Experiences of Rectovaginal Fistula in Anorectal Malformation

      Abstract

      Background

      Rectovaginal fistulas (RVFs) are very rare malformations in females with anorectal malformations (ARMs). Here, we share the clinical features of RVF and report the long-term outcomes.

      Methods

      RVF patients were classified using a retrospective analysis of ARM patients who underwent operations at Seoul National University Hospital between January 1999 and May 2017. The Krickenbeck continence scoring system was used to evaluate bowel function 5 and 10 years after surgery.

      Results

      Of the total 460 ARM patients, 203 were female, 7 of whom were diagnosed with RVF. The median age and weight at the time of anorectoplasty were 292 days (range, 140–617) and 8.2 kg (range, 5.5–12), respectively. Six patients had associated anomalies and three patients underwent redo-anorectoplasty. Voluntary bowel movements were observed in 6 out of 7 patients at 5 and 10 years of age. Soiling was observed in all patients at the age of five years and in 6 out of 7 patients at the age of ten years. Constipation was observed in 6 out of 7 patients at both five and ten years of age.

      Conclusions

      An RVF is a very rare malformation, accounting for 1.5% of total ARMs and 3.4% of ARMs in females. Long-term counseling, education, and guidance are needed for effective management of patients' bowel movements.

      Type of study

      Prognosis study

      Level of evidence

      Level IV

      Abbreviations:

      RVF (rectovaginal fistula), ARM (anorectal malformation), VBM (voluntary bowel movement,), PSARP (posterior sagittal anorectalplasty)

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal

      Subscribe:

      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Santulli T.V.
        The treatment of imperforate anus and associated fistulas.
        Surg Gynecol Obstet. 1952; 95: 601-614
        • Trusler G.A.
        • Wilkinson R.H.
        Imperforate anus: a review of 147 cases.
        Can J Surg. 1962; 5: 269-277
        • Smith E.D.
        • Saeki M.
        Associated anomalies.
        Birth Defects Orig Artic Ser. 1988; 24: 501-549
        • Levitt M.A.
        • Peña A.
        Anorectal malformations.
        Orphanet J Rare Dis. 2007; 2: 33
        • Bill A.H.
        • Hall D.G.
        • Johnson R.J.
        Position of rectal fistula in relation to the hymen in 46 girls with imperforate anus.
        J Pediatr Surg. 1975; 10: 361-365
        • Rosen N.G.
        • Hong A.R.
        • Soffer S.Z.
        • et al.
        Rectovaginal fistula: a common diagnostic error with significant consequences in girls with anorectal malformations.
        J Pediatr Surg. 2002; 37 (discussion -5): 961-965
        • Holschneider A.
        • Hutson J.
        • Pena A.
        • et al.
        Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations.
        J Pediatr Surg. 2005; 40: 1521-1526
        • Okonkwo J.E.
        • Crocker K.M.
        Cloacal dysgenesis.
        Obstet Gynecol. 1977; 50: 97-101
        • Herman R.S.
        • Teitelbaum D.H.
        Anorectal malformations.
        Clin Perinatol. 2012; 39: 403-422
      1. Benson C.D.M.W. Ravitch M.M. TV S. Imperforate anus. Year Book Medical Publishers, Pediatric Surgery1962: 821-836
        • Swenson O.
        • Donnellan W.L.
        Preservation of the puborectalis sling in imperforate anus repair.
        Surg Clin North Am. 1967; 47: 173-193
        • Santulli T.V.
        • Schullinger J.N.
        • Kiesewetter W.B.
        • et al.
        Imperforate anus: a survey from the members of the Surgical Secton of the American Academy of Pediatrics.
        J Pediatr Surg. 1971; 6: 484-487
      2. Anorectal malformations in children: update 1988. Birth Defects Orig Artic Ser 1988;24:1-604.

        • Hashish M.S.
        • Dawoud H.H.
        • Hirschl R.B.
        • et al.
        Long-term functional outcome and quality of life in patients with high imperforate anus.
        J Pediatr Surg. 2010; 45: 224-230
      3. Levitt MA, Pena A. Imperforate anus and cloacal malformations. In: George W. Holcomb III, J. Patrick Murphy, Daniel J. Ostlie, Shawn D. St. Peter, editors. Ashcraft's pediatric surgery. 6th ed. Elsevier; 2014. p. 492-514