Behind the Night, the surgery podcast, relevant and engaging content designed to help you dominate the day.

Hello behind the knife listeners. We are so excited to be back with you for another clinical challenges in colon and rectal surgery.

Here with the Leahy colorectal surgery team. It's been a hot minute since we put together an episode for our behind the knife audience and I'm sure that they have missed us quite dearly.

So to recap, we had some prior episodes talking about endoscopic management of advanced colorectal polyps.

The role of total new adjuvant therapy for local advanced rectal cancer surgical management of rectal prolapse.

We talked about the use of biologic medications and patients with Crohn's disease requiring illiocolic resection, small bowel structures and Crohn's disease.

And today, we're thrilled to address a very, very challenging topic, which is or shoe abscessant fistula.

We will put in a little plug there for our new colorectal team for Louisville, and they did a recent episode called Let's Talk Ostemes.

So once again, we have with us Dr. Peter West Marcello and Dr. Tess Hannah Alex. And we do have a special guest that we're going to introduce in a minute. So say hi everybody.

Hey guys, the team is great to be back together to do another episode behind the knife. It does seem like it's been a while and this is also August. So it's another new year for the colorectal residents.

We're excited to see Mike and Anna, our former residents, leave and start their careers. And we actually welcome Gabby and Vanessa as they start your training.

Yeah. Hey team, missing you all in Burlington. Similarly, sad to see our fellow Don you and go, but excited to see how things go in his first year and welcome our new fellow Samantha Revard, who also just started with us. So off to a great, great start for the year.

Awesome. Well, today we have a very, very special guest with us. So Dr. Julia Saraita Reeves, she's one of our esteemed partners in the Department of colon and rectal surgery at Leigh Hospital Medical Center.

So a brief introduction for Dr. Julia, as she is affectionately called by her patients. So Dr. Julia completed her general surgery residency at Mass General Hospital.

She did a one year colorectal fellowship at Leigh Hospital Medical Center and was then hired on a staff after training. So she's now in her sixth year of practice. Welcome, Dr. Julia.

Welcome.

Thanks for having me, everyone. Happy to be here.

Alright, so like our prior clinical challenges episodes, we're just going to describe one case and we're going to take a deep dive about complex medical and surgical decision making.

And then a reminder, you can follow along with us on the behind the knife YouTube channel for some relevant images.

Alright, so let's get into it. So this is a 59 year old female. She had no relevant medical or surgical history and she had been seen a year prior by one of our nurse practitioners for Buduck Pain.

She had been having this for a few months and this was low tailbone pain was associated with bowel movements. She had some difficulty sitting.

Wasn't really having any rectal drainage, but she could feel some swelling by her rectum on both sides. And so I guess test with that in getting ready to see a patient like this and clinic, what are you thinking about in terms of your differential?

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