Mammillary fistula

During a 6-year period 38 patients with 52 mammillary fistulae were seen. On average, 5 abscesses had preceded recognition of a fistula in the areolar region (range 1-18). In 11 cases the fistulae were immediately apparent as discharging openings but they more commonly presented as subareolar abscesses. Fistulae were treated either by laying open or by excision of the track and at mean follow-up of 25 months (range 1-75) there has been recurrent fistula formation in only one case. Mammillary fistulae should be suspected and sought in all patients presenting with abscesses adjacent to the nipple.     

Mammillary fistula revisited: Implications for immediate breast reconstruction

We present two patients with inverted nipples who underwent bilateral nipple‐sparing mastectomies (NSM) with immediate placement of tissue expanders with acellular dermal matrix (ADM). Both were complicated by postoperative infection and developed mammillary fistulae from the nipple into the breast capsule, and eroding through the ADM. For the first time, we report inverted nipples as a risk for the iatrogenic formation of mammillary fistulae and their infectious implications after NSM.     

Traumatic pancreatic fistula with associated gastro-colic fistula

A case of traumatic pancreatic fistula complicated by gastric and colonic fistulous tracts is presented, and management is discussed.     

Cecovesicovaginal fistula

A case of cecovesicovaginal fistula following radiation therapy and surgery for cervical carcinoma is reported. The steps in repairing this defect are described. The patient was returned to normal continence.     

Vesico-uterine fistula

Nine cases of vesico-uterine fistula caused by injury to the bladder at Caesarean section or by rupture of the uterus and bladder following obstructed labour are described. Symptoms depend on the level of the lesion, menstruation into the bladder and menouria occurring when the fistula is above the internal cervical os: whatever the level, most patients with vesico-uterine fistula present with incontinence of urine. A transperitoneal approach appears to give better results than a transvesical repair.     

Duodenobronchial fistula

Duodenobronchial fistulas are an extremely rare subgroup of abdominobronchial fistulas, which include bronchobiliary, gastrobronchial, enterobronchial, colobronchial, and splenobronchial fistulas. Only one case of a duodenobronchial fistula has been previously reported. Duodenobronchial fistulas occur as a complication of a duodenal injury. The characteristic symptoms are a cough that produces copious bilious secretions, shortness of breath, and fever. The diagnosis is made by contrast gastrointestinal studies. Treatment requires an abdominal approach with interruption of the fistula at its duodenal origin and control of the inciting inflammatory process. With prompt diagnosis and treatment, thoracic drainage or pulmonary resection should not be needed.     

Ureterocolic fistula

Three rare cases of ureterocolic fistula are presented with a brief discussion of the incidence, etiology, symptoms, findings, diagnostic measures, surgical or medical management, and the prognosis. Incidental findings of colonic mucosa in the ureter and adenocarcinoma of the fistulous tract were encountered in one patient.     

Ureteroarterial fistula

Ureteroarterial fistulas are rare. A case is presented of a fistula between the distal right limb of an aorto-bifemoral graft and the right ureter that was treated with preservation of the kidney. Some of the reported fistulas were associated with complex pelvic cancer procedures, some with difficult distal ureteral stone procedures, or represent old reports from the days when long-term ureteral stents were used often to treat pyelonephritis of pregnancy. The remainder are associated with vascular lesions. Since ureteral obstruction predated all of the fistulas reported, a high index of suspicion and an aggressive approach to progressive obstruction is indicated. Symptoms of a ureteroarterial fistula vary from mild hematuria and flank pain to vascular collapse. The retrograde pyelogram is the most useful diagnostic study.