Question: Background:

My 76 year old grandfather discovered he had very early-stage colon (large intestine near rectum) cancer 2 months ago. A month and a half ago, he went through colorectal surgery (partial colectomy) to get the tissue removed. The surgeon told us that everything seemed fine and there were no complications. However, my grandfather began to develop a high fever (38-39 Celsius), diarrhea, weight loss, and other irregular post-surgery problems. Imaging also showed large fluid build up in the pelvic cavity.

I suspected that there was a problem with the suturing of the wound and I told the surgeon this. We had another specialist check later and it was discovered that the stitched was not done properly and there seemed to be an opening along with severe inflammation. They did a second procedure to allow fecal drainage through an opening 5 cm away from the naval (Colostomy). With the bypass, the wound could be allowed to heal.

Two days after discharge, my grandfather noticed an infected open wound 3 cm away from his rectum (Now a fistula - please see picture). It started to get deeper and deeper followed with inflammation, puss, and some blood. At first, the hospital give him some antibiotics and some ointment (I am not sure what it was). However, the open wound got worse and the ointment did not seem to stick well to the wound. After a week, he was readmitted into the hospital and was put on intravenous antibiotic treatment. Recently, the doctors stopped the antibiotic treatment but it got much worse so they put him under a different antibiotic.

Yesterday, I got an update from him saying that pus and blood continues to flow out from the fistula every day, and medicine does not seem to be most effective. The orginal intestinal wound from the colectomy seems to be healing although slowly and inflammations has almost subsided.

Previous suggestions regarding further surgery might be dangerous as my grandfather is rather old and not in good conditions. As with previous comments, it was suggested to find the source of the infection causing the pus that is leaking from the fistula. The original wound from coloectomy seems to be in the process of healing and may not be the source, so I wonder if the infectious could be from some where else. I believe it was also suggested that the fistula be cut open to allow better drainage.

Any further suggestions or opinions would be greatly appreciated.

Thank you very much for you time and suggestion.

Dr. Ajit Naniksingh Kukreja,

Thank you kindly for your reply.
If possible, may I ask a few follow up questions.

Question #1:
Could you quickly explain Fistulectomy vs fistolotomy?
And why Fistulectomy would be best?

Question #2
Also, one major issue is what would happen post-surgery for fistulectomy?
Will his anus heal back to normal or would there be problems?

Question #3
What major dangers could happen for a fistulectomy surgery?
What are the worst results that can happen that the doctors should look for?

Thank you again and again for your time.

Hi.

Again thank you for your reply.

One more quick question. I got an update from the doctors in China. They seem to also believe to do a fistulectomy. However, they have trouble finding the opening of the fistula (where it ends on the inside). They are currently waiting for the opening to develop to find the opening before doing the surgery. Do you have any suggestions on finding where the fistula leads? Should they continue waiting for it to get worse to find the opening?

Thanks again.