Abstract
We encountered a case of external intestinal fistula that developed after resection of the colon and had been left untreated for 44 years. This report describes the functional and histological changes of the long-diverted large intestine and anus, detected during the treatment. The patient was a 69-year-old man who consulted our hospital with the chief complaint of dermatitis around the intestinal fistula. Only the sigmoid colon and rectum of the large intestine remained, and there was a subcutaneous anastomosis with the ileum, forming an external intestinal fistula. In the rectal biopsy specimen, mucosal chronic inflammatory infiltration, crypt distortion and atrophy, and surface erosions were detected histologically. We resected the intestinal segment containing the fistula and performed an ileoproctostomy. For two months postoperatively, aqueous soft stools were seen. This was presumably caused by dysfunction of water absorption due to disuse. Rectal biopsy performed three months later revealed that the inflammatory findings had disappeared. Though maximum resting pressure of the anal canal was as low as 40 cmH2O before surgery, it had recovered to 80 cmH2O three months postoperatively. It was thought that the decreased sphincteral function recovered as a result of reuse of the anus.
