Congenital rectovaginal fistula with anorectal agenesis

Abstract

BackgroundRectovaginal fistula is a rare type of anorectal malformation; the incidence being less than 1%. We describe five cases of rectovaginal fistula managed at our institution.Materials and methodsCase records of five female neonates with rectovaginal fistula managed at our institute between 2010 and 2016 were reviewed and analysed with respect to age at presentation, clinical presentations, physical findings, investigations, management and outcome.ResultsThe age at presentation varied from 1 day to 2 years of age. Three of them presented in the neonatal period, one presented at 1 month of age and one at two years of age with sigmoid loop colostomy done elsewhere. All had absent anal opening; two neonates passed small amounts of stools through vagina, but little in amounts. The one-month old patient had history of passing stools through vaginal orifice, but had presented to us with obstruction. All patients underwent high sigmoid loop colostomy followed by definitive procedure at a later date – Posterior Sagittal Anorectoplasty. One patient is awaiting definitive repair.ConclusionRectovaginal fistula is a rare anorectal malformation and needs thorough investigation and appropriate management for good outcome.

Evaluation and management of rectovaginal fistula in anorectal malformation: an observational study

“…It is higher than reported in the existing literature from 1.3 to 4% [2,7,8]. However, it is to be noted that RVF has been reported to be more common in India and some Asian countries [6]. The incidence was 6% in a study from India [9].…”

“…It is also evident from limited literature on this variant of ARM. Previously, RVF was believed to be a common clinical variant, with some reports claiming its incidence to be 84% [6]. Later on, it was realized that the vestibular fistula and cloaca were misdiagnosed as RVF [7].…”

“…However, in developing countries like India, despite advances in health care facilities, many deliveries are conducted at home in remote parts. The possibility of a missing ARM at that time delays the diagnosis [6]. Besides, if the fistula is decompressing, the time of delay increases [10].…”

Bartholin's gland abscess a rare cause of rectovaginal fistula: A case report and literature review

“…Rectovaginal fistula is a complex pathology with psycho-social, individual, familial, religious and ethno-environmental repercussions [5] (Touhidi). RVF complicates 0.1% of vaginal deliveries [3] (Lo 2016) and accounts for around 5% of anorectal fistulas, while their incidence due to a congenital malformation is less than 1% [6] (Tiwari). The fistulas that develop in the anal canal are anovaginal fistulas [7] (Guillermin).…”

“…The aetiologies of RVF are very varied and include obstetric and vaginal trauma, cryptoglandular infections, inflammatory bowel disease, rectal or vaginal surgery, radiation, neoplasms and pelvic infections in adults. In children, it is especially congenital malformations that are involved [6] (Tiwari). The diagnosis of a RVF is primarily clinical by the presence of stool through the vagina [8] (Woo et al).…”