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Enterovaginal Fistula


Presentation

  • Many months after termination of the chemotherapy and 15 months after placement, she presented with bowel contents per vagina.[ncbi.nlm.nih.gov]
  • Therefore, in the present patient, previous multiple surgeries may be associated with the development of an enterovaginal fistula.[onlinelibrary.wiley.com]
Hemophilia A
  • Stay up to date with new chapters on Clotting Disorders and Hemophilia, Patient-Centered Care, Health Disparities and Diversity in Emergency Medicine, Cost-Effectiveness Analysis, Antibiotic Recommendations for Empirical Treatment of Selected Infectious[books.google.ro]
Foul Smelling Discharge
  • You may experience urine leakage, gas or foul-smelling discharge, and your genitals may become irritated or infected. The first step in diagnosing fistulas is a vaginal examination.[mercy.net]
  • Unlike many urogynecological disorders, a vaginal fistula does not cause pain, but rather presents itself in symptoms including: Urinary incontinence Defecatory dysfunction such as the passage of feces into the vagina, causing uncontrollable soiling Foul-smelling[coyleinstitute.com]
Leg Edema
  • Black arrow indicates the location of the enterovaginal fistula formation Physical examination revealed anemia and leg edema.[onlinelibrary.wiley.com]
Mucosal Edema
High Fever
  • fever, diarrhea, intermittent spotting into urine‐absorbing pads, and constant fluid discharge from the vagina.[onlinelibrary.wiley.com]
Pneumonia
  • Urinalysis revealed bacteriuria, and Klebsiella pneumoniae and Serratia species were detected by urine culture. A CT scan showed fluid collection in the pelvic cavity (Figure 3 A).[onlinelibrary.wiley.com]
Intestinal Disease
  • Colonic Diseases Also called: Large intestine diseases Your colon, also known as the large intestine, is part of your digestive system. It's a long, hollow tube at the end of your digestive tract where your body makes and stores stool.[icdlist.com]
  • Complications may be the first manifestation of Crohn's disease; therefore, clinicians should be aware that unsuspected intestinal disease might be the underlying problem in women presenting with apparent gynecologic complaints.[aafp.org]
  • Inflammatory Bowel Disease Anorectal abscesses and fistulas involving the vagina, with a reported incidence ranging from 1.7% to 23%, may complicate Crohn’s disease. 10, 11, 12 The more distal the location of the intestinal disease, the higher the risk[glowm.com]
  • Main causes of pelvic fistulas are surgical or obstetric procedures, malignant tumors, radiotherapy, pelvic infections, traumas and inflammatory intestinal diseases (2,4,5).[scielo.br]
Heart Failure
  • Failure and Transplantation Cardiology Nita Ahuja MD, MBA Gastrointestinal Surgical Oncology, General Surgery, Minimally Invasive Surgery, Sarcoma and Connective Tissue Surgical Oncology Paul Aiello MD Radiology, Diagnostic Radiology Joseph Akar MD,[yalemedicine.org]
Arthritis
  • Factors associated with gastrointestinal perforation in a cohort of patients with rheumatoid arthritis. Arthritis Care Res. 2012 ;64: 1819 - 1828. Google Scholar Crossref ISI 2. Strangfeld, A, Richter, A, Siegmund, B.[journals.sagepub.com]
Vaginal Discharge
  • Type your tag names separated by a space and hit enter Abstract BACKGROUND An enterovaginal or vesicovaginal fistula is a complication resulting in vaginal discharge of succus, urine, or stool that can lead to significant complications.[unboundmedicine.com]
  • Abstract The diagnosis of a rectovaginal or enterovaginal fistula is mostly made by a careful historical of a faecal vaginal discharge. When a rectovaginal fistula is low, an examination will demonstrate it with ease.[ncbi.nlm.nih.gov]
  • BACKGROUND: An enterovaginal or vesicovaginal fistula is a complication resulting in vaginal discharge of succus, urine, or stool that can lead to significant complications. For low-volume fistulae, tampons or pads may be used.[ingentaconnect.com]
Vaginal Bleeding
  • Affected patients experience a myriad assortment of major complaints, which may include the passage of feces or flatus from the vagina, recurrent urinary tract infections, vaginitis, vaginal bleeding, and/or malodorous vaginal discharge [ 9, 10 ].[mdpi.com]

