Rektovajinal fistüle bağlı masif gastrointestinal kanama

Öz

Rektovajinal fistüller genellikle doğum sırasındaki obstetrik travmalara, rektal veya jinekolojik malignitelere bağlı, malign lezyonların cerrahi veya radyoterapisi sonrası görülür. Rektovajinal fistüllere en çok genel cerrahi ve jinekoloji kliniklerinde rastlanır. Bununla birlikte bu lezyonlar gastroenteroloji pratiğinde nadiren görülür. Gastroenteroloji kliniğinde rektovajinal fistüllerle Crohn hastalığı seyrinde karşılaşabiliriz. Bu lezyonlar hastaların yaşam kalitesini kötüleştirir, morbidite ve mortaliteyi arttırır. Endoskopi, fistül lokalizasyonunu saptamada ve doğru tedavi modalitesini seçmede yardımcı olabilir. Endoskopi bazen de endoklip veya stent kullanılarak tedavide kullanılabilir. Rektovajinal fistülün tipik şikayetleri vajinadan hava, gaz veya mukus gelmesidir. Disparöni, perineal ağrı veya rekürren vajinal enfeksiyonlar da görülebilir. Rektal kanama sık görülen bir bulgusu değildir. Burada over karsinomu nedeniyle debulking cerrahi operasyonu sonrası massif rektal kanama ile presente olan nadir bir rektovajinal fistül vakasını sunacağız.

Anahtar Kelimeler

• Rektovajinal fistül
• hematokezya
• alt gastrointestinal sistem kanaması

Massive gastrointestinal bleeding due to rectovaginal fistula: A rare case report

Öz

Rectovaginal fistula is usually observed due to obstetric traumas during giving birth, rectal or gynecologic malignities or after surgical therapy of malignant lesions or radiotherapy. Rectovaginal fistulas are not common in general surgery and gynecology clinics. However, these lesions are rarely seen during gastroenterology practice. In gastroenterology practice, we may face with rectovaginal fistula during Crohn’s disease’s course. These lesions deteriorate patients’ quality of life and increase morbidity and mortality. Endoscopy may be used to detect the localization of fistula and may help to choose correct treatment modality. Endoscopy sometimes may also be used to treat rectovaginal fistula via endoclips or stents. Typical complaints for rectovaginal fistulas are air, gas, or mucus discharge from vagina. Dyspareunia, perineal pain, or recurrent vaginal infections may also be seen. Rectal bleeding is not a common complaint for rectovaginal fistulas. Herein we report a rare case with rectovaginal fistula presenting with massive rectal bleeding after debulking surgery for ovarian carcinoma.

Anahtar Kelimeler

• Rectovaginal fistula
• hematochezia
• lower gastrointestinal bleeding

Kaynakça

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