. Diseases of the rectum and anus: designed for students and practitioners of medicine. Fig. 68.—Complex Horseshoe Fistula with Multiple Openings Inand Outside the Rectum. these two organs is large, fecal matter may escape into thevagina. This condition is sometimes the result of injury to therecto-vaginal septum during parturition. Complex Fistula consists of multiple sinuses and numerousopenings through the skin, mucous membrane, or both. Inthese cases the sinuses extend for a considerable distance be-neath the mucous membrane, partially or completely aroundthe bowel, or to distant organs (F
. Diseases of the rectum and anus: designed for students and practitioners of medicine. Fig. 68.—Complex Horseshoe Fistula with Multiple Openings Inand Outside the Rectum. these two organs is large, fecal matter may escape into thevagina. This condition is sometimes the result of injury to therecto-vaginal septum during parturition. Complex Fistula consists of multiple sinuses and numerousopenings through the skin, mucous membrane, or both. Inthese cases the sinuses extend for a considerable distance be-neath the mucous membrane, partially or completely aroundthe bowel, or to distant organs (Figs. 66 and 68). It occursmost frequently in syphilitic or tuberculous subjects. Horseshoe Fistula owes its name to the fact that the fistu-lous sinus courses around the rectum from one side to theother, and is shaped somewhat hke a horseshoe (Fig. 67).There are one or more openings upon the buttocks on eitherside of the anus, communicating with each other and with the. PLATE XV.—CASE OF RECTOVESICAL FISTULA IN NEGRO, SHOWING RESULT OF EXTRAVASATION OF URINE INTO BUTTOCK, SCROTUM, AND PENIS. ANO-RECTAL FISTULA 241 rectum, usually by an opening into the posterior wall of thebowel; in some cases there may be two or even more open-ings into the rectum. In a bad case of horseshoe fistula theremay be multiple sinuses and openings (Figs. 66 and 68).The author recently operated on a woman in whom there wereforty-five external openings and thirty-two sinuses. The but-tocks looked very much as if a load of buckshot had beenemptied into them. One rarely meets with two cases of horse-shoe fistula in which the sinuses take the same direction. Eecto-vesical Fistula is one in which there is a communica-tion between the rectum and the bladder (Fig. 69, A; and PlateXV), as a result of solution of the partition between both
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectanusdis, bookyear1910
