Gorovitz & Borten, P.C.
Attorneys at Law

550 Cochituate Road, Suite 25
Framingham, Massachusetts
Tel: (781) 890-9095
Rectal Fistula
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:

  • Perineal lacerations (third and fourth degree lacerations)
  • Failure to recognize a perineal laceration
  • 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:

  • Passage of stool per vagina
  • Foul smelling vaginal discharge
  • Recurrent bouts of vaginitis
  • Recurrent episodes of cystitis
  • Fecal incontinence (anal sphincter damage)

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:

  • Vaginal tampon
  • Methylene blue instillation
  • Barium enema
  • Proctosigmoidoscopy

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:

  • Simple fistulotomy
  • 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:

  • Bowel resection
  • Fistula division and closure without bowel resection
  • Interposition of healthy tissue between the vaginal and rectal walls.
  • Bricker patch

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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