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Rectovaginal Fistula

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Rectovaginal fistula was thought to be a sufficiently common anomaly in 1985 to have retained a place in Wingspread [72]; however it is now considered rare. Pena's group has only six cases [58]; they found that many vestibular and cloacal fistulas had been erroneously labeled as vaginal fistulas. However, Wakhlu's group (2005, personal communication) has experienced 8 cases and we have 22. In three of Wakhlu's cases and in three of ours, the rectum opened high up in the posterior fornix; these were high anomalies. The others were intermediate anomalies with the rectum opening in the lower vagina. One of Wakhlu's cases had been put up for surgery for vestibular fistula but was found to have at operation a vaginal fistula. These figures suggest that rectovaginal fistula is a regional variant that is seen more in India than in Western countries.

Fig. 15.2 Diagrammatic SS of rectoperineal fistula ending at the perineoscrotal junction

Fig. 15.2 Diagrammatic SS of rectoperineal fistula ending at the perineoscrotal junction

Fig. 15.4 Perineum of rectovesicoperineal fistula showing a wide opening of the bladder with visible ureteric orifices in front and a rectal fistula behind. The patient also had hypospadias with severe chordee, left undescended testis, and right inguinal hernia

Fig. 15.4 Perineum of rectovesicoperineal fistula showing a wide opening of the bladder with visible ureteric orifices in front and a rectal fistula behind. The patient also had hypospadias with severe chordee, left undescended testis, and right inguinal hernia

Fig. 15.3 Diagrammatic SS of rectoperineal fistula ending at the penoscrotal junction

Fig. 15.5 Diagrammatic SS of the same anomaly as shown in Fig. 15.4

Fig. 15.6 Perineum of rectourethroperineal fistula showing a smaller opening in the perineum with urethra in front and rectum behind. The patient also had hypospadias with severe chordee

Fig. 15.7 Diagrammatic SS of the same anomaly as shown in Fig. 15.6

Fig. 15.7 Diagrammatic SS of the same anomaly as shown in Fig. 15.6

15.3.5 Rectopenile and Anopenile Fistulas

These have been described by Stephens and Smith [72] and the Japanese Study Group [24]. Unlike the common varieties of rectourethral fistula, the bowel in these anomalies terminates in the penile urethra distal to the bulbar portion.