Rectovestibular fistula with vaginal malformations

Abstract

Anorectal malformations are associated with other anomalies among which vaginal malformations are occasionally encountered and may go unnoticed by the primary physician. Between January 1998 and December 2003, 563 cases of anorectal malformations were managed in Pediatric Surgery Department, Chittagong Medical College & Hospital, Chittagong, Bangladesh. Among these, five cases of rectovestibular fistula were associated with vaginal malformations. In this retrospective study age, physical findings, operative findings and procedures, outcome of operation and postoperative follow-up were evaluated. Mean age at presentation was 8.67 years (range 2 months to 17 years). All cases referred as rectovaginal fistula and vaginal anomalies (atresia to agenesis) were detected after thorough examination. Initial pelvic colostomy was done in all patients. Cases 1, 3 and 4 had distal vaginal agenesis and underwent posterior sagittal anorectovaginoplasty. In case 5, atretic vaginal duplication was found with didelphic hypoplastic uterus and absent left kidney. Case 2 (vaginal atresia) operated elsewhere is waiting for definitive surgery. Colostomy closure was done in four cases. The third patient had already married and conceived. Bowel habits are regular in all except the second patient. In females, a thorough understanding of anorectal malformations is necessary to identify the association with vaginal anomalies and awareness of this association will lead to earlier diagnosis and appropriate operative measures.

Rectovestibular fistula—rarely recognized associated gynecologic anomalies

“…The treatment modalities used in the 22 cases of vestibular fistula with absent vagina, reported in the literature [3,[6][7][8][9]11,[15][16][17][18], included 8 vaginal replacements with rectum, 3 replacements with sigmoid, 3 successful vaginal mobilization in cases of distal vaginal atresia, 2 replacements with small bowel, and 1 with skin flaps. No information was found related to the vaginal reconstruction in the remaining 5 cases.…”

“…When treated appropriately, these patients have an excellent functional prognosis for bowel and urinary control [1]. In a review of the literature, we found that associated gynecologic defects are rarely mentioned [2][3][4][5][6][7][8][9][10][11].…”

“…Summary of vestibular fistula and absent vagina cases published in the literature[3,[6][7][8][9]11,[15][16][17][18] …”

Anomalia anorretal e cuidados maternos

“…O impacto do nascimento de uma criança mal formada é profundo, aliado ao problema da imperfuração anal inclui, aos pais e familiares, o desapontamento, a vergonha, os complexos de culpa, acusações mútuas, rejeições, preocupações financeiras e o medo das futuras gestações (3)(4)7) . A imperfuração anal é uma das anomalias anorretais e está associadas aos defeitos em outros sistemas do corpo (3,8) , e estudos mostram a associação mais frequente com o trato urogenital (9)(10)(11)(12)(13)(14) ; a sobrevida depende da severidade das anomalias associadas. Logo no início deve-se obter uma anamnese sistemática e iniciar o tratamento, cirúrgico ou clínico, o mais precoce possível, a lesão se desenvolve devido à falta de complementação do complexo embriológico (15)(16)(17)(18)(19) .…”

Rectovestibular fistula - diagnosis by radiological evaluation: a case report

“…Rectovestibular fistula is found exclusively in females and is of congenital in nature [2]. This is often confused with rectovaginal fistula which is found in less than 1% cases [3]. There is no definitive causative factor noted in this anomaly but the drugs used during pregnancy are thought to be one of the reasons for this anomaly.…”