II. Enteric Fistulas

  1. Enterovesical fistula (bowel to Bladder fistula)
    1. Less common in women than enterovaginal fistula
    2. Presentations
      1. Pneumaturia and Urinary Tract Infection symptoms
      2. Polymicrobial Urinary Tract Infection
  2. Enterovaginal fistula
    1. Presentations
      1. Fecal Vaginal Discharge
      2. Passing of gas vaginally
    2. Differential diagnosis
      1. Diverticulitis
      2. Colon Cancer
    3. Diagnostic modalities
      1. Vaginoscopy with rectal insufflation
      2. Gastrografin enema
      3. Rectal methylene blue stain
      4. Fistulogram with contrast dye
  3. Other fistula locations
    1. Uterus
    2. Adnexa
    3. Vulva
    4. Perineum

III. Perineum and Vulva

  1. Perineal lesions after Vaginal Birth with episiotomy
    1. Responds to Flagyl with other Crohn's Disease agents
  2. Vulvar lesions
    1. Presentations
      1. Isolated granulomatous vulvar lesions
      2. Pyoderma Gangrenosum of the vulva
      3. Vulvar Cancer (squamous cell)
      4. Vulvar lesions or fistulas
    2. Differential Diagnosis
      1. Bartholin's Gland Cyst
      2. Tuberculosis
      3. Actinomycosis
      4. Lymphogranuloma venereum
      5. Genital Herpes

IV. Miscellaneous gynecologic associations

  1. Granulomatous lesions of Adnexa Differential Diagnosis
    1. Pelvic Inflammatory Disease
    2. Endometriosis
    3. Appendicitis
    4. Diverticulitis
  2. Menstrual abnormalities (may be exacerbated by NSAIDs)
    1. Dysmenorrhea
    2. Amenorrhea
    3. Menorrhagia
    4. Cyclic variation in bowel symptoms with Menses

V. Psychological Affects

  1. Altered self-image and body image
  2. Sexual Dysfunction (e.g. perineal pain)
  3. Socially inhibited

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