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Clin Colon Rectal Surg 2021; 34(01): 028-039
DOI: 10.1055/s-0040-1714284
Review Article

Rectovaginal Fistulas Secondary to Obstetrical Injury

Aaron J. Dawes
1   Department of Surgery, University of Minnesota, Minneapolis, Minnesota
,
Christine C. Jensen
1   Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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Abstract

Rectovaginal fistula (RVF), defined as any abnormal connection between the rectum and the vagina, is a complex and debilitating condition. RVF can occur for a variety of reasons, but frequently develops following obstetric injury. Patients with suspected RVF require thorough evaluation, including history and physical examination, imaging, and objective evaluation of the anal sphincter complex. Prior to attempting repair, sepsis must be controlled and the tract allowed to mature over a period of 3 to 6 months. All repair techniques involve reestablishing a healthy, well-vascularized rectovaginal septum, either through reconstruction with local tissue or tissue transfer via a pedicled flap. The selection of a specific repair technique is determined by the level of the fistula tract and the status of the anal sphincter. Despite best efforts, recurrence is common and should be discussed with patients prior to repair. As the ultimate goal of RVF repair is to minimize symptoms and maximize quality of life, patients should help to direct their own care based on the risks and benefits of available treatment options.

Keywords

rectovaginal fistula - obstetric trauma - obstetric anal sphincter injury - fistula repair


Publication History

Article published online:
22 September 2020

© 2020. Thieme. All rights reserved.

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