. Diseases of the rectum and anus: designed for students and practitioners of medicine. 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
. Diseases of the rectum and anus: designed for students and practitioners of medicine. 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. Fig. 69.—A, Recto-vesical Fistula; B, Recto-urethral Fistula. organs. Flatus and feces may pass through the urethra, andthe urine may flow into the rectum. The diagnostic point isthe passage of urine and feces through unnatural fistula is usually caused by rupture of the blad-der, urinary calculi, extensive ulceration, or penetratingwounds. The author has treated two cases due to rupture ofthe bladder and one caused by a very large urinary calculuswhich ulcerated through into the rectum (see chapter onenteroliths). TTrinary, or Recto-urethral, Fistula is rare, indeed. In suchcases the rectum communicates with the urethra at some point 242 DISEASES OF THE RECTUM AND ANUS (Fig. 69, B). Cripps has reported a very unusual and interest-ing case which healed spontaneously. This condition may bedue to traumatism; disease of the rectum, prostate, urethra,or bladder; or to operations. The author once treated a boyfor recto-urethral fistula following rupture of the uret
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