Materiały źródłowe

• #1 Rectovaginal Fistula: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22260-rectovaginal-fistula

  A rectovaginal fistula is a tunnel-like opening that develops between your vagina and rectum. […] In a rectovaginal fistula, damage to vaginal tissue causes the tissue to die and a hole (fistula) to form. This opening lets stool and gas enter your vagina. […] Symptoms of a rectovaginal fistula include: […] Diagnostic tests for rectovaginal fistulas include: […] Most women with rectovaginal fistulas need surgery to close the opening. […] Most women who have rectovaginal fistula repair recover fully. They no longer have symptoms. […] Rectovaginal fistula repair surgery is highly successful at closing the fistula and putting an end to uncomfortable symptoms.

• #2 Rectovaginal Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK535350/

  A fistula is an abnormal connection between 2 epithelial surfaces. […] Recto-vaginal fistula starts from the rectum and extends to the vagina. […] The underlying etiology determines the method of assessment, management, and prognosis. […] When RVF is suspected, a workup should be started to confirm the diagnosis, assess the extent of the fistula, and identify the underlying diagnosis. […] Endoscopy, like colposcopy and/or proctosigmoidoscopy (rigid or preferably flexible), may reveal the site of the fistula with the underlying disease. […] Imaging is commonly used and useful to confirm the diagnosis and identify the underlying disease. […] Treating RVF involves treating the underlying disease, the fistula itself, and any related complications. […] Therefore, confirming the fistula etiology should be done before planning treatment.

• #3 Rectovaginal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectovaginal-fistula/diagnosis-treatment/drc-20377113

  To diagnose a rectovaginal fistula, your health care provider will likely talk to you about your symptoms and do a physical exam. Your provider may suggest certain tests depending on your needs. […] Your health care provider does a physical exam to try to locate the rectovaginal fistula and check for a possible tumor, infection or abscess. The exam generally includes looking at your vagina, anus and the area between them, called the perineum, with a gloved hand. A tool specially designed to be inserted through a fistula may be used to find the fistula tunnel. […] Most commonly, a rectovaginal fistula is easily seen during a pelvic exam. If a fistula is not found during the exam, you may need tests. These tests can help your medical team find and look at a rectovaginal fistula and can help plan for surgery, if needed.

• #4 Rectovaginal Fistula | UT Medical Center

  https://www.utmedicalcenter.org/treatments/rectovaginal-fistula

  Much in the same manner as urinary fistula are diagnosed, the diagnosis of a rectovaginal fistula begins with a careful medical and surgical history, followed by a detailed physical exam. […] If the initial physical exam does not reveal the fistula tract, your doctor may choose to perform a dye test, in which blue dye can be introduced into the rectum and then, with a finger in the rectum, your doctor can express blue dye from the rectum into the vagina revealing the location of the fistula tract. […] If the diagnosis is still uncertain, other tests such as defecograms and barium enemas may be used to determine the location of the fistula.

• #5 Rectovaginal Fistula Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/193277-clinical

  The clinical presentation of rectovaginal fistula (RVF) varies little. A few patients are asymptomatic, but most report the passage of flatus or stool through the vagina, which is understandably distressing. Patients may also experience vaginitis or cystitis. At times, a foul-smelling vaginal discharge develops, but frank stool through the vagina usually occurs only when the patient has diarrhea. The clinical picture may include fecal incontinence due to associated anal sphincter damage or bloody, mucus-rich diarrhea caused by the underlying clinical etiology. […] Physical examination is essential. This usually confirms the diagnosis of RVF and provides a great deal of information regarding the size and location of the fistula, the functioning of the sphincters, and the possibility of inflammatory bowel disease (IBD) or local neoplasm. (Anal sphincter disruptions are commonly seen in association with RVFs of obstetric origin. Sphincter function should be evaluated prior to any repair.)

• #5 Rectovaginal Fistula Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/193277-clinical

  Office examination usually consists of a rectovaginal examination (visual and palpation) and proctosigmoidoscopy. The fistula opening may be seen as a small dimple or pit and occasionally can be gently probed for confirmation. […] Placing a vaginal tampon, instilling methylene blue into the rectum, and examining the tampon after 15-20 minutes can often establish the presence of RVF. If the tampon is unstained, another part of the gastrointestinal (GI) tract may be involved.

• #6

• #6 Rectovaginal Fistula | Colon & Rectal Surgical Specialists

  https://www.crssny.com/conditions/rectovaginal-fistula/

  Whether a result of childbirth, disease, or complications following surgery, some women develop an abnormal connection between their large intestine and vagina. Known as a rectovaginal fistula, this damage can result in bowel contents leaking into the vagina and leaving you vulnerable to infection. Our doctors in Nesconset, NY, can diagnose and provide treatment for this condition. […] If you experience any of these symptoms, you should reach out to our Nesconset office. Although it can be a sensitive or embarrassing subject, our doctors are trained to diagnose and treat this condition with discretion and compassion. A fistula may be the first warning of more serious problems, including infection, abscess, or cancer. […] One of our highly skilled doctors in New York City will perform a physical exam to determine the location of the fistula. This typically involves inspecting your vagina, anus, and perineum with a gloved hand. In some cases, they may need to perform a biopsy to verify the diagnosis. If you do have a rectovaginal fistula, a customized treatment plan will be developed to address the condition.

