Skip to main content
SpringerLink
Log in

Fistules rectovaginales : classifications, clinique et examens complémentaires

Rectovaginal fistulas: classification, clinical examination and additional assessment

  • Dossier Thématique / Thematic File
  • Published:
Pelvi-périnéologie

Résumé

Les fistules rectovaginales (FRV) sont d’étiologies variées, dominées par les fistules postobstétricales. Leur pronostic est lié à leur anatomie et à leur étiologie. Les fistules simples intéressant la partie inférieure du vagin et en re`gle postobstétricales ou cryptiques sont de pronostic meilleur que les fistules plus hautes ou dues à la maladie de Crohn (MC), séquellaires de la chirurgie ou de la radiothérapie. Le diagnostic est aisé, basé sur la clinique. Les examens complémentaires sont utiles pour le bilan de la maladie causale et le bilan sphinctérien.

Abstract

Rectovaginal fistulas have various aetiologies and mainly occur as post-delivery complications. Prognosis depends on the underlying disease and the anatomy of the fistulous tract. Simple fistulas involving the lower vagina, as well as post-delivery and cryptoglandular fistulas, have better prognoses than more complex fistulas or those related to Crohn’s disease, postoperative sequelae or radiation therapy. Diagnosis is straightforward and based on clinical examination. Additional imaging is only useful in assessing the anal sphincter and the underlying disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Références

  1. Stecco C, Macchi V, Porzionato A, et al. (2005) Histotopographic study of the rectovaginal septum. Ital J Anat Embryol 110: 247–254

    PubMed  Google Scholar 

  2. Rothenberger DA, Goldberg SM (1983) The management of rectovaginal fistulae. Surg Clin North Am 63: 61–79

    PubMed  CAS  Google Scholar 

  3. Frileux P, Berger A, Zinzindohoue F, et al. (1994) Rectovaginal fistulas in adults. Ann Chir 48: 412–420

    PubMed  CAS  Google Scholar 

  4. Coombes R (2004) Supporting surgery for obstetric fistula. Br Med J 329: 1125

    Article  Google Scholar 

  5. Gessessew A, Mesfin M (2003) Genitourinary and rectovaginal fistulae in Adigrat Zonal Hospital, Tigray, North Ethiopia. Ethiop Med J 41: 123–130

    PubMed  Google Scholar 

  6. Kelly J (1992) Vesicovaginal and rectovaginal fistulae. J R Soc Med 85: 257–258

    PubMed  CAS  Google Scholar 

  7. Venkatesh KS, Ramanujam PS, Larson DM, et al. (1989) Anorectal complications of vaginal delivery. Dis Colon Rectum 32: 1039–1041

    Article  PubMed  CAS  Google Scholar 

  8. Goldaber KG, Wendel PJ, McIntire DD, et al. (1993) Postpartum perineal morbidity after fourth-degree perineal repair. Am J Obstet Gynecol 168: 489–493

    PubMed  CAS  Google Scholar 

  9. Rahman MS, Al-Suleiman SA, El-Yahia AR, et al. (2003) Surgical treatment of rectovaginal fistula of obstetric origin: a review of 15 years experience in a teaching hospital. J Obstet Gynecol 23: 607–610

    CAS  Google Scholar 

  10. Soriano D, Lemoine A, Laplace C, et al. (2001) Results of rectovaginal fistula repair: retrospective analysis of 48 cases. Eur J Obstet Gynecol Reprod Biol 96: 75–79

    Article  PubMed  CAS  Google Scholar 

  11. Khanduja KS, Padmanabhan A, Kerner BA, et al. (1999) Reconstruction of rectovaginal fistula with sphincter disruption by combining rectal mucosal advancement flap and anal sphincteroplasty. Dis Colon Rectum 42: 1432–1437

    Article  PubMed  CAS  Google Scholar 

  12. Scott NA, Nair A, Hughes LE (1992) Anovaginal and rectovaginal fistula in patients with Crohn’s disease. Br J Surg 79: 1379–1380

    Article  PubMed  CAS  Google Scholar 

  13. Radcliffe AG, Ritchie JK, Hawley PR, et al. (1988) Anovaginal and rectovaginal fistulas in Crohn’s disease. Dis Colon Rectum 31: 94–99

