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Kindly concise
Rectovaginal Fistula - Concise Summary
Definition
An abnormal communication between the rectum and vagina.
Causes
| Category | Examples |
|---|---|
| Most common | Obstetric injury (complete perineal tear, imperfect repair) |
| Infections | Tuberculosis, lymphogranuloma inguinale, anal crypt abscess |
| Malignancy | Cervical/rectal carcinoma, post-radiotherapy |
| Iatrogenic | Post-perineorrhaphy, post-Wertheim's operation |
| Other | Diverticulitis, rectal abscess, trauma, congenital (rare) |
Diagnosis
- Small fistulas are hard to detect (especially if surrounded by fibrosis)
- Investigations: Proctoscopy, sigmoidoscopy, radiopaque dye injection
- Figure 16.2: Examining finger passed through rectum emerges into vagina
Treatment
Preoperative prep:
- Bowel emptied with enema
- Vaginal disinfection (Betadine/flavine douches)
- Antibiotics (phthalylsulphathiazole/neomycin) for a few days
Surgical options by fistula type:
| Situation | Surgery |
|---|---|
| Small fistula, intact perineal body | Local excision + closure |
| Large fistula, thin skin bridge | Cut skin bridge → convert to complete perineal tear → repair (as per Ch. 15) |
| High rectovaginal fistula | Preliminary colostomy |
| Fistula from cervical/rectal cancer | Exenteration |
| Post-radiotherapy fistula | Colpocleisis (obliterate vaginal cavity after denuding mucosa) |
| Anal crypt origin | Excise entire fistulous tract + divide external sphincter |
Future delivery: Most gynaecologists recommend elective caesarean section to avoid further sphincter damage.
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