Rectovaginal Fistulas

Abstract

Rectovaginal fistulas are abnormal epithelial-lined connections between the rectum and vagina. They can be quite bothersome to both the patient and the surgeon due to their irritating and embarrassing symptoms and high failure rate after repair. An individualized, systematic approach to these fistulas based on their size, location, and etiology provides a more concise treatment plan. Treatment options of medical therapy, advancement flaps, plugs, fistula ligation, and tissue interposition are discussed.

Case report: Treatment of rectovaginal fistula with Bioglue®

“…It is also important to classify RVF into simple and complex due to the different treatment algorithms. 2 Simple fistulas are defined as low lying fistulas, less than 2.5 cm in size, and associated with simple trauma or infection. Complex RVFs are defined as size greater than 2.5 cm, high fistulas near the cervix, associated with inflammatory bowel disease, or are recurrent.…”

“…Complex RVFs are defined as size greater than 2.5 cm, high fistulas near the cervix, associated with inflammatory bowel disease, or are recurrent. 2 Simple RVFs can be repaired using the endo-rectal advancement flap, however, complex RVFs involve larger surgeries. In high RVFs the transabdominal approach is often sited with the repair involving interposition of healthy tissue between the rectum and vagina with surgical modalities including low anterior resections, abdominal perineal resections, and complex muscle flaps.…”

Pattern of non-obstetric infectious recto-vaginal fistula: a case series and literature review in Cameroon, Central Africa

“…Various causes of lower third RVFs have been reported: abscess of the rectovaginal septum, lymphogranuloma venerum, tuberculosis, abscess of bartholin's gland and HIVassociated bacterial and viral infections. 10,11 In developed countries, the main cause of non-obstetrical RVF is Crohn's disease that is less frequent in tropical regions.…”

“…Kouadio et al reported 37 cases of RVFs of which 11 were of infectious origin. 10,11 Bankole et al described 6 cases of pediatric infectious RVFs of which 5 were in HIV patients. 2 Lymphogranuloma venereum, genital tuberculosis and perineal abscess have been identified by some authors as causes of RVF.…”

“…2 Lymphogranuloma venereum, genital tuberculosis and perineal abscess have been identified by some authors as causes of RVF. 10,12 Little is known about infectious RVF in adults. There is therefore a great need to explore this pathology.…”