• #7

  https://drmaherabbas.com/colorectal-conditions/rectovaginal-fistula/

  A rectovaginal fistula is a condition best described as a tunnel that communicates between the rectum and the vagina. […] The history and physical examination are often sufficient to make the diagnosis. An office-based examination includes visual inspection, probing of any vaginal or skin opening with a thin metal probe, a finger examination, and Anoscopy or Proctoscopy to look inside the anus and the rectum. One or more of the following tests may be recommended to complete the evaluation: Endoscopic examination: Colonoscopy to assess the large bowel (colon and rectum). Colonoscopy is a very important test especially if the patient has any abdominal symptoms, rectal bleeding, or fistula features suggestive of the possibility of inflammatory bowel disease such as Crohns disease. Vaginoscopy is an examination where the inside of the vagina is inspected using special instruments to document the presence and location of the fistula. […] Some rectovaginal fistulas are very narrow and difficult to find during the office visit or additional testing. Under such circumstance, it may be necessary to perform an examination under anesthesia in the operating room in order to employ various maneuvers to identify the fistula.

• #8 Rectovaginal fistula | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/rectovaginal-fistula?content_id=CON-20377094

  To diagnose a rectovaginal fistula, your health care provider will likely talk to you about your symptoms and do a physical exam. Your provider may suggest certain tests depending on your needs. […] Your health care provider does a physical exam to try to locate the rectovaginal fistula and check for a possible tumor, infection or abscess. The exam generally includes looking at your vagina, anus and the area between them, called the perineum, with a gloved hand. A tool specially designed to be inserted through a fistula may be used to find the fistula tunnel. […] Most commonly, a rectovaginal fistula is easily seen during a pelvic exam. If a fistula is not found during the exam, you may need tests. These tests can help your medical team find and look at a rectovaginal fistula and can help plan for surgery, if needed.

• #8 Rectovaginal fistula | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/rectovaginal-fistula?content_id=CON-20377094

  A CT scan of your abdomen and pelvis gives more detail than does a standard X-ray. The CT scan can help locate a fistula and determine its cause. […] This test creates images of soft tissues in your body. MRI can show the location of a fistula, whether other pelvic organs are involved or whether you have a tumor. […] If your health care provider thinks you have an inflammatory bowel disease, you may have a colonoscopy to look at the inside of your colon. During the procedure, small samples of tissue may be collected for lab analysis. Samples can help tell if you have Crohn’s disease or other inflammatory bowel conditions. […] If other testing does not find a fistula, your surgeon may need to examine you in the operating room. This allows for a thorough look into the anus and rectum and can help locate the fistula and help plan surgery.

• #9 Rectovaginal Fistula | WakeMed

  https://www.wakemed.org/care-and-services/gastroenterology/conditions-we-treat/rectovaginal-fistula

  A rectovaginal fistula occurs when theres an opening between the rectum and the vagina. This opening allows gas and stool to pass through the vagina. […] To diagnose a rectovaginal fistula, the doctor will first perform a physical examination, and look at the vagina, rectum, and surrounding area. The doctor may need to use a speculum or proctoscope to look inside the vagina or rectum. […] If the doctor suspects a fistula, he or she may order additional tests, including: Barium enema, in which the doctor inserts barium liquid into the patients rectum, and then takes a detailed look using an X-ray camera; Imaging scans, including either computed tomography (CT) or magnetic resonance imaging (MRI) scans; Endoanal ultrasound, which uses sound waves to produce pictures of the pelvic area; Methylene enema, or blue dye test, which involves placing a tampon into the vagina, and injecting blue dye into the rectum. Seeing the tampon turn blue would indicate a fistula.

• #10 Rectovaginal Fistula: Diagnosis and Management – Surgical Expert in Chandigarh

  https://drrajeevkapoor.com/rectovaginal-fistula-diagnosis-and-management/

  A vaginogram or a barium enema can aid determine a fistula situated in the upper potion of rectum. These examinations make use of a dye material to show the vagina or the bowel on an X-ray image. […] Blue dye examination. This test includes placing a tampon right into your vagina, after that infusing blue color dye into your rectum. Blue staining on the tampon shows a fistula. […] CT Scan. A CT scan of your abdomen and pelvis gives a lot more information than does a conventional X-ray. The CT check can help situate a fistula as well as establish its reason. […] Magnetic vibration imaging (MRI). This examination can show the place of a fistula, whether other pelvic body organs are included or whether you have a lump. […] Anorectal manometry. This examination measures the level of sensitivity and also feature of your anus and can give information about the rectal sphincter as well as your capacity to control stool passage. This examination does not locate fistulas, lecz may help in planning the fistula repair service.

