Official websites use. Share sensitive information only on official, secure websites. Address for correspondence and reprint requests: David E. Rivadeneira M. Rectovaginal fistulas represent an often devastating condition in patients and a challenge for surgeons. Successful management of this condition must take into account a variety of variables including the etiology, size, and location of the fistula. Etiologies include obstetrical trauma, inflammatory bowel disease, malignant processes, and complications of radiation therapy and surgery.
Repair options include local repairs, tissue transfer techniques, and abdominal operations. In addition, the condition of the involved tissues and overall medial condition of the patient are of considerable importance. These fistulas can develop from a multitude conditions, including obstetrical trauma, inflammatory bowel disease, carcinoma, radiation, diverticulitis, and infectious processes, and as a result of postsurgical procedures.
The most common etiological cause of rectovaginal fistulas is obstetrical trauma. Several factors contribute to this process. A prolonged obstructed labor may produce injuries to multiple organ systems. The best known, and most common, of these injuries is obstetric fistula formation. When obstructed labor is unrelieved, the presenting fetal part is impacted against the soft tissues of the pelvis and a widespread ischemic vascular injury develops that results in tissue necrosis and subsequent fistula formation.
Other predisposing factors include forceps delivery, midline episiotomy, and third- or fourth-degree perineal lacerations. Goldabar et al reported a 1. Radcliffe et al reported an incidence of 9. Malignant processes, including cancers of the rectum, cervix, uterus, or vagina, can also contribute to the presences of a rectovaginal fistula.
In addition, the fistulas can develop as complications of radiation therapy and postsurgical operations including low anterior resection with stapled anastomosis, hysterectomy, rectocele repair, and restorative proctocolectomy with ileal pouch anastomosis. Patients with rectovaginal fistulas typically present with complaints of passage of flatus or feces from the vagina. Recurrent urinary tract infections and vaginitis with malodorous vaginal discharge may also be the presenting complaints.
