| Rectovestibular fistula | |
|---|---|
 | |
| Rectovaginal fistula | |
| Specialty | Gynecology |
| Diagnostic method | • No anal opening • A gloved finger or thermometer cannot be inserted into the infants rectum• No history of passage of meconium• Presence of abdominal distension • Presence of meconium in urine |
| Treatment | PSARP |
Arectovaginal fistula is a medical condition where there is afistula or abnormal connection between therectum and thevagina.[1]
Rectovaginal fistulae may be extremely debilitating. If the opening between the rectum and vagina is wide it will allow bothflatulence andfeces to escape through the vagina, leading tofecal incontinence. There is an association with recurrent urinary and vaginal infections. The fistula may also connect the rectum and urethra, which is called recto-urethral fistula. Either conditions can lead tolabial fusion. This type of fistula can cause pediatricians to misdiagnoseimperforate anus. The severity of the symptoms will depend on the size of fistula. Most often, it appears after about one week or so after childbirth.
Rectovaginal fistulas are often the result of trauma during childbirth (in which case it is known asobstetric fistula), with increased risk associated with significant lacerations or interventions are used such asepisiotomy or operative (forceps/vacuum extraction) deliveries[2] or in situations where there is inadequate health care, such as in somedeveloping countries. Rectovaginal fistula is said to be known as the leading cause in maternal death in developing countries.[3] Risk factors include prolonged labour, difficult instrumental delivery and paramedianepisiotomy. Rates inEritrea are estimated as high as 350 per 100,000 vaginal births. Fistulas can also develop as a result of physical trauma to either the vagina or anus, including fromrape.[4] Women with rectovaginal fistulae are often stigmatized in developing countries, and become outcasts.[5]
Rectovaginal fistula can also be a symptom of various diseases, including infection bylymphogranuloma venereum,[6] or the unintended result of surgery, such as episiotomy orsex reassignment surgery. They may present as a complication of vaginal surgery, including vaginalhysterectomy. They are a recognized presentation of rectalcarcinoma or rarelydiverticular disease of the bowel orCrohn's disease. They are seen rarely afterradiotherapy treatment forcervical cancer.[citation needed]
After diagnosing rectovaginal fistula, it is best to wait for around three months to allow the inflammation to subside. For low fistulae, a vaginal approach is best, while an abdominal repair would be necessary for a high fistula at theposterior fornix.
A circular incision is made around the fistula and vagina is separated from the underlying rectum with a sharp circumferential dissection. The entire fistulous tract, along with a small rim of rectal mucosa is incised. The rectal wall is then closed extramucosally.[7]
Most rectovaginal fistulas will need surgery to fix. Medications such as antibiotics andInfliximab may be prescribed to help close the rectovaginal fistula or prepare for surgery.[8][9]
Media related toRectovaginal fistula at Wikimedia Commons
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