• #11 Rectovaginal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectovaginal-fistula/diagnosis-treatment/drc-20377113

  A CT scan of your abdomen and pelvis gives more detail than does a standard X-ray. The CT scan can help locate a fistula and determine its cause. […] This test creates images of soft tissues in your body. MRI can show the location of a fistula, whether other pelvic organs are involved or whether you have a tumor. […] If other testing does not find a fistula, your surgeon may need to examine you in the operating room. This allows for a thorough look into the anus and rectum and can help locate the fistula and help plan surgery. […] In most cases, surgery is needed to close or repair a rectovaginal fistula. Before an operation can be done, the skin and other tissue around the fistula should be free of infection or inflammation. […] The goal is to remove the fistula tunnel and close the opening by sewing together healthy tissue. […] If a colostomy is needed, your surgeon may wait 3 to 6 months. Then if your provider is sure that your fistula has healed, the colostomy can be reversed so that stool again passes through the rectum.

• #12 Complications of Endometriosis – Case Report of a Postoperative Recurrence of Rectovaginal Fistula

  https://www.scientificarchives.com/article/complications-of-endometriosis-case-report-of-a-postoperative-recurrence-of-rectovaginal-fistula

  Endometriosis is considered a clinical condition that is difficult to diagnose, but recurrent in the female population. […] Physical examination and clinical history are of little help in concluding the diagnosis, depending on the stage of the disease, thus requiring the use of diagnostic methods such as imaging tests, especially transvaginal and pelvic ultrasound and magnetic resonance imaging. […] Rectovaginal fistula is an abnormal connection between the lower gastrointestinal tract and the vagina. They pose a great challenge to colorectal surgeons because of their complexity which depends on location, etiology and quality of the surrounding tissues. […] The type of procedure will depend on the quality of the surrounding tissues, the location, and the etiology of the fistula. […] Therefore, we can verify the difficulty in the management of rectovaginal fistulas, treatment success, and latent risk of recurrence. […] For this, it is necessary to recognize the importance of early diagnosis and treatment of the disease, in order to avoid possible complications such as the one described in this case report, which directly influences the woman’s infertility and fertilization rate.

• #13 Rectovaginal fistula (MRI enema) | Radiology Case | Radiopaedia.org

  https://radiopaedia.org/cases/rectovaginal-fistula-mri-enema?lang=us

  Rectovaginal fistula after childbirth. Defunctioning colostomy. Assess for fistula healing. […] Gel is seen to enter an anterior track (12 o’clock position) between the low rectum (just above the anorectal junction) and the posterior vagina, with gel within the lumen of the vagina, indicating a rectovaginal fistula. […] An MRI enema protocol utilizes the soft tissue resolution of MRI to delineate vaginal and anorectal anatomy, with the luminal gel insertion providing further data regarding the possibility of a fistula track. Multiplanar reformats of the volume T2 sequences aid in image analysis and reporting. The study can be acquired in 20 minutes and avoids the need for radiation from fluoroscopy or CT, of greater importance in younger patients undergoing investigation for obstetric anorectovaginal fistula.

• #14 Rectovaginal Fistula Workup: Laboratory Studies, Imaging Studies, Endoscopy

  https://emedicine.medscape.com/article/193277-workup

  Laboratory studies (eg, complete blood count [CBC], blood cultures, electrolytes, blood urea nitrogen [BUN], creatinine, and type and screen) are obtained to assess for sepsis, which is extremely rare in fistulas between the gastrointestinal (GI) tract and the female genital tract. Laboratory studies are also helpful in the establishment of preoperative baselines. […] Ancillary studies may illustrate a rectovaginal fistula (RVF) that is elusive on physical examination. Barium enema can demonstrate RVF or the more common sigmoidvaginal cuff fistula observed in diverticulitis. Computed tomography (CT) often shows perifistular inflammation, identifying the responsible digestive organ. Endorectal and transvaginal ultrasonography (US) may be used to help identify low fistulas. Magnetic resonance imaging (MRI) has been employed in the diagnosis of RVFs.

• #15 Rectovaginal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2967329/

  Rectovaginal fistulas are abnormal epithelial-lined connections between the rectum and vagina. They can be quite bothersome to both the patient and the surgeon due to their irritating and embarrassing symptoms and high failure rate after repair. […] An individualized, systematic approach to these fistulas based on their size, location, and etiology provides a more concise treatment plan. […] Supplemental studies may be necessary to confirm the presence of a fistula or to determine the extent of underlying disease. Endorectal and transvaginal ultrasounds may be used to identify a low fistula tract. […] More proximal fistulas are best diagnosed with vaginography or computed tomography with rectal contrast. […] Overall, confirmatory diagnostic studies are only necessary when the rectovaginal fistula eludes identification on physical examination or if the extent of underlying disease is unknown.

• #16 Clinical value of endoluminal ultrasonography in the diagnosis of rectovaginal fistula | BMC Medical Imaging | Full Text

  https://bmcmedimaging.biomedcentral.com/articles/10.1186/s12880-016-0131-2

  Rectovaginal fistula (RVF) refers to a pathological passage between the rectum and vagina, which is a public health challenge. This study was aimed to explore the clinical value of endoluminal biplane ultrasonography in the diagnosis of rectovaginal fistula (RVF). […] All of the internal openings located at the anal canal and rectum of the 28 patients and confirmed during surgery were revealed by preoperative endosonography, which showed a positive predictive value of 100 %. […] The use of endoluminal biplane ultrasonography in the diagnosis of RVF can accurately determine the internal openings in the rectum or vagina and can relatively accurately identify concomitant branches and abscesses located in the rectovaginal septum. […] The clinical diagnosis of simple RVF (only one relatively short tube) based on medical history and anovaginal digital or probe examination is generally not difficult. However, for complex RVF i.e., RVF with branches and concomitant rectovaginal septum abscesses or perianal or perineal abscesses, the diagnosis must rely on imaging examinations.

