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Vaginal Fistula


Presentation

  • They may present as a complication of vaginal surgery, including vaginal hysterectomy. They are a recognized presentation of rectal carcinoma or rarely diverticular disease of the bowel or Crohn's disease.[en.wikipedia.org]
  • Simple fistulas are usually small in size ( 0.5cm) and are present as single non-radiated fistulas.[ncbi.nlm.nih.gov]
  • A simple colostomy presents a low rate of spontaneous healing (about 35.3%) [ 17 ].[ncbi.nlm.nih.gov]
  • Our patient in the video had previously underwent multiple various repairs which failed to provide adequate resolution of her fistula and therefore presented for a Modified Martius flap repair.[csurgeries.com]
  • Occasionally, patients present with symptomatic Bartholin gland abscesses during labor.[aafp.org]
Intravenous Administration
  • After the intravenous administration of the contrast agent, there is high-density material in both the bladder and the vagina, consistent with a VVF Treatment Treatment of patients with VVF must embrace their immediate and, in most cases, subsequent surgical[ncbi.nlm.nih.gov]
Disability
  • The symptoms reported by majority of patients are unbearable for social, emotional, and sexual morbidity, and may sometimes be disabling.[ncbi.nlm.nih.gov]
Abdominal Distension
  • Rectovaginal fistula Rectovaginal fistula Specialty Gynecology Diagnostic method • No anal opening • A gloved finger or thermometer cannot be inserted into the infants rectum • No history of passage of meconium • Presence of abdominal distension • Presence[en.wikipedia.org]
Colic
  • In our case the opening on the anastomosis and the fibrous retraction of the stumps with bleeding were treated infact with lowering the colic stump wasn't possible for its difficult isolation.[ncbi.nlm.nih.gov]
Foul Smelling Vaginal Discharge
  • Signs and symptoms of a rectovaginal fistula may include: Passage of gas, stool or pus from your vagina Foul-smelling vaginal discharge Recurrent vaginal or urinary tract infections Irritation or pain in the vulva, vagina and the area between your vagina[mayoclinic.org]
Bladder Spasm
  • Anticholinergic drugs should be administered if bladder spasms occur. As far as causing discomfort to the patient, it has been suggested that these contractions may compromise healing of the repair.[ncbi.nlm.nih.gov]
Neglect
  • Other causes of VVF include urologic or gynecologic instrumentation, including percutaneous procedure, retroperitoneal, vascular or pelvic surgery, infectious and inflammatory diseases, foreign bodies (including neglected pessaries), sexual trauma, vaginal[ncbi.nlm.nih.gov]

Workup

  • Advanced Procedure Modified Martius flap for rectovaginal fistula Indications Repair of rectovaginal fistula after multiple failed attempts Contraindications Pre-existing dyspareunia (relative) Preoperative Workup CT scan, digital rectal exam, vaginal[csurgeries.com]
Pneumoperitoneum
  • A five-port technique has been described using a vaginal pack to maintain pneumoperitoneum throughout the case [ 29 ]. The successful closure was confirmed by the retention of pneumoperitoneum after the removal of the vaginal pack.[ncbi.nlm.nih.gov]
Gastric Fistula
  • fistula 1. one communicating between the stomach and some other body part. 2. a passage created artificially through the abdominal wall into the stomach. horseshoe fistula one near the anus, having a semicircular tract with both openings on the skin.[medical-dictionary.thefreedictionary.com]

Treatment

  • Treatment for recto-vaginal fistulas includes either posterior sagittal anorectoplasty, as described above, or a minimally invasive (laparoscopic) pull-through procedure.[cedars-sinai.edu]
  • "Rectovaginal fistula: Treatment and Management". Medscape. Retrieved 14 August 2012. "Rectovaginal fistula Treatments and drugs - Mayo Clinic". www.mayoclinic.org. Retrieved 2015-12-14.[en.wikipedia.org]
  • Natural Treatment For Fistula - Rectovaginal * Several years ago, I published an experimental treatment for healing fistulas in my book Listen To Your Gut.[listentoyourgut.com]
  • , guidelines, discoveries in your fields of interest; be notified You are informed about innovative treatments, techniques and innovations in medicine This video is limited to doctors and other health professionals.[medtube.net]
  • A fistula caused by radiation usually forms within six months to two years after treatment. Surgery involving your vagina, perineum, rectum or anus.[mayoclinic.org]

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]
  • Hospital-based reports show the incidence to be between 0.6 and 6.5 per 1,000 births. [5] Prognosis The success rate of vesicovaginal and ureterovaginal fistula repair approaches 90% at first attempt and approaches 100% after a second attempt.[emedicine.medscape.com]
  • Surgical treatment and prognosis of rectovaginal fistulae according to their origin. Zentralbl Chir. 2012; 137 (4):390–395.[ncbi.nlm.nih.gov]

Etiology

  • The most common etiology is obstetric injury, followed by radiation injury, inflammatory bowel disease ([IBD], most often Crohn disease), operative trauma, infectious etiologies, and neoplasm. tags: recto-vaginal fistula fistula cancer colonoscopy rectum[medtube.net]
  • For those patients whom surgery is indicated, there are several different approaches depending on the fistula etiology and previous attempts at repair.[csurgeries.com]
  • Etiology The etiology of VVF varies and may broadly be categorized into congenital or acquired, the latter being divided into obstetric, surgical, radiation, malignant, and miscellaneous causes.[ncbi.nlm.nih.gov]
  • In developed countries, radiation injury and Crohn's disease are also common etiological factors.[annalsafrmed.org]
  • RVFs are classified according to etiology, location and the dimensions. They may also be classified as simple or complex (Table 1 ). Various techniques have been described to repair RVFs and their associated anatomical defects [ 4, 5 ].[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiology A systematic review over a 35-year period reported 83.2% of fistula in developed countries were iatrogenic whereas 95.2% of fistula in developing countries were the result of obstetric complications. [3] However, the incidence of vesicovaginal[emedicine.medscape.com]
  • Epidemiological determinants of vesicovaginal fistulas. Br J Obstet Gynaecol. 1983; 90 :387–391. doi: 10.1111/j.1471-0528.1983.tb08933.x. [ PubMed ] [ CrossRef ] [ Google Scholar ] 7. Hilton P. Surgical fistulae and obstetric fistulae.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Unrecognized bladder injury during a difficult hysterectomy or cesarean delivery may result in vesicovaginal fistula formation.[emedicine.medscape.com]

Prevention

  • In some cases, a preventive intestinal derivation for at least 3-6 months is necessary and is the only possible and definitive therapy.[ncbi.nlm.nih.gov]
  • Measures for prevention must include universal education, improvement in the status of women, and improved and accessible medical services. References 1. Waaldijk K. Surgical classification of obstetric fistulas.[ncbi.nlm.nih.gov]
  • The authors theorized that the larger opening prevented occlusion of the newly formed orifice, a feature that may make the window operation more advantageous than the marsupialization procedure.[aafp.org]
  • Vaginal infections are usually prevented by the protective bacteria (lactobacilli) that normally live in the vagina. These bacteria keep the acidity of the vagina in the normal range.[msdmanuals.com]

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