[Temporary total fecal diversion--ultimate solution for complex recurrent anal fistula]. / Colostomie terminala temporara--solutie extrema într-un caz de fistula perianala complexa multirecidivata.

Anal fistula is a frequent disease, but complex fistulae are relatively uncommon. The treatment for this pathology remains debated all over the world, and in cases of complex fistulae represents a challenge. We present a 55 years old male, operated more than 40 times in the last 15 years for perianal recurrent fistulas and abscesses. The fistula has had a progressive evolution despite all kind of surgery and has extended finally to entire perineal and gluteal region; more than 30 orifices were founded on skin surface and many internal anorectal orifices as well. The patient is weakened, anemic, in chronic sepsis. As a last resort, we decided to perform a terminal fecal diverting stoma at the level of sigmoid colon, with closure of distal end. There were subsequent operations necessary to resolve perineal and gluteal disease: extensive excisions of altered tissues, various full-thickness skin grafts and covering flaps. After 12 months the perineal region was clean, so remaking of colic continuity was possible. Continuous follow-up until 12 months revealed no sign of recurrence. We conclude that temporary total fecal diversion followed by wide excisions of perianal fistulous tissues represents an ultimate solution to complex recurrent perianal fistula, with good results at least in our case.

[Visceral leishmaniasis--surgical aspects]. / Leishmanioza viscerala--aspecte chirurgicale.

Visceral Leishmaniasis is a multi-organic parasitic disease caused by an intracellular protozoon named Leishmania Donovani; the mean signs are: weight loss, cough, fever, hepatosplenomegaly, adenopathy and cutaneous lesions; death without treatment is the rule. The main treatment is a conservative one. Surgical treatment is necessary for complications, especially for those intra-abdominally. We wish to present a young female patient who underwent two subsequent interventions due to an unclear diagnosis. We emphasize the difficulties in achieving a certain diagnostic, because of the rarity of disease in Romania; there are also revealed surgical aspects, which are important because of very few available data in the literature.

[Fournier's gangrene--atypical onset for lower rectal cancer]. / Gangrena Fournier--modalitate atipica de debut in neoplasmul rectal inferior.

The onset for rectal cancer is often revealed by one of its complications. With lower frequency, for the rectum below peritoneal reflexion, the perforative-suppurative onset is possible. We wish to expose a 64 years old woman's case, presenting with Fournier's gangrene as a unique sign of a lower rectal adenocarcinoma. Diabetes mellitus determined the extension of infectious process to its ultimate form, and the poor postoperative evolution, leading to death as well. The need for rectal examination is obvious in perianal abscesses, even in absence of malignant signs.