What is a Rectal-vaginal Fistula of Traumatic Origin?
Rectal-vaginal fistulas are most often formed as a result of obstetric trauma – a third-degree perineal rupture in labor by a large fetus, in a pelvic presentation, when obstetric forceps are applied, and fruit-destroying operations.
Causes of Rectal-vaginal Fistula of Traumatic Origin
Perhaps the occurrence of rectal-vaginal fistula due to gynecological, proctological operations, violent injury, less often as a complication of purulent paraproctitis.
Symptoms of Rectal-vaginal Fistula of Traumatic Origin
Most often, recto-vaginal fistulas of traumatic origin are of low and medium levels, are located on the posterior or posterolateral wall of the vagina and open in the anal canal or region of the sphincter of the rectum. With point fistulas of patients, the involuntary discharge of gases from the vagina is disturbing, with large fistulas – gas and fecal incontinence, burning, itching in the vagina due to maceration of the mucous membrane around the fistula and colpitis. Rectal-vaginal fistulas are often combined with severe cicatricial deformity of the perineum and posterior wall of the vagina, failure of the pelvic floor and sphincter of the rectum.
High rectal-vaginal fistulas are formed on the 7th-9th day after gynecological or proctological operations due to the failure of the sutures on the intestine and are manifested by the passage of gases and feces from the vagina, pain in the lower abdomen, fever, intoxication, and abundant purulent discharge from the vagina. The fistulous course is located in the infiltrate.
Diagnosis of Rectal-vaginal Fistula of Traumatic Origin
For the diagnosis of fistula, vaginal examination using mirrors, rectovaginal two-handed examination, sounding of the fistulous course are used. On examination, it is necessary to determine the localization of the fistulous passage in the vagina, the condition of the tissues around it, the severity of the cicatricial changes in the vaginal wall, perineum, and anal area. Vaginal examination allows you to clarify whether the fistulous passage is located in the infiltrate, what are its sizes, consistency, the possibility of abscess formation, and the condition of the pelvic organs. Probing reveals the direction of the fistulous course and its relation to the sphincter of the rectum. The localization of the fistula is clarified by sigmoidoscopy.
Fistulography is necessary for rectal-vaginal fistulas to trace all the branches of the fistulous course.
Treatment of Rectal-vaginal Fistula of Traumatic Origin
The choice of treatment method is based on a combination of the main characteristics of the fistula, the surrounding tissues, the anatomical and functional consistency of the muscles of the pelvic floor and the sphincter of the rectum.
With rectal-vaginal fistulas of low and medium levels, surgical treatment is indicated. With rectal-vaginal fistulas of a high level, conservative tactics are preferable: high enemas, ointment swabs in the vagina, local sanitation of the vagina, general strengthening, immunostimulating therapy.