An unusual injury resulting in a jejuno-rectal stump fistula

摘要

We report a case where anal intercourse resulted in a jejuno-rectal stump fistula. This occurred in a 70-year lady who had undergone formation of ileal conduit and end colostomy earlier in the same year. Previous gynaecological surgery for cancer of the cervix, radiation and multiple surgical procedures for dyspareunia, urinary incontinence and vesico-rectal fistula were factors responsible for a poor quality of life. Following an unsuccessful trial of conservative therapy with total parenteral nutrition (TPN) for the high-output fistula, a surgical procedure was planned. An injury to the jejunum adherent to the low rectal stump following previous surgery was identified to be the cause. Resection of a short segment of jejunum and anastomosis was performed at laparotomy. Histology of the specimen of jejunum revealed post-irradiation changes. The patient was discharged following uneventful postoperative recovery. There are no reported instances of such injury resulting in a fistula.