Rectovaginal Fistula
10 results
1 - 10
Anorectal Disease- A 53-year-old woman, gravida 3, para 3, with a BMI of 38 and diabetes, and who is an active smoker presents to your office with a draining seton placed for recurrent fistula in ano. Magnetic resonance imaging (MRI) shows a right anterolateral transsphincteric fistula with an anterior sphincter defect. Which factor places her at the highest risk for anal advancement flap failure?
- A 36-year-old patient with quiescent Crohn’s disease involving the ileum and rectum presents to your clinic to discuss treatment for a symptomatic rectovaginal fistula. She is maintained on biologic therapy with excellent control. Recent colonoscopy has demonstrated no active proctitis. The best approach for this patient is management with
- A 29-year-old patient presents with an anovaginal fistula following a vaginal delivery 2 years ago and which was complicated by a fourth-degree perineal laceration. She reports incontinence to gas and liquid stool. Digital rectal examination demonstrates diminished sphincter tone, and anoscopy reveals a 1-cm internal fistula opening in the anterior midline at the dentate line. The most next appropriate step is
- A 55-year-old woman presents with persistent feculent drainage from the vagina despite prior transanal and transvaginal repairs. What is the best next step?
- A 24-year-old woman reports feculent vaginal discharge 8 months after spontaneous vaginal delivery complicated by a 4th-degree perineal laceration, which was previously repaired. Physical examination reveals a 3-mm rectovaginal fistula 2 cm proximal to the anal verge with significant thinning of the perineal body and a palpable sphincter defect anteriorly. Endoanal ultrasound confirms a 90° defect of the external sphincter at the anterior midline. The best next step in management is
- A 29-year-old female patient presents 3 weeks postpartum following a vaginal delivery. She has incontinence to flatus and flatus per vagina. Examination shows an intact perineum, adequate resting anal tone, and a 5-mm anterior defect in the upper anal canal. What is the most appropriate next step in her management?
- A 38-year-old patient presents with symptomatic grade 3 internal hemorrhoids. Which of the following is a contraindication to stapled hemorrhoidopexy?
- Benign Disease
- A 24-year-old patient underwent penile inversion vaginoplasty 5 days ago. You notice feculent drainage on the vaginal packing. The patient has no signs of sepsis. The speculum examination does not show an obvious rectovaginal fistula. The patient has minimal fecal discharge per her vagina over the past few days. The best next step in management is
- A 54-year-old woman with a history of endometriosis is referred to you for worsening constipation, bloating, and pelvic pain. She previously underwent a laparoscopic-assisted hysterectomy with bilateral salpingo-oophorectomy. You perform a colonoscopy and identify a stricture at the rectosigmoid; the rest of her colon was normal. Pelvic magenetic resonance imaging (MRI) shows irregular thickness with three large spiculated nodules that were hypointense on T1- and T2-weighted images, encasing 70% of the wall of the rectosigmoid, consistent with endometriosis. What is the best surgical option for this patient?
- A 39-year-old woman with a history of long-standing ulcerative colitis (UC) undergoes an elective total proctocolectomy and ileoanal pouch anal anastomosis (IPAA). Two months postoperatively, she reports a persistent low-grade fever, dyspareunia, vaginal air, and mucopurulent rectal drainage. A gastrografin pouch study demonstrates a pouch vaginal fistula. What is the most likely etiology?