• #17 Clinical value of endoluminal ultrasonography in the diagnosis of rectovaginal fistula | springermedizin.de

  https://www.springermedizin.de/clinical-value-of-endoluminal-ultrasonography-in-the-diagnosis-o/10026602

  Rectovaginal fistula (RVF) refers to a pathological passage between the rectum and vagina, which is a public health challenge. This study was aimed to explore the clinical value of endoluminal biplane ultrasonography in the diagnosis of rectovaginal fistula (RVF). […] All 28 patients underwent preoperative endoluminal ultrasonography, and the obtained diagnostic results were compared with the corresponding surgical results. […] All of the internal openings located at the anal canal and rectum of the 28 patients and confirmed during surgery were revealed by preoperative endosonography, which showed a positive predictive value of 100 %. […] The use of endoluminal biplane ultrasonography in the diagnosis of RVF can accurately determine the internal openings in the rectum or vagina and can relatively accurately identify concomitant branches and abscesses located in the rectovaginal septum.

• #18 Clinical value of endoluminal ultrasonography in the diagnosis of rectovaginal fistula | springermedizin.de

  https://www.springermedizin.de/clinical-value-of-endoluminal-ultrasonography-in-the-diagnosis-o/10026602

  Endoluminal ultrasonography involves real-time imaging that is not disturbed by visceral movement, respiration or other factors. It can relatively clearly reveal the internal and external sphincters, making it easy for morphological classification. […] Our results suggest that endoluminal ultrasonography exhibits relatively high sensitivity and positive predictive value in the diagnosis of RVF internal openings and fistula morphology. […] In summary, diagnosing RVF using transrectal endoluminal biplane ultrasonography can not only accurately determine the internal openings in the rectum or vagina but also relatively accurately identify concomitant branches and abscesses located in the rectovaginal septum.

• #19 Rectovaginal Fistula Workup: Laboratory Studies, Imaging Studies, Endoscopy

  https://emedicine.medscape.com/article/193277-workup

  Flexible endoscopy (sigmoidoscopy or colonoscopy) is used to fully evaluate the possibility of inflammatory bowel disease (IBD; more often Crohn disease than ulcerative colitis). Because treatment varies according to the diagnosis, endoscopy with biopsies must precede any operative approach to the fistula when IBD is in the differential diagnosis. […] Histology is most important in the evaluation of possible IBD. Neither a diagnosis of ulcerative colitis nor a diagnosis of Crohn disease completely excludes operative repair of an RVF, but operative planning is altered, as is the prognosis. If the rectum is grossly normal in Crohn disease, the prognosis of RVF repair is fair; if the rectum is abnormal, the prognosis is considerably worse. With any fistula considered suggestive of a primary or recurrent neoplasm, the histopathology is of the utmost importance.

• #20 Rectovaginal Fistula | Intimate Wellness Institute

  https://iwiva.com/home-page/womens-speciality-care/urogynecology/bowel-issues/rectovaginal-fistula/

  How is a rectovaginal fistula diagnosed? The IWI team will perform a physical exam and pelvic exam. Theyll also ask about your symptoms. […] Diagnostic tests for rectovaginal fistulas include: Complete blood count and urinalysis to look for infections. Dye test using dye in your rectum to check for signs of leakage between your vagina and rectum. Fistulogram X-ray to determine the number and size of fistulas. Pelvic MRI or CT scan to take images of your vagina and rectum. Flexible sigmoidoscopy to view your rectum and the lower part of your large intestine (colon). Colonoscopy to examine the inside of your rectum and all of your large intestine. Ano-rectal manometry and endo-anal ultrasound to evaluate the nerves and muscles.

• #21 Rectovaginal Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK535350/

  The treatment approach depends on condition severity, acuity, presenting symptoms, patient’s general condition, underlying etiology, and complications resulting from the fistula. […] Multiple operative approaches are used to treat RVF depending on complexity, recurrence, and the underlying disease. […] The principles of successful repair are to remove the unhealthy fistula tissue, replace with healthy tissue that has a good blood supply to enhance healing, and maintain thick interposing tissue between the rectal and vaginal walls. […] Following these principles (although not always possible) increase the chance of successful fistula treatment.

• #22 Rectovaginal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2967329/

  All patients require assessment of fecal continence. […] Determining the cause of incontinence is important prior to operative intervention for a rectovaginal fistula. […] The actual surgical approach in patients with complex rectovaginal fistulas should be individualized to each patient. […] Rectovaginal fistula repair should be postponed in the face of inflammation. […] An individualized, systematic approach to these fistulas based on their size, location, and etiology provides a more concise treatment plan for their resolution, which is possible with correct technique.

