Rectovaginal Fistulae

Rectovaginal fistulae occur in 3-10% of women with Crohn's disease [74, 75]. Most of these fistulae originate from an anterior rectal ulcer eroding into the vagina, which usually occurs in the midportion of the rectovaginal septum. These fistulae are the most difficult to treat and have a poor prognosis [76-78]. Less commonly, these fistulae may arise from an infected anal gland and they may travel superficially, through, or above the sphincters. Bartholin's abscesses may also fistulise to the anorectum. This type of fistula carries a poor prognosis [79]. Patients with rectovaginal

Rectal Mucosal Flap Surgery
Fig. 8. Advancing flap technique. a Fistula tract is cored out without sphincter division. b Excision of the primary orifice and removal of the entire tract. c Liberation of a mucosal flap and suture of the muscular space. d Suture of the mucosal flap

fistulae typically present with benign symptoms and severe incontinence and excoriation are rare. Instead, these patients complain of intermittent vaginal discharge or the passage of gas through the vagina [76]. The diagnosis of these fistulae may be difficult. The best test can be done during rectoscopy by injecting air into the rectum and verifying its passage into the vagina. In some cases, examination should be done under anaesthesia. The treatment options in these cases are reduced, in our point of view, to the advancing flap technique described previously.

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