Rectourethral fistula secondary to a bowel management system.
A 67-year-old Caucasian male was admitted under the vascular team with critical lower limb ischaemia. Bypass surgery was performed and he was admitted to the intensive care unit post-operatively. The patient experienced a turbulent post-operative recovery complicated by pneumonia, poor respiratory wean and faecal incontinence. A bowel management system was inserted but after 18 days it was reported faecal matter was bypassing his catheter. A CT scan demonstrated an area of necrosis where the bowel management system had been sited which formed a rectourethral fistula. Bowel management systems are frequently used in intensive care unit settings where a high proportion of patients suffer from faecal incontinence. If used correctly they can reduce skin contamination, infection and maintain patient hygiene. However, appropriate assessment and investigations should be addressed before inserting such devices. This case report highlights serious adverse effects of these devices and describes the first documented case of these devices causing a rectourethral fistula.
Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom. Electronic address: Jamie.acourt@doctors.org.uk.
Jamie
J
A'Court
Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
Petros
P
Yiannoullou
Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
Lyndsay
L
Pearce
Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
James
J
Hill
Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
David
D
Donnelly
Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
David
D
Murray
D000368:Aged; D005242:Fecal Incontinence / Q000601:surgery*; D006801:Humans; D008297:Male; D065666:Mesenteric Ischemia / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012003:Rectal Fistula / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000209:etiology* / Q000601:surgery*
Bowel management system; Faecal incontinence; Pelvic ischaemia; Pressure necrosis; Rectourethral fistula