• #23 Recto-vaginal fistula – GPnotebook

  https://gpnotebook.com/pages/gastroenterology/recto-vaginal-fistula

  Rectovaginal fistula (RVF): RVFs are epithelial-lined tracts between the rectum and vagina – the majority of RVFs are located at or just above the dentate line. If a fistula is below the dentate line then this is an anovaginal fistula (i.e. not a true RVF) […] a low RVF is defined as being between the lower third of the rectum and the lower half of the vagina; a high RVF is between the middle third of the rectum and the posterior vaginal fornix. RVFs may vary greatly in size – the majority are less than 2 cm in diameter […] Causes: most common cause is obstetric injury. Other causes in descending order of frequency include radiation injury, inflammatory bowel disease (IBD, most often Crohn disease), operative trauma, infection, and neoplasm […] IBD (Crohn’s and ulcerative colitis) have been associated with developments of RVF

• #23 Recto-vaginal fistula – GPnotebook

  https://gpnotebook.com/pages/gastroenterology/recto-vaginal-fistula

  radiation therapy used in pelvic malignancy may be complicated by development of a RVF […] rectal or vaginal operations may cause a RVF […] pelvic operations can be complicated by the development of a RVF […] Clinical features: the usual presentation is that of flatus or, more rarely, stool through the vagina. Patients may also suffer recurrent episodes of cystitis or vaginitis […] Management: refer for specialist advice. Medical management options include: if a fistula is secondary to trauma (including those secondary to obstetric trauma), caused by infection or complicated by secondary infection – in these situations then medical management including abscess drainage and antibiotic therapy may be employed. It may be decided to leave the RVF to heal for a 6-12 week period. During this period dietary modification and fibre supplements may substantially reduce symptoms. This treatment regime may result in complete healing of an RVF secondary to trauma. However if the RVF persists then surgical repair may be required. If an RVF is due to another aetiology (e.g. IBD, neoplasm) then management will also be dictated by the aetiological process […] surgical therapy may be initial treatment or employed if failure of medical therapy.

• #24 da Vinci Assisted Take Down of a Rectovaginal Fistula Through a Posterior Vaginectomy – CSurgeries

  https://csurgeries.com/video/da-vinci-assisted-take-down-of-a-rectovaginal-fistula-through-a-posterior-vaginectomy/

  A rectovaginal fistula (RVF) is an epithelial lined tract between the rectum and vagina. This can result in recurrent urinary tract or vaginal infections, but also creates a significant psychosocial burden for the patient. Unfortunately, due to the individual complexities of these patients, they are difficult to manage despite the numerous surgical options presently described. […] Generally RVFs are classified as low, middle or high, due to the location of the rectal and vaginal opening. Due to this, both low and middle RVFs may be approached via anal, perineal or vaginal routes. Where as high RVFs, which have their vaginal opening near the cervix, generally require an abdominal approach for repair. […] Traditionally for high RVFs patients underwent open surgery; however, minimally invasive surgery has recently been widely accepted as the preferred approach. Although surgeons are becoming more facile with these approaches, both pelvic surgery and a reoperative abdomen still impose significant technical difficulties.

• #25 Rectovaginal Fistulas | GLOWM

  https://www.glowm.com/section-view/heading/Rectovaginal%20Fistulas/item/65

  A rectovaginal fistula is an epithelialized communication between the rectum and the vagina (when distal to the dentate line, it is an anovaginal fistula). Rectovaginal fistulas may cause distressing symptoms, and their severity depends on the size and site of the fistulous tract. They are within the scope of both the gynecologist and the colorectal surgeon. […] The management of fistulas associated with Crohns disease is controversial and remains a challenge for clinicians. Medical treatments provide only low rates of long term symptomatic control and have an unacceptably high rate of recurrence even when initially successful. […] The anatomic site of the fistula needs to be carefully defined. The ostia in the anorectum and in the vagina must be described. The direction, length, width, and associated blind tracks must be appreciated. The size of the fistula affects the choice for repair.

• #26 Rectovaginal Fistulas | GLOWM

  https://www.glowm.com/section-view/heading/Rectovaginal%20Fistulas/item/65

  When considering a surgical repair, the anal continence mechanism must be assessed to evaluate for associated sphincter deficiency or scarring of the perineal body. Endoanal ultrasonography is validated to accurately identify both external and internal anal sphincter defects. […] Rectovaginal fistulas can be repaired through a multitude of approaches including transanal, vaginal, perineal, abdominal, and transsacral. […] The majority of fistulas secondary to trauma or obstetric causes may be repaired early. Repair should be deferred until the resolution of active infection, inflammation, induration, or local cellulitis. […] The goal in the treatment of rectovaginal and anal fistulas is to eliminate the fistula without a change in continence. No single technique exists that is appropriate for the treatment of all fistulas.

