Fulminant Clostridium Septicum myonecrosis in well controlled diabetes: a case report

Diabetic myonecrosis with Clostridium Septicum is uncommon but carries a high mortality rate. This commensal organism is part of the gastrointestinal tract flora and can become extremely virulent, often in the setting of immuno-suppression such as neutropenia, occult malignancy (commonly caecal) and poorly controlled diabetes. The case report is unusual in that there are few risk factors other than very mild neutropenia. This highlights the opportunistic character of the organism and recommends that a high index of suspicion and vigilance be carried out in the presence of fevers and sepsis, even in the well-controlled diabetic population

Transperineal repair of obstetric-related anovaginal fistula

The definitive version is available at www.blackwell-synergy.comBackground: To describe an operative technique for the repair of anovaginal fistulae secondary to obstetric injury and to assess its functional outcome and patient satisfaction. Methods: An operative repair involving division of the anovaginal fistula, closure of rectal and vaginal walls, anterior levatoplasty and overlapping sphincteroplasty is described. Postoperative complications and recurrence were recorded. A telephone interview was carried out to assess the functional outcome and the satisfaction score. Results: Seven consecutive patients had a repair of an obstetric-related anovaginal fistula. Their mean age was 34 years (range: 22–72). They had a mean duration of symptoms of 14 months (range: 1.5–54). Four patients did not have any previous repair and no stoma was necessary in any of the seven patients. There was no significant postoperative complication and only one recurrence. Telephone interviews were conducted for six patients and one was lost to follow-up. The mean follow-up period was 24 months (11–35). The Wexner's continence score improved from a mean preoperative score of 13.4 to a mean postoperative score of 5.6. With satisfaction scores ranging from +3 to −3 (+3 indicating complete satisfaction and −3 indicating complete dissatisfaction), five patients scored 1 and one scored 0. Conclusion: This technique is straightforward and effective in healing obstetric-related anovaginal fistula. It achieves improved continence and reasonable satisfaction.Anovaginal fistula; obstetric; sphincter repair; transperineal repai