Key Concepts

• Rectovaginal fistula (RVF) may result from benign or malignant disease or iatrogenic causes.
• Diagnostic evaluation of RVF is based on history and examination and may be enhanced by radiological studies.
• Anal sphincter function is a key component in the evaluation and treatment of RVF.
• When infection complicates RVF, it must be resolved prior to definitive treatment of the fistula.
• Asymptomatic or minimally symptomatic RVF may not require intervention.
• RVF due to Crohn’s disease may, in some cases, be effectively managed with medical therapy alone.
• Surgical treatment of RVF is influenced by the etiology of the fistula, its location, the integrity of the anal sphincter, and if it is a primary or recurrent fistula.
• In some cases, the use of a well-vascularized soft-tissue flap and/or fecal diversion may be required to effectively manage the RVF.