Rectovaginal fistula – a fistula between the lumens of the rectum and vagina.
In the bulk of cases, the disease is acquired, much less often it is congenital. In such cases, fistulas are distinguished by peculiar topographic and anatomical forms and methods of treatment carried out by pediatricians.
The causes of rectovaginal fistulas are quite diverse. The most frequent of them are pathological births (prolonged labor, long anhydrous interval, perineal ruptures) and inflammatory complications of surgical aids during obstetrics.
Relatively less often, rectovaginal fistulas appear as a result of injury to the rectal wall during various operations on the pelvic organs, spontaneous opening of acute paraproctitis in the vaginal lumen, traumatic damage to the rectovaginal septum. Not infrequently, rectovaginal fistulas are a complication of Crohn’s disease, colonic diverticulosis (especially in women who have undergone hysterectomy).
The most characteristic complaint is the discharge of gases and feces from the vagina. There are frequent complaints of pus discharge from the vagina, dysuria, pain in the perineum, the improbability of sexual intercourse. The release of gases and fecal contents through the vagina in the presence of a rectovaginal fistula is explained by the presence of a muscular obturator apparatus in the distal intestine and its absence in the vaginal tube. Because of this, the accumulated intestinal discharge at any time, under any circumstances and in any quantity is freely evacuated to the outside not in a natural way, but through the vagina.
It is most convenient to determine the height of the fistula by the fistulous opening in the vaginal wall, the length of the vaginal tube is within 9 cm, the rear wall is accessible for inspection in the mirrors almost to the arch, you can see the anastomosis itself and the discharge from the fistula. And since in the vast majority of cases the hole in the wall of the intestine and vagina coincide, the height of the fistula can be judged by the localization of the fistula opening in the vagina.
All patients undergo sigmoidoscopy, if differential diagnosis is necessary, colonoscopy and irrigoscopy.
The only method of radical cure of rectovaginal fistulas is surgical.
Acute traumatic injuries of the rectovaginal septum can be eliminated with a minimal risk of purulent complications during the first 18 hours from the moment of their formation. The operation consists in extended primary treatment of the wound with refreshment of its edges, excision of all crushed and non-viable tissues, followed by layer-by-layer suturing of the defect of the rectum and levators using monofilament sutures on an atraumatic needle. The defect in the vagina is sutured with catgut.
A more difficult task is the surgical elimination of formed fistulas. There is no universal radical operation and cannot be; It is no coincidence that due to the diversity of anatomical and topographic situations, more than 30 surgical techniques have been proposed to date, a number of which have been recognized in domestic and foreign surgery.