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    Rectocutaneous Fistula in A Cat: A Case Report: Makale Kodu (Article Code) : KVFD-2009-1429

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    蔡旻珊
    This case report describes a rectocutaneous fistula in a cat that developed after anal sac surgery. Conservative treatment involving drainage and antibiotics resolved the fistula without complications. Rectocutaneous fistulas are rare in cats and can develop due to various causes like surgery or trauma.

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    Rectocutaneous Fistula in A Cat: A Case Report: Makale Kodu (Article Code) : KVFD-2009-1429

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    蔡旻珊
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    This case report describes a rectocutaneous fistula in a cat that developed after anal sac surgery. Conservative treatment involving drainage and antibiotics resolved the fistula without complications. Rectocutaneous fistulas are rare in cats and can develop due to various causes like surgery or trauma.

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    This case report describes a rectocutaneous fistula in a cat that developed after anal sac surgery. Conservative treatment involving drainage and antibiotics resolved the fistula without complications. Rectocutaneous fistulas are rare in cats and can develop due to various causes like surgery or trauma.

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    20 views3 pages

    Rectocutaneous Fistula in A Cat: A Case Report: Makale Kodu (Article Code) : KVFD-2009-1429

    Uploaded by

    蔡旻珊
    This case report describes a rectocutaneous fistula in a cat that developed after anal sac surgery. Conservative treatment involving drainage and antibiotics resolved the fistula without complications. Rectocutaneous fistulas are rare in cats and can develop due to various causes like surgery or trauma.

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    © All Rights Reserved
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    of 3

    Kafkas Univ Vet Fak Derg

    16 (4): 681-683, 2010


    DOI:10.9775/kvfd.2009.1429

    CASE REPORT

    Rectocutaneous Fistula in A Cat: A Case Report


    Nuh KILI *  Rahime YAYGINGL *
    * Adnan Menderes niversitesi, Veteriner Fakltesi, Cerrahi Anabilim Dal, TR-09016, Aydn - TRKYE

    Makale Kodu (Article Code): KVFD-2009-1429

    Summary
    A 2-year-old intact male cat weighing 6.8 kg was presented to the Veterinary Medical Teaching Hospital, Adnan Menderes
    University, with a non-healing wound craniodorsal to the anus. He had previously undergone anal sac surgery two weeks ago
    and had been on continuous wound therapy in a local animal hospital. Following radiographic and clinical examinations, the
    problem was diagnosed as an rectocutaneous fistula due to the perforated rectum under the skin. Conservative treatment of
    the fistula involving the bowel loop resolved all symptoms.

    Keywords: Cat, Rectocutaneous fistula, Anal sac surgery

    Bir Kedide Rektokutanz Fistl Olgusu


    zet
    Adnan Menderes niversitesi Veteriner Fakltesi Kliniine 2 yanda, 6.8 kg arlnda erkek bir kedi ansn kraniyo
    dorsalinde iyilemeyen bir yara ikayetiyle getirildi. Hasta 2 hafta nce zel bir hayvan hastanesinde anal kese cerrahisi geirmi
    ve ak yara saaltm grmt. Radyografik incelemeler ve klinik muayeneler sonucu, perfore rektum ve deri arasnda bir
    rektokutanz fistl tans konuldu. Fistln konservatif saaltm sonucu tamamen iyiletii gzlendi.

