Photoclinic: Rectovaginal Fistula
Following a complicated vaginal delivery 4 months earlier, a 22-year-old mother of a healthy 9.5-lb infant girl experienced stool incontinence and leakage. An infection had occurred at the site of the episiotomy shortly after the delivery; fecal and flatus incontinence developed about 2 weeks later. Virendra Parikh, MD, of Fort Wayne, Ind, detected a fistula between the lower rectum and the vagina (A ); insertion of an anal retractor delineated the fistula (B ). The patient also had very low anal sphincter tone. Rectovaginal fistulas can result from several different mechanisms, including— as in this case—traumatic laceration during childbirth.1 Complications of pelvic radiation, severe perirectal infections, and surgical trauma are other causes. Surgical repair of symptomatic rectovaginal fistulas is usually required. The type of surgery depends on the size of the fistula, amount of scarring in the perineum, and presence of symptoms.1 This patient underwent an overlapping anal sphincteroplasty of the fistula and underlying anal sphincter. At 1-year follow-up, she was doing well. REFERENCE: 1. Homsi R, Daikoku NH, Littlejohn J, Wheeless CR Jr. Episiotomy: risks of dehiscence and rectovaginal fistula. Obstet Gynecol Surv. 1994;49:803-808.