Background: Optimal surgical management of the neonate with imperforate anus (IA) depends on determining accurate location of sphincter muscle complex, pouch of rectum and rectourinary fistula. We aimed to investigate a novel minimally invasive technique of anorectoplasty assisted by intraoperative sonography pull-through for repair of anorectal malformation and rectourinary fistula. Materials and Methods: Eight male patients with anorectal malformation and IA underwent formation of a diverting colostomy within 48 hours after birth. These patients had anorectoplasty about 6-8 weeks postoperatively. A urinary catheter was inserted per urethra into the bladder and sonography of perineum was carried out under general anesthesia. The neoanus was reconstructed by suturing the pulled-through anorectum to the anal sphincter muscle complex and the skin using absorbable 4/0 sutures. Results: In all cases, the distance of pouch of rectum to the skin was 15-18 mm and entrance of the guide wire to fistula was 6-7 mm. Of eight patients 6 had removal of urinary catheter after two days, and 2 patients after 10 days because the fistula was not closed. The median range of hospital stay was 2. 12 days and follow-up was 30 days. We calibrate all of patients with size 12F dilators. Patients were followed up at one week and one month postoperatively, and all had defecation frequency of 3-5 times a day. There were no complications. Conclusion Intra-operative sonography guided pulled-through anorectoplasty (ISPA) is a novel and safe technique for surgical treatment of IA and Rectourethral fistula. ISPA is a minimally invasive approach, which preserves the external anal sphincter muscle complex with good functional outcome.

Introduction: Rectourethral fistula is a relatively rare condition with a worldwide incidence rate of less than 3%, featuring a wide range of clinical presentations. Treatment mostly involves surgical correction via different techniques. Here, we look at a case series of complex Rectourethral fistulae and their management involving local tissue flaps. Case Presentation: Three patients with complex Rectourethral fistulae underwent surgical repair with pedicled gracilis muscle flaps. All patients underwent a pelvic magnetic resonance scan and a flexible antegrade and retrograde cystoscopy before their repair. The gracilis muscle flap was harvested from the left thigh in two patients and the right thigh in the third patient. Conclusion: Trauma and radiation are the two most common causes of Rectourethral fistulae. Most of these patients have a poor quality of life and require surgical repair with some form of tissue interposition. The failure of a prior Rectourethral fistula repair worsens the patient’, s quality of life and makes the subsequent surgery more challenging. Diversion of both the urine and feces as the initial treatment results in better outcomes of the final repair and hence should always be included in the management protocol of this rare entity.

Introduction: We evaluated the efficacy and safety of repair of the Rectourethral and rectovaginal fistulas with transanal approach using the Latzko technique.Materials and Methods: We repaired 8 fistulas with transanal approach.fistulas were Rectourethral in 5 patients, and in the only woman of the series, they were rectovaginal and vesicovaginal. In 3 patients, The fistulas had been diagnosed following prostatectomy, urethral stricture repair, and colonic resection and radiotherapy due to rectosigmoid cancer in 3, 2, and 1 patients, respectively. Complying with Latzko technique, the fistula orifice was exposed and a fusiform incision was made with the orifice in its center.The mucosa lying between the incision and the orifice was excised in the direction of the incision to the orifice, leaving the fistula edges to meet. Then, the edges were closed, followed by closure of the muscular layers above it.Finally, the edges of the rectal mucosa were closed.Results: Two patients had 2 fistulas and 4 had 1 fistula who were all managed by transanal approach. During a median follow-up period of 44 months, no serious complication was noted, except for recurrence of deep vein thrombosis in 1 patient with a positive history for this complication.Hospitalization period was 1 to 7 days.Conclusion: It seems that transanal repair is a simple and effective technique with minimal complication rate in the treatment of Rectourethral fistulas.Regardless of the etiology, this method can be used as the preferred therapeutic technique. Further studies are necessary to confirm our findings.

INTRODUCTION: Vesicocutaneous fistula (VCF) is a known complication of longstanding suprapubic cystostomy tract. We report the first case of neglected urethral stricture with Rectourethral fistula following pelvic trauma presenting as "watering-can abdomen" due to multiple vesicocutaneous fistulas following suprapubic cystostomy.

Secondary aortoenteric fistula (SAF) is an uncommon but very important complication of abdominal aortic reconstruction. The complication often occurs months to years after aortic surgery.The clinical manifestation of the aortoenteric fistula is always upper gastrointestinal bleeding.Treatment of the disease is early surgical intervention. If operative treatment is not performed promptly, the mortality is high. We present a case of secondary aortoduodenal fistula found 6 years after aortic reconstructive surgery, with the clinical presentation of upper gastrointestinal bleeding. On Immediate exploratory laparatomy, proximal part of abdominal Aorta was clamped. Duodonorrhaphy and aortic reconstruction with patch graft at the proximal suture line of aortic prosthesis was performed.Fortunately there was no pus, so tissue culture was not done. The intervention was concluded with an omentoplasty in order to protect the patch graft and to separate it from duodenorhaphy. Patient did well after the surgical management. Because of the increasing number of elective aortic aneurysm repairs in the aging population, it is likely that more patients with secondary aortoenteric fistula will present to the clinical physicians in the future. So, a high index of suspicion is necessary for prompt diagnosis and treatment of this actually life threatening event.

Background: Perforation of gall bladder is one of the complications of acute cholecystitis, which is of relatively high prevalence. It has been rarely reported as Cholecystocutaneous fistula. This paper presents a case of Cholecystocutaneous fistula referring to Taleqani Hospital in 2002. Case Report: The patient was a 48-year-old diabetic man, complaining of white discharge and swelling in right upper quadrant of abdomen, not responding to antibiotic therapy. The patient underwent cholecystectomy and fistula curettage. Conclusion: With respect to rare reports, in every patient with fistula in right upper quadrant and history of cholecystitis signs and symptoms, involvement of gall bladder should be considered.