Unusual case of congenital fistula between external auditory canal and nasopharynx

<p class="abstract">Defects in the development in the neck area of the embryo result in branchial cleft anomalies. Various first branchial cleft anomalies are described in literature including preauricular sinuses, cysts and collaural fistula. In our case study, we document a very unusual case of fistula between floor of external auditory canal and nasopharynx. Such patient requires thorough evaluation and step-wise approach to treat. After clinical examination and radiological evaluation, surgically the fistula was excised in toto via external approach using Modified Blair’s incision. In our case, fistulous tract was running from external auditory canal to nasopharynx, running superior and medial to the trunk of facial nerve. No such case is found to be reported in literature after extensive search. Hence, it would be strongly advocated to keep this presentation in the differential diagnosis during evaluation. Also, it is worth mentioning and recommending that a careful radiological examination is a must before approaching for surgery.</p>

Assessment of the aetiology and outcome of fistulae cases (VVF RVF) operated at Shaikh Zaid woman hospital Larkana

Aims: To study etiology of fistula in patient at Shaikh Zaid Women hospital Larkana. Methods: A cross-sectional Survey was conducted at Gynecology and obstetrics wards of Shaikh Zaid Women hospital Larkana. All patients were admitted in outpatient departments along with emergency department were the part of the study. Sample was collected by universal sample technique. Total sample size was of 49 patients. Detailed history regarding fistula formation and its etiology and duration, examination and related investigation carried out in each and every patient. Young and elderly patients both were included. Results: 49 patients were selected, who were admitted and registered at the gynecological and obstetrics wards of Shaikh Zaid Women hospital, out of which 38 patients were found having urinary fistula from which 28 patients were having fistula due to obstetric causes while 10 pts were having fistula due to iatrogenic causes. Moreover, 11 patients were having fecal fistula from them 7 were again due to obstetric causes, 1 patient was having congenital fistula and remaining 3 patients were found having fistulas due to malignancy. Conclusions: Obstetrics fistula is still most common cause of fistula followed by iatrogenic cause. Urinary fistula is more common than fecal fistula.

Angka Mortalitas dan Faktor yang Memengaruhi pada Pasien Trakeoesofageal Fistula (TEF) yang Menjalani Operasi di RSUP Dr. Hasan Sadikin Bandung

Trakeoesofageal fistula (TEF) merupakan kelainan esofagus yang bersifat kongenital ditandai dengan fistula antara trakea dan esofagus yang merupakan koneksi abnormal yang dapat disertai putusnya antara distal dan proksimal esofagus. Insidensi TEF kongenital mencapai 1:2.400‒4.500 kelahiran hidup. Tujuan penelitian ini mengetahui angka mortalitas dan faktor yang memengaruhi pada pasien TEF yang menjalani operasi di RSUP Dr. Hasan Sadikin Bandung pada tahun 2010–2015. Metode penelitian ini bersifat deskriptif yang dilakukan secara retrospektif terhadap 35 rekam medik pasien TEF yang menjalani operasi di RSUP Dr. Hasan Sadikin Bandung pada tahun 2010‒2015. Hasil penelitian ini menunjukkan angka mortalitas pascaoperasi pasien TEF sebesar 19 dari 34 dan mortalitas tertinggi terjadi pada perempuan 7 dari 12, bayi lahir lahir prematur 5 dari 5, berat badan lahir kurang dari 1.500 gram 1 dari 1, TEF tipe C 19 dari 32, riwayat persalinan di bidan/puskesmas 9 dari 11, disertai kelainan kongenital penyerta selain kelainan anorektal, usia saat operasi lebih dari 7 hari 15 dari 17, penyulit preoperatif lebih dari satu, lama operasi lebih dari 3 jam, tidak dilakukan ekstubasi 15 dari 20, kenaikan berat badan lebih dari 10% 14 dari 18, leakage pascaoperasi dan faktor penyulit pascaoperasi lebih dari satu. Simpulan Angka mortalitas pasien TEF yang menjalani operasi di RSUP Dr. Hasan Sadikin Bandung pada tahun 2010–2015 sebanyak 54,3%. Kata kunci: Mortalitas pascaoperasi, operasi, trakeoesofageal fistula Mortality and The Influencing Factors of Trakeoesofageal Fistula (TEF)Patients which Operated in Dr. Hasan Sadikin General Hospital BandungTracheoesophageal fistula (TEF) is a disorder of the esophagus that is characterized by congenital fistula between the trachea and esophagus wich is an abnormal connection that can be accompanied by a break between the distal and proximal esophagus. The incidence of congenital TEF reached 1:2,400‒4,500 live births. The purpose of this study to determine mortality and factors affecting mortality in patients TEF in Dr. Hasan Sadikin General Hospital Bandung in 2010‒2015. This research method was descriptive retrospectively of 35 patients taken from the medical records underwent surgery TEF in Dr. Hasan Sadikin Central Hospital Bandung in 2010‒2015. Results of this study showed a mortality rate of postoperative patients TEF rate of 19 from 34 and the highest mortality among women 7 from 12, premature birth, birth weigth less than 1,500 g, TEF type C 19 from 36, childbirth history at the midwife 9 from 11, congenital abnormalities other than anorectal disease, age at surgery of more than 7 days 15 from 17, preoperative complications more than one, the operating time of more than 3 hours, do not extubation 15 from 20, weight gain more than 10% 14 from 18, the leakage postoperative and more than one complications postoperative factors. In conclusion, mortality of trakeoesofageal fistula (TEF) patients which operated in Dr. Hasan Sadikin General Hospital Bandung in 2010–2015 was 54.3%.Key words: Postoperative mortality, operatif, tracheoesophageal fistula