• #27 Rectovaginal fistula – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectovaginal-fistula/symptoms-causes/syc-20377108

  A rectovaginal fistula may result from: […] Talk with your health care provider if you have symptoms of a rectovaginal fistula, even if it’s embarrassing. Some rectovaginal fistulas may close on their own, but most need surgery to fix them. […] See your health care provider if you have any symptoms of a rectovaginal fistula. […] A rectovaginal fistula may form as a result of: […] Delivery-related injuries are the most common cause of rectovaginal fistulas. […] The second most common cause of rectovaginal fistulas is Crohn’s disease and, more rarely, ulcerative colitis. […] A cancerous tumor in your rectum, cervix, vagina, uterus or anal canal can result in a rectovaginal fistula. […] In rare cases, prior surgery in your lower pelvic area, such as removing an infected Bartholin’s gland, can cause a fistula to develop.

• #28 Rectovaginal Fistula – Your Pelvic Floor

  https://www.yourpelvicfloor.org/conditions/rectovaginal-fistula/

  A rectovaginal fistula is an abnormal passage, or opening, between the rectum and vagina. […] How is a rectovaginal fistula assessed? A discussion with your primary care doctor is the first step of the assessment. Your doctor will thoroughly review your medical, obstetric, and surgical histories as well as discuss your symptoms. A pelvic exam should be done to assess the perineum (area of skin between the vagina and anus). Applying rectal pressure during the exam assess the perineum, anus/rectum, and vagina. A thin probe may also be used to identify the fistula. […] Rectovaginal fistulas may involve disruption to the internal and external anal sphincter muscles. Further testing may be done to help assess these muscles as well as confirm a fistula if one is not evident on examination. This may involve function of the rectal and anal muscles, which assesses the muscle tone and ability of these muscles to contract. Endoanal ultrasound may also be used to look for disruption of the muscles. Further imaging studies like a CT scan or colonoscopy may be utilized to rule out fistulas involving the colon or small bowel. Other medical conditions should be ruled out including inflammatory bowel disease and cancer.

• #29 Novel Approach in Rectovaginal Fistula Treatment: Combination of Modified Martius Flap and Autologous Micro-Fragmented Adipose Tissue

  https://www.mdpi.com/2227-9059/11/9/2509

  In this paper, we introduce an innovative therapeutic approach for managing rectovaginal fistulas (RVF), by combining the modified Martius flap and micro-fragmented adipose tissue (MFAT) enriched with mesenchymal stem cells (MSC). […] A rectovaginal fistula (RVF) is an abnormal, epithelium-lined communication between the vagina and rectum or only the anal canal. RVFs are less common than both simple and complex perianal fistulas that connect the rectum and/or the anal canal to the perianal skin. […] The presumed reason lies in the poorly vascularized rectovaginal septum. […] The conservative therapeutic options for treating CD-related RVF include antibiotics and various immunomodulators such as tacrolimus, azathioprine, 6-mercaptopurine, and biologic agents. […] Infliximab has been shown to be successful in treating fistulizing CD with different reported success rates.

• #30 How fistulas impacted my health, and my life

  https://crohnsandcolitis.org.uk/news-stories/blog-posts/how-fistulas-impacted-my-health-and-my-life

  Rectovaginal fistulas impacted Rachael’s health, both physically and mentally, and it was a long journey to get to where she is today and achieve her PhD. […] A rectovaginal fistula is an abnormal connection between the rectum and the vagina. Fistulas can allow wind and faecal matter to pass through the vagina and cause infections, soreness, discharge, and abscesses. […] In 2014 my health began to deteriorate rapidly. I experienced lethargy, weight loss, pain, bleeding, and discharge from both the anal and vaginal areas, which were the first signs and symptoms of the developing fistulas. […] While trying to keep clean became a 24-hour battle, the mental and emotional effects of the fistulas were having a huge impact upon my confidence and self-esteem. […] At this point I also had a loop ileostomy formed and commenced infliximab and azathioprine in an attempt to calm down my Crohns and heal my fistulas. While this helped, I would still have bouts of vomiting, abdominal pain, and further rectovaginal infections. […] Living with Crohns and a fistula doesnt just affect a persons physical health but their mental and emotional health too. […] Rectovaginal fistulas can be terribly embarrassing and because of this good information, empathy and support are scant.

• #31 Radiation-induced rectovaginal fistula surgical treatment: a case report – Barzola – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/9975/html

  Radiation-induced rectovaginal fistula (RI-RVF) is a serious complication of radiation therapy for pelvic malignancies. […] The success rate of repair varies from 18% to 93% depending on the surgical technique and patient characteristics. […] We describe a case of a high fistula associated with a rectal stricture. This case highlights the effectiveness of employing both transabdominal and transvaginal approaches in the excision of a high fistula and rectal stump resection, as well as the use of the Turnbull-Cutait colon pull-through procedure and Singapore flap for safe reconstruction, enhancing wound healing, and preventing fistula recurrence. […] Management of RI-RVF should be individualized. The best outcomes are seen when non-irradiated tissue is involved in the reconstruction, which can be achieved with a pull-through operation and delayed coloanal anastomosis. […] Tuttle transvaginal access, Turnbull-Cutait pull-through, and Singapore flap procedures could represent a viable reconstruction option for RI-RVFs, especially in a setting where local tissue quality is insufficient for re-anastomosis and wound healing.