    Anahtar szckler: Kedi, Rektokutanz fistl, Anal kese cerrahisi

    INTRODUCTION
    Enterocutaneous fistula is defined as an abnormal
    anatomical passage between the bowels and the skin. In
    humans, the most common cause of enterocutaneous
    fistulae has been reported as complication during surgery
    on the small intestine 1. In the veterinary medicine,
    enterocutaneous fistulae have most commonly been
    reported in large animals resulting from complications in
    umbilical hernias or their treatment 2-7. Many reports on
    fistulas caused by other etiologies in various areas of the
    body in the small animal practice have been presented,
    but the enterocutaneous fistula has not been presented
    except for one report on rectocutaneous and entero
    cutaneous fistula formation after pelvic trauma in a dog 8.
    Rectal perforation in dogs and cats has been most
    frequently described in association with pelvic fractures 8,9.
    Other causes of rectal perforation include penetrating
    

    letiim (Correspondence)

    +90 256 2470700


    [email protected]

    animal bites, perineal herniorrhaphy or anal sacculectomy,


    trauma from ingested foreign bodies or intraluminal
    foreign bodies entering via the anus, iatrogenic tears
    during rectal examination, improper use of enema
    tubes, gunshot wounds, and stab wounds 9,10. The
    following report describes the signs, investigations and
    management of the rectocutaneous fistula in a cat.

    CASE HISTORY
    The rectoocutaneous fistula in present case was
    formed following surgical repair of anal sacculitis. This
    was a rare case of feline rectocutaneous fistula that
    causes from anal sac surgery. A 2-year-old intact male
    cat weighing 6.8 kg was presented to the Veterinary

    682
    Rectocutaneous Fistula in A Cat

    Medical Teaching Hospital, Adnan Menderes University,


    with a non-healing wound craniodorsal to the anus. He
    had previously undergone surgery two weeks ago and
    had been on continuous wound therapy in a local
    animal hospital. According to the owner, the cat had
    constipation over the last six months. The wound had
    healed under the owners care but resulted in scar
    tissue with a thickened skin like mass in the surgery
    region. Approximately one week later, the cat had
    treatment in order to repair the scar tissue in the region.
    After the initial surgery, the wound was not healed and
    had fecal discharge. When originally presented to our
    team, the cat elicited signs of pain when palpated
    over the wound region. The wound region was firm,
    had an opening of 2 mm in diameter and exhibited
    maceration around the opening (Fig. 1). A purulent

    fluid and feces was observed discharging from the


    wound opening. Routine hematology and biochemistry
    profiles were within normal limits. Fistulography with
    iohexol (OmnipaqueTM, AmershamHealth, Cork, Ireland)
    was performed The origin of the tract was rectum. After
    the rectal lavage with iod solutioun, the drainage was
    seen through a fistula (Fig. 2). Because of the clinical
    history and the radiolologic findings, a diagnosis of
    rectocutaneous fistula was made. Recommendations
    were made for treatment with adequate drainage of
    perineal area and antibiotic therapie. The topical anti
    biotic and iodine as a drainage were performed for 1
    week. Daily treatment with penicillin-streptomycine was
    continued for 10 days. The follow-up were obtained at 2
    weeks after the initial treatment. No recurrence of the
    fistula has been observed 6 months after the treatment.

    Fig 1. A rectocutaneous fistula in the perianal


    region in a cat
    ekil 1. Bir kedide perianal blgede rekto
    kutanz fistl

    Fig 2. Rectal lavage with iod solution. Drainage


    was seen through the fistula
    ekil 2. yod solusyonuyla rectal lavaj. Fistl
    deliinden drenaj grlyor

    683
    KILI, YAYGINGL

    DISCUSSION
    Rectal perforation in dogs and cats has been most

    frequently described in association with pelvic fractures 8-9.

    Overall, rectocutaneous fistulas are very rare in cats.

    The rectocutaneous fistula in present case was occurred

    following an anal sac surgery.