Workup

  • Evaluation When RVF is suspected, a workup should be started to confirm the diagnosis, assess the extent of the fistula, and identify the underlying diagnosis.[statpearls.com]
  • At later diagnostic workup, three patients were found to have Crohn's disease. Endoluminal Sonography Before sonography, a limited rectal cleaning was performed.[ajronline.org]
  • Workup Laboratory Studies Although laboratory tests do not help diagnose or confirm the presence of intestinal fistulas, they are important for defining the patient’s clinical condition and guiding treatment.[emedicine.medscape.com]
  • After a comprehensive workup and evaluation of the perineum, the remainder of the small and large bowel, rectum, and anal canal must be investigated.[wjgnet.com]
Pericardial Effusion

Treatment

  • She underwent radical hysterectomy and radiotherapy for the treatment of carcinoma of the uterine cervix 35 years previously. After the treatment of cervix cancer, she developed bilateral hydronephrosis and multiple episodes of ileus.[onlinelibrary.wiley.com]

Prognosis

  • Treatment and prognosis The usual management is surgical with primary resection and anastomosis 4. A conservative management approach may be adopted for poor surgical candidates.[radiopaedia.org]
  • If the rectum is grossly normal in Crohn disease, the prognosis of RVF repair is fair; if the rectum is abnormal, the prognosis is considerably worse.[emedicine.medscape.com]
  • Gynecologic fistula is classified as simple or complicated and may have important implications for surgical approach as well as prognosis for cure. (3) Although the simple vesico-vaginal fistulas are usually uncomplicated surgical cases with good prognosis[womenshealthsection.com]

Etiology

  • Computed tomographic findings associated with vaginal fistulas such as radiation changes, contiguous pelvic mass, or adherent thickened bowel gave clues to the underlying etiology of the fistula and provided important information regarding the extent[jhu.pure.elsevier.com]
  • Development of an acquired gastrointestinal fistula can greatly affect patient outcome, yet the clinical manifestations are often protean in nature and the etiology, elusive.[researchgate.net]
  • RVFs are classified on the basis of location, size, and etiology (see Etiology ), each of which affects the treatment plan and prognosis.[emedicine.medscape.com]

Epidemiology

  • Epidemiology The frequency of rectovaginal fistula varies according to the cause. They are typically classified by etiology, location, and size which affects the treatment and prognosis.[statpearls.com]
  • Epidemiology Among reported series, the frequency with which RVFs occur varies according to the cause. RVFs are classified on the basis of location, size, and etiology (see Etiology ), each of which affects the treatment plan and prognosis.[emedicine.medscape.com]
  • In this article, we seek to provide a broad overview of the MRI characteristics of female pelvic fistulizing disease in combination with epidemiologic and clinical characteristics.[researchgate.net]
Sex distribution
Age distribution

Pathophysiology

  • Other causes in descending order of frequency include radiation injury, inflammatory bowel disease ((IBD), most often Crohn disease), operative trauma, infection, and neoplasm pathophysiology: there are many causes of RVFs: perineal lacerations during[gpnotebook.co.uk]
  • A good understanding of the pathophysiological process helps to assess better, manage, and prevent fistulae.[statpearls.com]
  • Such conditions may include: chronic steroid use smoking poorly controlled diabetes mellitus infection malignancy return to top Pathophysiology Fistulas often occur following injury to the vaginal tissue.[sharinginhealth.ca]
  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia: Elsevier Saunders; 2016. Vol 1: 439-53. Williams LJ, Zolfaghari S, Boushey RP.[emedicine.medscape.com]

Prevention

  • This complication may be prevented by use of longer commercially available enteroscopes or by use of an enterotomy to insert the endoscope.[ncbi.nlm.nih.gov]
  • Kalloo and the Division of Gastroenterology and Hepatology aim to advance the understanding, diagnosis, treatment, and prevention of gastrointestinal and liver disease through patient care, education, and research.[books.google.de]
  • Prevention Obstetric fistulas are the only preventable fistulas. These can be prevented with good prenatal and childbirth care and by avoiding pregnancy in very young girls.[encyclopedia.com]
  • The other complications are: paralysis of parts of the lower half of the body if the nerves to the lower limbs are damaged birth to stillborn baby, after which the woman can be childless Prevention Prevention of vaginal fistulas requires skilled attendants[humanitas.net]
  • Prevention There are no current guidelines to prevent rectovaginal fistula.[winchesterhospital.org]

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