Rectovaginal Fistula

Brooke H. Gurland, Jon D. Vogel

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.

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Last updated: January 26, 2022