    Complications of rectocutaneous fistulae include


    weight loss, chronic diarrhea, fluid and electrolyte
    imbalances, sepsis, and local infection 8-12. An experimental
    model where dogs with enterocutaneous fistulae were
    fed a normal diet lost 40% of their body weight and
    became cachectic 11. A dog that developed an entero
    cutaneous fistula following pelvic trauma lost 30% of its
    body weight and had sepsis 8. The cat in our report did
    not show evidence of having a rectocutaneous fistula
    other than the presence of local infection. The possibility
    of a fistula without sepsis was considered to the lesion
    being acute for a period of two weeks and the presence
    of localized inflammation.
    It is often stated that minor retroperitoneal rectal
    perforations can heal by second intention if adequate
    drainage is provided 8,12,13. However, healing by second
    intention was reported in only two of eight patients with
    rectal perforation/rectocutaneous fistula that survived
    the perioperative period 2,3,9 . Both of these cases
    required fecal diversion by colostomy or jejunostomy
    before a successful outcome was achieved 3,9. The size of
    the defect appears to have little impact on the outcome
    of the case. In six cases in which rectal defect sizes were
    reported, the defects ranged from 2 mm in diameter to
    20 40 mm, with a median length of 17.5 mm 2,3,8. In
    one of the two cases that ultimately required fecal
    diversion to heal, the rectal perforation was only 2 mm
    in diameter. Conservative treatment using octreotide is
    considered to provide a good outcome for fistula
    treatment and aids in spontaneous closure of the fistula
    which has been shown to convert high output fistulas to
    low output fistulas in human cases. However, long-term
    hospitalization is often required, and surgical intervention
    may be required in the end 14. In present case, the cat
    was in optimal clinical and nutritional condition for
    conservative treatment and the lesion was acute condition.

    Although present case was conservatively treated,


    various types of treatment for rectocutaneous fistula
    are needed in the small animal practice. No
    complication of the fistula has been observed 6 months
    after the treatment.

    REFERENCES
    1. Martinez-Ordaz JL, Luque-de-Leon E, Suarez-Moreno RM,

    Blanco-Benavides R: Postoperative entero-cutaneous fistula.

    Gac Med Mex, 139, 144-151, 2003.

    2. Birchard SJ, Stickle RL, Thornhill JA: A fistulous tract

    induced by a foreign body in a dog. Vet Med Small Anim

    Clin, 75, 601-605, 1980.

    3. Freeman DE, Orsini JA, Harrison IW, Muller NS, Leitch M:


    Complications of umbilical hernias in horses: 13 cases (1972
    1986). J Am Vet Med Assoc, 192, 804-807, 1988.

    4. Bristol DG: Enterocutaneous fistulae in horses: 18 cases

    (1964 to 1992). Vet Surg, 23, 167-171, 1994.

    5. Rijkenhuizen AB, Sickmann HG: Incarcerated umbilical


    hernia with enterocutaneous fistula in a calf. Tijdschr
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    Buzalarda intestinal atresia olgular ve operatif saaltmlar.

    Kafkas Univ Vet Fak Derg, 9, 113-118, 2003.

    7. Kilic N, Sarierler M: Congenital intestinal atresia in calves:


    61 cases (1999-2003), Rev Med Vet, 155, 381-384, 2004.

    8.Tobias KM: Rectal perforation, rectocutaneous fistula

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    9. Lewis DD, Beale BS, Pechman RD: Rectal perforations

    associated with pelvic fractures and sacroiliac fracture

    separations in four dogs. J Am Anim Hosp Assoc, 28 (2): 175


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    10. Muir P: Rectal perforation associated with pelvic fracture

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    11. Schiller AG, Helper LC, Knecht CD: Repair of recto-

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    758-759, 1967.

    12. Fransson BA: Rectocutaneous fistulas. Compend Contin

    Educ Vet, 4, 224-236, 2008.

    13. Medeiros Ada C, Soares CE: Treatment of enterocutaneous

    fistulas by high-pressure suction with a normal diet. Am J

    Surg, 159, 411-413, 1990.

    14. Karabulut R, Karakus C, Hirfanoglu I, Turan O, Tkyilmaz

    Z, Snmez K, Onal EE, Atalay Y, Bassaklar AC: Treatment of

    postoperative enterocutaneous fistulas with octreotide in two

    neonates. Eur J Pediatr Surg, 18, 56-58, 2008.

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