A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. Passage of gas, stool or pus from the vagina. Foul-smelling vaginal discharge. Recurrent vaginal or urinary tract infections. Irritation or pain in the vulva, vagina and the area between the vagina and anus (perineum) Pain during sexual intercourse.
After diagnosing rectovaginal fistula, it is best to wait for around 3 months to allow the inflammation to subside. For low fistulae, a vaginal approach is best, while an abdominal repair would be necessary for a high fistula at the posterior fornix. A circular incision is made around the fistula and vagina is separated from the underlying rectum with a sharp circumferential dissection. The entire fistulous tract, along with a small rim of rectal mucosa is incised. The rectal wall is then closed extramucosally.
28 patients with persistent fistulas were identified. In 18 patients the fistula was classified as simple, and in 10 the fistula was complex. 14 fistulas were secondary to obstetric injury, 5 were caused by Crohn's disease, and 9 patients had miscellaneous etiologies for their fistulas. Of patients with persistent simple fistulas, 13 (72 percent) of the fistulas healed, 5 after advancement flaps, 5 following sphincteroplasty, and 3 after coloanal anastomoses. Of persistent complex fistulas, only 4-10 (40 percent) healed, one following sphincteroplasty, one with coloanal anastomosis, and two after gracilis transposition. A total of 23 advancement flaps were done in 17 patients with 5 fistulas healing (29 percent). Sphincteroplasty and fistulectomy was successful in six of seven patients (86 percent). Coloanal anastomosis resulted in healing of four of six patients (67 percent) in whom it was attempted. Gracilis muscle transfer was successful in two of two patients (100 percent).