A fistula is defined as the communication between two organ sites that is lined with epithelium. Rectal fistulas that communicate with the vagina are called rectovaginal fistulas. A rectovaginal fistula may be located between the lower third of the rectum and the lower third of the vagina or the middle third of the rectum and the vaginal fornix. Obstetric injury at the time of childbirth (most common in primigravidas) is a very common cause of rectovaginal fistulas. The cause is usually due to:
Unsuccessful attempt to repair a laceration or an extension of a planned episiotomy.
Gynecologic surgery (operative trauma) is also a contributory cause to the formation of a rectovaginal fistula. At times, a rectovaginal fistula may result from a complication of Crohn’s disease or following radiation therapy for a pelvic malignancy. Fistulas following radiation therapy usually become apparent 6 to 24 months after therapy is completed.
Symptoms associated with a rectovaginal fistula can vary amongst patients. They can range from:
Smaller fistulas may only reveal passage of stool per vagina when the patient has diarrhea.
Before attempting repair of a rectovaginal fistula, the cause of the rectovaginal fistula must be identified. In addition to a physical examination, diagnosis of a rectovaginal fistula may require the use of ancillary tests. They include:
Methylene blue instillation
Repair of a rectovaginal fistula can be simple or extremely complicated. Small rectovaginal fistulaslocated in the lower third of the rectum can be repaired utilizing various local methods. They include:
Transanal advancement flap repair
Transvaginal inversion repair
Conversion to perineal laceration with layer closure
Transabdominal repairs are usually reserved for rectovaginal fistulas affecting the middle third of the rectum (high fistulas) which are usually the result of Crohn’;s disease, neoplasms or post-radiation therapy. These methods include:
Fistula division and closure without bowel resection
Interposition of healthy tissue between the vaginal and rectal walls.
Obstetrically caused rectovaginal fistulas have a better repair prognosis than those caused by radiation or chronic diseases. The rate of recurrence is greater in the latter group.
If you believe that you or your loved have been diagnosed with a rectovaginal fistula or fecal incontinence and suspect the injury may be the result of an obstetrical or gynecologic error that was diagnosable, avoidable and/or preventable, you may have a valid cause of action. The injury may be the result of a medical provider's mistake in handling your gynecologic condition and the result of medical negligence. Dr. Borten has over 35 years of experience as an obstetrician and gynecologic surgeon to fully evaluate the merits of your potential case. Allow the Boston area medical malpractice attorneys at Gorovitz & Borten help you assert your rights and get the compensation you deserve.
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