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Review
. 2016 Mar;29(1):50-6.
doi: 10.1055/s-0035-1570393.

Rectovaginal Fistulae

Bidhan Das  1 , Michael Snyder  2
Affiliations
Review

Rectovaginal Fistulae

Bidhan Das et al. Clin Colon Rectal Surg. 2016 Mar.

Abstract

Rectovaginal fistulae are abnormal epithelialized connections between the rectum and vagina. Fistulae from the anorectal region to the posterior vagina are truly best characterized as anovaginal or very low rectovaginal fistulae. True rectovaginal fistulae are less common and result from inflammatory bowel disease, trauma, or iatrogenic injury. A very few patients are asymptomatic, but the symptoms of rectovaginal fistula are incredibly distressing and unacceptable. Diagnostic approach, timing, and choice of surgical intervention, including sphincteroplasty, gracilis flaps, Martius flaps, and special circumstances are discussed.

Keywords: Martius flap; advancement flap; anovaginal fistula; fistula plug; rectovaginal fistula.

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Figures

Fig. 1
Fig. 1
Enterovaginal fistula. Contrast administered per vagina directly communicates to segment of sigmoid colon, inflamed by diverticulitis.
Fig. 2
Fig. 2
Algorithm for the management of rectovaginal fistula. (From: Hull T. Rectovaginal Fistula. In: Fazio VF, Church JM, Delaney CP, eds. Current Therapy in Colon and Rectal Surgery. 2nd ed. Philadelphia, PA: Mosby, Inc.; 2005:39.)
Fig. 3
Fig. 3
a, b Endorectal advancement flap. (From: Hull TL, Fazio VW. Surgical approaches to low anovaginal fistula in Crohn's disease. Am J Surg 1997;173:95–98.)
Fig. 4
Fig. 4
Gracilis muscle interposition flap. (From: Keighley MRB, Williams NS, Church JM Pahlman L, Sholefield JH, Scott NA. Surgery of the Colon, Rectum, and Anus. 3rd ed. Philadelphia, PA: Elsevier Limited; 2008:509.)
Fig. 5
Fig. 5
Martius flap with the bulbocavernosus flap from the left labia exposed.
See this image and copyright information in PMC

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