistula repair.And after angio reversal of colostomy.
So Shalabh does a laparoscopic colostomy successfully in a plastered pelvis.Can't dissect the rectum from above.
I start developing a plain between rectum and vagina.God,the defect is just too big.The biggest ever RVF seen by me.Anaesthetist asks....Have you done a dye test for fistula :-))?Here a three fingers of mine can pass through the fistula.Who needs dye to make a diagnosis!!So a plain was developed nicely on the right and anterior aspect.But on right side the rectum is tightly adherent to the bone and vagina.Did some dissection but not enough tissue to do a tension free suturing of the rectum.It is impossible.So both me and shalabh decide to close back the dissection.
She has a diverting colostomy now.She won't be sitting on a puddle of stool .But then it is not fair.A rent so big as is impossible to even approximate it.Hope her quality of life would be better,if not 100%,atleast 50%!!