Q - "Cause of non-healing fistula?" - Prof. Ismail
A - "Why over three years this thing has not healed, either it is not being treated well or the collection is not being drained properly or there is a chronic pathology that produce the chronic inflammation, those are the question you need to ask yourself as a surgeon" - Prof. Ismail
"Nowadays doing fistulogram does not add any information or won't change your management. Most of the time you will get that the track is not well defined, the dye/contrast go into don't know what.. so the best investigation if the contrast CT-Scan. Contrast Ct-Scan can outline if there is other collection, it can tell you if there is connection to the bowel also outlined the mucosa of the small bowel" - Prof Ismail
Q - "What are the features from Ct-contrast to suggest Crohn's?" - Prof. Ismail
A - "multiple strictures, some more?????... I know Crohn's is rare here" - Prof. Ismail
"Not so rare in Aberdeen.... ha Ngoo your're from Aberdeen..." - Prof. Hanafiah
Q - "What are the complication of Crohn's" - Prof. Hanafiah
A - "internal fistulation, small lumen" - Dr. Ngoo
Q - "Has foreign body been ruled out" - Mr. Imtiaz
Q - "What is the management for this patient" - Prof. Ismail
A - "After the Ct-Scan, exploration of the wound" - Dr. Sadhana
A - "Ya, you have to go in, debride and see the bowel if there is fistula you may need to resect the bowel and anastomosis, but there is a probability of right hemicolectomy. Also beware of the right ureter and deodenum" - Prof. Ismail
Q - "What will be the complication at the deodenum" - Prof. Ismail
A - "Bleeding from the paradeodenul veins" - Dr. Wahab
zairul
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