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Rectovaginal and anovaginal fistulas

Author
Marc R Toglia, MD
Section Editor
Linda Brubaker, MD, FACS, FACOG
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Anovaginal and rectovaginal fistulas are abnormal tracts that connect the lower gastrointestinal tract with the vagina. Other types of urogenital or anorectal fistulas are discussed elsewhere. (See "Urogenital tract fistulas in women" and "Anorectal fistula: Clinical manifestations, diagnosis, and management principles".)

ETIOLOGY

Anovaginal fistulas (AVFs) and rectovaginal fistulas (RVFs) most frequently result from obstetric trauma, especially in undeveloped countries where prolonged obstructed labor can lead to pressure necrosis of the rectovaginal septum. These fistulas can also occur following a failed repair of a third- or fourth-degree laceration of the perineum, from unrecognized injury at the time of vaginal delivery, and from episiotomy infection. Radiation damage and Crohn disease are two other important causes of RVFs [1,2].

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. In addition, treatment options for pelvic organ prolapse such as pessaries [3] and various mesh repair procedures have been associated with RVFs [4].

CLASSIFICATION OF FISTULAS

Although the term "rectovaginal fistula" is sometimes used loosely in clinical practice to refer to all fistulas that involve the bowel and vagina, it is preferable to subclassify female genital fistulas according to anatomic landmarks:

                                  

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Literature review current through: Nov 2016. | This topic last updated: Thu Aug 25 00:00:00 GMT+00:00 2016.
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References
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