Rectovaginal fistula

Introduction to rectal vagina The length of the female rectum adjacent to the posterior wall of the vagina is about 9 cm. Therefore, rectal vaginal fistula can occur in any part of the rectum vaginal diaphragm during trauma, inflammation, etc. It is the most common type in obstetrics and gynecology. Fecal sputum, classification: low rectal fistula, that is, repair can be carried out from the perineal route; high rectal vaginal fistula, it is safer from abdominal surgery, the pupil of most cases is smaller, about <2cm. basic knowledge The proportion of the disease: the incidence rate of women is about 0.004%-0.008% Susceptible people: women Mode of infection: non-infectious Complications: vaginitis intestinal obstruction

Rectal vaginal fistula

Causes:

Abnormal development:

1 congenital malformation.

2 childbirth injuries, the most common, including delayed labor and obstetric surgery.

3 gynecological surgery injury, transabdominal or transvaginal pelvic gynecological surgery.

4 inflammatory bowel disease.

5 drug corrosion or foreign matter.

6 after cancer erosion or radiation therapy.

7 other penetrating or occlusive injury; such as riding a cross injury or rape can also form such sputum, in many causes, 3 degrees perineal tear, obstetric surgery such as perineal incision, especially perineal rectal incision, very easy Rectal vaginal fistula occurs, and these injuries are not discovered in time, or repaired in time, or infection occurs after repair, and rectal vaginal fistula, vaginal or rectal surgery will occur, especially in patients with dentate lines.

Different locations:

1. According to the position of the iliac crest, 2/3 of the distal rectal wall of the rectum is connected to the posterior wall of the vagina. According to its etiology, rectal vaginal fistula can occur in any part of the rectal vaginal septum of 9 cm. Generally, the rectal vagina is divided into 3 type.

(1) Low position: The fistula is located at or above the tooth septum, and the vaginal opening is at the labial ligament. It is also suggested that the iliac crest is in the lower third of the rectum, and the lower 1/2 of the vagina is easy to be repaired from the perineum. .

(2) High position: in the middle third of the rectum and the posterior vaginal fornix, near the cervix, need to be repaired by the abdomen, the median is between the low and high.

2. According to the size of the sputum: rectal vaginal fistula size of about 1 ~ 2cm diameter, can be divided into 3 types:

1 small: the diameter of the cornice is <0.5cm.

2 intermediate type: 0.5 to 2 cm.

3 large: >2.5cm, 3 degree defect including the entire posterior wall of the vagina, up to the cervix.

Rectal vaginal fistula prevention

1. Prevent abdominal trauma.

2. There are no effective preventive measures for congenital anorectal malformations.

3. Pay attention to protect the perineum during childbirth.

Rectal vaginal fistula complications Complications, vaginitis, intestinal obstruction

1. Vaginitis.

2. Intestinal obstruction.

Symptoms of rectal vaginal fistula Common symptoms , thin stools, constipation, abdominal pain

Rectal vaginal fistula can be diagnosed according to clinical manifestations and original disease symptoms, but the position of the fistula should be accurately positioned to determine the treatment plan. For the position of the fistula, the probe should be inserted into the fistula to explore it; or in the proctoscope Observe; if necessary, perform tube angiography to determine the position of the fistula, place gauze in the vagina, inject 10 inches into the rectum for a few minutes, then take out the gauze to see if blue staining can determine the presence or absence of vaginal fistula.

The clinical manifestations of rectal vaginal fistula range from mild feces to significant fecal sputum, small incision or anal stenosis or anal atresia, which is characterized by chronic incomplete intestinal obstruction, several days or even months after birth or 2 to 3 After the age, the child has difficulty in defecation, and there are stubborn constipation. Sometimes it is necessary to enema or use laxative to defecate. If the mouth is large, there is no obstruction but there is abnormal bowel position, pain in bowel movement and deformation of feces.

The pupil is large and low, showing that the stool is discharged from the vagina and the uncontrolled exhaust. The pupil is small. When the stool is dry, the transvaginal defecation cannot be seen, but there is still uncontrollable exhaust, due to the stimulation of secretions. Chronic vulvitis can occur, with symptoms such as scratching, exudation and rash.

1. History of women with infants and young children suffering from congenital malformations of rectal anal canal, or female patients have a history of birth injury, or history of transabdominal or transvaginal pelvic gynecological surgery, or history of inflammatory bowel disease, or vaginal medication or foreign body history, or cancer History of swollen erosion or radiation therapy, and history of perineal penetration or closed injury.

2. Clinical symptoms and signs Patients have feces discharged from the vagina, vaginal speculum exposed to see, or refers to the mouth of the mouth, or uterine probes to explore the vaginal mouth, the fingertips in the anus touch the probe head can be clearly diagnosed, necessary The barium enema X-ray examination and the methylene blue injection test can be used to assist in the diagnosis.

Examination of rectal vaginal fistula

1. For the position of the fistula, the probe should be inserted into the fistula to explore the movement, 2. or under the proctoscope, 3. If necessary, perform a fistula angiography to determine the position of the fistula.

1. Vaginal examination can sometimes touch the mouth of the vagina on the posterior wall of the vagina.

2. The vaginal speculum examines the large pupil, which can be seen under the exposure of the vaginal speculum, the pupil is small, or a small bright red granulation tissue can be seen.

3. In the methylene blue injection test, gauze was placed in the vagina, and 10 ml of methylene blue was injected into the rectum. After a few minutes, the gauze was taken out to observe whether blue staining could determine the presence or absence of vaginal fistula.

4. The probe probe is inserted through the vaginal fistula and the other finger reaches the anus. The fingertip can touch the probe head.

5. Barium enema angiography in the presence of rectal vaginal fistula, it can be seen that the sputum into the fistula.

Diagnosis and diagnosis of rectal vaginal fistula

diagnosis

Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.

Differential diagnosis

Distinguish from congenital anal malformations.

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