From the Guidelines
A rectovaginal fistula is an abnormal connection or passageway that forms between the rectum and vagina, allowing stool and gas to pass from the rectum into the vagina, causing symptoms such as the passage of feces or gas through the vagina, recurrent vaginal infections, and foul-smelling vaginal discharge. This condition can develop due to various causes including childbirth injuries, Crohn's disease, radiation therapy, surgery complications, cancer, or infections. The size of fistulas can vary from very small to large openings.
Causes and Symptoms
- Childbirth injuries
- Crohn's disease
- Radiation therapy
- Surgery complications
- Cancer
- Infections Treatment typically depends on the size, location, and cause of the fistula, with surgical repair being the primary approach in most cases, as suggested by the most recent study 1.
Treatment Options
- Surgical repair
- Conservative management including antibiotics and proper hygiene for small fistulas
- Medical treatment with anti-TNF agents, such as infliximab, for patients with Crohn's disease 1 The specific surgical technique chosen depends on the fistula's characteristics and the patient's overall health, with options including primary closure, transanal advancement flap, sleeve advancement flap, and transvaginal advancement flap. Recovery after surgical repair requires careful attention to bowel movements and hygiene to prevent recurrence or infection while the area heals. According to the ECCO guidelines 1, medical treatment should be considered in anogenital and rectogenital CD fistulae, and counseling for surgical closure in selected patients with CD.
From the Research
Definition of Rectovaginal Fistula
A rectovaginal fistula (RVF) is an abnormal connection between the rectum and the vagina, allowing stool or gas to pass from the rectum into the vagina 2, 3, 4, 5, 6.
Causes and Types of Rectovaginal Fistula
The causes of RVF can vary, including:
- Trauma or injury during childbirth
- Surgery, such as hysterectomy or rectal surgery
- Inflammatory bowel disease, such as Crohn's disease
- Infection or abscess
- Malignancy
- Iatrogenic causes, such as complications from medical procedures
Symptoms of Rectovaginal Fistula
The symptoms of RVF can include:
- Passage of stool or gas from the rectum into the vagina
- Fecal incontinence or leakage
- Vaginal discharge or odor
- Pelvic pain or discomfort
- Recurrent vaginal or urinary tract infections
Treatment Options for Rectovaginal Fistula
Treatment options for RVF can vary depending on the cause, size, and location of the fistula, as well as the patient's overall health. Some common treatment options include:
- Surgical repair, such as endorectal advancement flap or Martius flap
- Fistulotomy or ligation of the intersphincteric fistula tract
- Plug or fibrin glue repair
- Abdominal resections with or without proximal diversion and ileostomy takedown
- Gracilis muscle transposition
Success Rates of Treatment Options
The success rates of treatment options for RVF can vary, with some studies reporting: