Brief Answer:
I am unable to locate your current concerns...

Detailed Answer:
Hi,

I am sorry, I feel I have received your complete question here. All I read is that emergency room doctors has diagnosed fistula as the cause of stool incontinence. This needs to be evaluated by the surgeons. It may or may not need surgical treatment.

Besides that you also mentioned she had a concern that is causing her trouble since years which was believed to be hernia.

I am not sure if your sister's concern are presented in detail with the above post here. Can you post those concerns in the follow up. I shall try to help her out.

Awaiting your response...

Regards

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Brief Answer:
review with surgeon

Detailed Answer:
Hi,

The described symptoms are non specific, hence I'm unable to arrive at a conclusion. Based on the described symptoms my comments are as follows:
1. Hernia is a clinical diagnosis. We co-relate symptoms and signs and diagnose this entity. However if there are doubts whether or not you have hernia, we can consider using ultrasound scans. You can talk to another surgeon and review clinical findings and perhaps use scans to confirmhernia.
2. I'm unable to explain severe abdominal pain by fistula. May be the pain is due to hernia or other surgical cause. Can you describe her pain -the type of pain and the Location of pain?
3. I would like to check the patency of colostomy /ileostomy if she has fecal incontinence. Her surgeon Can check for it.
4. You have not described her urine problem. Please explain if in the follow up.

Hope this helps.

Regards

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Brief Answer:
Let me clarify.

Detailed Answer:
1. As far as pain is concerned, severe abdominal pain is very non specific entity. As a clinician I need to know where exactly the pain is. We can classify abdomen broadly in relation to the belly button into four quadrants - upper / lower; right or left. Further if you can describe the pain - a continuous ache, a burning pain, intermittent spasmodic / colicy ache, stabbing, etc., I will be able to relate it better.

2. Presence of foul smelling vaginal discharge is a feature of genital infection. In some case this infection can ascend up into the pelvic organ and lead to lower abdominal pain. However as I mentioned in the first point, your description is important to know whether or not this is related.

3. A stoma (ileostomy/colostomy) is created for two reasons
a) To give time for lower gut tissues heal
b) To treat lower gut obstruction.
I did not find any symptoms that suggest lower gut obstruction. Therefore perhaps the ileostomy / colostomy was created to aid fistula or any other lower gut pathology to heal. If this stoma is fully patent, stools are sufficiently directed to the bad. If there are no stools in the bag, then perhaps the stoma is not fully patent. Her surgeon should check for it.
At this point of time, the doctor can reassess whether there is a need to close stoma or not.

4. If her surgeons feel there is no hernia and the doctors previously misdiagnosed it, then may be the doctor is right. Ultrasound scans and radiological tests can prove his point. It can also help to assess the some causes of abdominal pain. It's an useful investigation in this context. Discuss with her treating doctor.

5. I am not very sure what type of problem she has with urination. You may want to describe that.

6. Lastly the gynecologist consult will be extremely useful. It may be the missing link to all her clinical symptoms. I too look forward to that.

Hope things are clear now. I will be glad to clarify further should you have any more doubts.

Regards

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