We recommend cystoscopy and urine cytology for faecal material as the first-line investigations in all patients with a suspected enterovesical fistulae. CT scanning and barium enema should not be first line investigations but may be performed subsequently to help determine the aetiology and planning of surgery.
A broad-spectrum 5-day regimen is superior to 'single-shot' antibiotic prophylaxis in preventing infection-related wound complications. However, this study needs to be conducted in a larger number of patients to have statistical power.
In this study patients with metachronous tumours seemed to do very well while those with synchronous lesions did very badly. There were no identifiable demographic or clinical characteristics to account for this. There is a need to study this group of patients and identify factors like tumour biology or host resistance which prevent spread of tumour.
With careful selection of patients, PPH may be indicated for prolapsed internal haemorrhoids. More specific national guidelines are required with regard to contraindications to PPH.
A case of adrenal abscess due to bacteroides and peptostreptococcus in a 16-day-old infant is presented. The clinical manifestations consisted of a huge abdominal swelling associated with fever and lethargy. This is the first case report of an adrenal abscess due to gas-forming organisms, a finding which makes the preoperative diagnosis more difficult. Surgical drainage, subtotal excision of the abscess wall under cover of antibiotics and preservation of the ipsilateral kidney were followed by survival.
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