• #32 Rectovaginal Fistulas | GLOWM

  https://www.glowm.com/section-view/heading/Rectovaginal%20Fistulas/item/65

  Diverting colostomy is typically used in the management of radiation-induced fistulas, very large rectovaginal fistulas, and some fistulas secondary to inflammatory bowel disease. A repair of the fistula can then be accomplished after all evidence of cellulitis and inflammation has resolved (usually 8-12 weeks). […] Rectovaginal fistulas can be a vexing problem for women. The successful management of this problem depends on the etiology, size, and location of the fistula, as well as assessing the competence of the continence mechanism.

• #33 Rectovaginal and anovaginal fistulas – UpToDate

  https://www.uptodate.com/contents/rectovaginal-and-anovaginal-fistulas/print

  Anovaginal and rectovaginal fistulas are abnormal tracts that connect the lower gastrointestinal tract with the vagina. […] Anovaginal fistulas (AVFs) and rectovaginal fistulas (RVFs) most frequently result from obstetric trauma, especially in resource-limited countries where prolonged obstructed labor can lead to pressure necrosis of the rectovaginal septum. […] RVFs may also occur following difficult hysterectomies, especially those performed for severe endometriosis with involvement or obliteration of the posterior cul-de-sac (pouch of Douglas); from extension or rupture of perirectal, perianal, and, rarely, Bartholin’s abscesses; and from any surgical procedures involving the posterior vaginal wall, perineum, anus, or rectum. […] In older women, RVFs can occur as a result of diverticulitis, colon cancer, or fecal impaction.

• #34 Rectovaginal fistula – UOAA Discussion Board

  https://www.uoaa.org/forum/viewtopic.php?t=25694

  Hello everyone. I would like to know if anyone has any experience with a rectovaginal fistula. I unfortunately have one. I have already had one surgery to fix it but it was unsuccessful. […] I had rectosigmoid cancer. After the surgery to remove the cancer I developed a mrsa infection and they say that’s what caused the fistula. So they went back in and did the illeostomy so I wouldn’t leak stool in my abdomen. Several months later they attempted the fistula repair that was unsuccessful. […] I would suggest you get a second opinion on this, as I haven’t ever heard of using a colon to repair a vaginal fistula before. […] R/V fistulas are tricky. […] Do patients have retrovaginal fistulars that do heal? Or is it, once you have one you always have one? […] Good news for me! My second surgery to repair the rv fistula seems to have worked! The doc redid my original anastomisis moving it below the fistula and closed the fistula with stitches. He said I still had a small sinus tract there and wants to repeat the barium enema before my reversal surgery. This happens this Thursday so I’ll try to update the curious. So it seems as though they can be repaired…I believe time to heal is the biggest asset.

• #35 Rectovaginal Fistula – Your Pelvic Floor

  https://www.yourpelvicfloor.org/conditions/rectovaginal-fistula/

  The success rate for rectovaginal fistula repair is high, ranging from 90-95%. Patients with recurrent fistulas or a history of radiation may have a poorer outcome. Fecal incontinence, even with successful fistula repair, up to 30-40% of women may still experience fecal incontinence with leakage of stool or gas from the anus, especially if the fistula involved the anal muscles.

• #36 Genitourinary and Rectovaginal Fistulas – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/obgyn/urogynecology/genitourinary-rectovaginal-fistulas

  Effective fistula treatment requires advanced care with an experienced team of specialized urogynecologic surgeons. […] Your urogynecologic surgeon may suspect a fistula based on your medical history and a comprehensive physical exam. Additional tests are often needed to confirm the diagnosis and identify the type of fistula, which is critical to successfully treat your symptoms. […] Some of the diagnostic tests available include: […] Fistulas do not usually heal on their own. In most cases, surgery is needed to correct the problem and should only be performed by a urogynecologic surgeon with specialized training in fistula repair. […] Fistula repair surgery involves removing the fistula tract and repairing affected organs so they are no longer connected. It can be successfully performed using minimally invasive techniques (laparoscopic, robotic and through the vagina) to enhance healing and recovery. Whenever possible, treatment of the underlying cause of the fistula should occur before surgery to maximize its success.

• #37 Rectovaginal fistula – Wikipedia

  https://en.wikipedia.org/wiki/Rectovaginal_fistula

  A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. […] Rectovaginal fistulas are often the result of trauma during childbirth (in which case it is known as obstetric fistula), with increased risk associated with significant lacerations or interventions are used such as episiotomy or operative (forceps/vacuum extraction) deliveries or in situations where there is inadequate health care, such as in some developing countries. […] After diagnosing rectovaginal fistula, it is best to wait for around three months to allow the inflammation to subside. […] Most rectovaginal fistulas will need surgery to fix.

• #38 Elucidating vaginal fistulas on CT and MRI | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-019-0812-9

  Vaginal fistulas (VF) represent abnormal communications between the vagina and either the distal portion of the digestive system or the lower urinary tract, but lack an accepted classification and standardised terminology. […] Since diagnosis of VF is challenging at gynaecologic examination, ano-proctoscopy and urethro-cystoscopy, imaging is crucial to confirm the fistula, to visualise its site, course and involved organ, and to characterise the underlying disease. […] The traditional conventional radiographic studies provided limited cross-sectional information and are nowadays largely replaced by CT and MRI studies. […] CT diagnosis of bowel vaginal fistulas benefits from small field-of-view oblique and sagittal interpretation, and optional intrarectal contrast. […] If not contraindicated, focused MRI provides superior visualisation of ano- and rectovaginal fistulas.

• #39 Elucidating vaginal fistulas on CT and MRI | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-019-0812-9

  CT-urography and additional CT-cystography now represent the mainstay techniques to diagnose urinary VF. […] The majority of patients with VF are initially referred to a gynaecologist; however, despite more or less evident clinical signs, vaginal exploration may identify the fistulous orifice in less than 80% of cases. […] As a result, clinicians and surgeons need critical help from radiologists to (1) confirm the presence of a VF, (2) visualise its site, course and involved organs, and (3) characterise the underlying pathology. […] In recent years, CT and MRI studies are largely replacing conventional radiologic techniques. […] With appropriate acquisition and focused interpretation, state-of-the art cross-sectional imaging may provide optimal visualisation of VF, involved organs and underlying diseases, which is crucial for correct choice between conservative and surgical treatment and appropriate surgical planning.

• #40 Elucidating vaginal fistulas on CT and MRI | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-019-0812-9

  MRI arguably represents the best imaging modality to visualise the normal pelvic and perineal structures including the anal sphincter muscles and to elucidate suspected vaginal disorders. […] Therefore, if allowed by the patients clinical conditions, MRI is the preferred imaging modality to investigate suspected urethro-, vesico-, ano- and recto-VF. […] CT studies should include at least a portal-venous phase of enhancement after intravenous injection of contrast medium. […] In selected patients with suspected recto- or colo-VF, CT may be repeated following administration of diluted contrast medium via a rectal probe. […] CT-urography represents the preferred technique to obtain a comprehensive evaluation of the urinary tract and is generally warranted in patients with suspected iatrogenic injuries.

• #41 Elucidating vaginal fistulas on CT and MRI | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-019-0812-9

  In patients with suspected VF, a vaginal tampon may be placed before performing either CT-urography or CT-cystography. […] The detection of solid pelvic tissue is the hallmark of a neoplastic aetiology of the recto-VF. […] Depending on fistula site, cause and features, surgical management may be performed via transabdominal, transperineal, endorectal or vaginal approach. […] Recto-VF are recognizable on sagittal CT and MRI images and connect the posterior aspect of vagina and anterior wall of rectum.

• #42 Vaginal Fistula Treatments NYC | Mount Sinai – New York

  https://www.mountsinai.org/care/obgyn/services/fistula-care

  At Mount Sinai, our fistula experts are second to none in terms of surgical experience, patient care, and supportive services. We take a multidisciplinary and individualized approach to fistula care. […] The most common fistula seen in the United States is a rectovaginal fistula, which is an opening between the rectum and vagina and is usually caused by complicated childbirth. […] We diagnose a rectovaginal fistula through a vaginal and rectal exam. If we need more information to be certain, we conduct a barium enema or CAT scan with oral and rectal contrast. […] We treat rectovaginal fistula by performing a multi-layer repair of the area between the rectum and the vagina. Most women have enough tissue in this area that we can place multiple layers between the previous defects in the rectum and the vagina to ensure that the fistula does not return.

• #43 Rectovaginal Fistula | SpringerLink

  https://link.springer.com/10.1007/978-3-030-71112-2_46-1

  A rectovaginal fistula (RVF) is an abnormal communicating tract between the epithelialized surfaces of the rectum and vagina that is formed as a consequence of injury or inflammation. […] Diagnosis should comprise of a thorough history and targeted physical exam, along with imaging and/or direct visualization. […] Significant emphasis is placed on the careful and thoughtful extent of multidisciplinary planning to diagnosis and address rectovaginal fistulas and their underlying etiology.

• #44 Rectovaginal Fistula: Diagnosis and Management – Surgical Expert in Chandigarh

  https://drrajeevkapoor.com/rectovaginal-fistula-diagnosis-and-management/

  Anorectal ultrasound. This procedure uses sound waves to produce a video clip image of your anus as well as rectum. Your physician inserts a slim, wand-like instrument into your rectum and rectum. This examination can examine the structure of your anal sphincter and may reveal childbirth-related injury. […] Other examinations. If your physician believes you have inflammatory digestive tract illness, he or she may get a colonoscopy to see your colon. During the treatment, your medical professional can take small examples of tissue (biopsy) for laboratory evaluation, which can aid validate Crohns illness.

• #45 Clinical value of endoluminal ultrasonography in the diagnosis of rectovaginal fistula | BMC Medical Imaging | Full Text

  https://bmcmedimaging.biomedcentral.com/articles/10.1186/s12880-016-0131-2

  Endoluminal ultrasonography exhibits relatively high sensitivity and positive predictive value in the diagnosis of RVF internal openings and fistula morphology. […] In summary, diagnosing RVF using transrectal endoluminal biplane ultrasonography can not only accurately determine the internal openings in the rectum or vagina but also relatively accurately identify concomitant branches and abscesses located in the rectovaginal septum.

Zobacz więcej