    Article  PubMed  CAS  Google Scholar 

  14. Athanasiadis S, Yazigi R, Kohler A, et al. (2007) Recovery rates and functional results after repair for rectovaginal fistula in Crohn’s disease: a comparison of different techniques. Int J Colorectal Dis

  15. Gallot D, Malafosse M, Contou JF, et al. (1991) Local surgical treatment of anal-perineal lesions in Crohn’s disease. Retrospective study of 68 cases. Ann Gastroenterol Hepatol (Paris) 27: 243–248

    CAS  Google Scholar 

  16. Penninckx F, Moneghini D, D’Hoore A, et al. (2001) Success and failure after repair of rectovaginal fistula in Crohn’s disease: analysis of prognostic factors. Colorectal Dis 3: 406–411

    Article  PubMed  CAS  Google Scholar 

  17. Halverson AL, Hull TL, Fazio VW, et al. (2001) Repair of recurrent rectovaginal fistulas. Surgery 130: 753–757; discussion 757–8

    Article  PubMed  CAS  Google Scholar 

  18. Ozuner G, Hull TL, Cartmill J, et al. (1996) Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal-vaginal fistulas. Dis Colon Rectum 39: 10–14

    Article  PubMed  CAS  Google Scholar 

  19. Moore-Maxwell CA, Robboy SJ (2004) Mucinous adenocarcinoma arising in rectovaginal fistulas associated with Crohn’s disease. Gynecol Oncol 93: 266–268

    Article  PubMed  Google Scholar 

  20. O’Brien JJ, Bayless TM, Bayless JA (1991) Use of azathioprine or 6-mercaptopurine in the treatment of Crohn’s disease. Gastroenterology 101: 39–46

    PubMed  CAS  Google Scholar 

  21. Dejaco C, Harrer M, Waldhoer T, et al. (2003) Antibiotics and azathioprine for the treatment of perianal fistulas in Crohn’s disease. Aliment Pharmacol Ther 18: 1113–1120

    Article  PubMed  CAS  Google Scholar 

  22. Sands BE, Blank MA, Patel K, et al. (2004) Long-term treatment of rectovaginal fistulas in Crohn’s disease: response to infliximab in the ACCENT II Study. Clin Gastroenterol Hepatol 2: 912–920

    Article  PubMed  CAS  Google Scholar 

  23. Penninckx F, D’Hoore A, et al. (2001) Advancement flap plasty for the closure of anal and rectovaginal fistulas in Crohn’s disease. Acta Gastroenterol Belg 64: 223–226

    PubMed  CAS  Google Scholar 

  24. Zinicola R, Nicholls RJ (2004) Restorative proctocolectomy in patients with ulcerative colitis having a rectovaginal fistula. Colorectal Dis 6: 261–264

    Article  PubMed  CAS  Google Scholar 

  25. Krausz MM, Duek SD (2005) Restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis and familial adenomatous polyposis: 20 years follow-up in 174 patients. Isr Med Assoc J 7: 23–27

    PubMed  Google Scholar 

  26. Kosugi C, Saito N, Kimata Y, et al. (2005) Rectovaginal fistulas after rectal cancer surgery: incidence and operative repair by gluteal-fold flap repair. Surgery 137: 329–336

    Article  PubMed  Google Scholar 

  27. Nakagoe T, Sawai T, Tuji T, et al. (1999) Successful transvaginal repair of a rectovaginal fistula developing after double-stapled anastomosis in low anterior resection: report of four cases. Surg Today 29: 443–445

    Article  PubMed  CAS  Google Scholar 

  28. Paye F, Penna C, Chiche L, et al. (1996) Pouch-related fistula following restorative proctocolectomy. Br J Surg 83: 1574–1577

    Article  PubMed  CAS  Google Scholar 

  29. Sugarbaker PH (1996) Rectovaginal fistula following low circular stapled anastomosis in women with rectal cancer. J Surg Oncol 61: 155–158

    Article  PubMed  CAS  Google Scholar 

  30. Lolohea S, Lynch AC, Robertson GB, et al. (2005) Ileal pouch-anal anastomosis vaginal fistula: a review. Dis Colon Rectum 48: 1802–1810

    Article  PubMed  CAS  Google Scholar 

  31. Heriot AG, Tekkis PP, Smith JJ, et al. (2005) Management and outcome of pouch-vaginal fistulas following restorative proctocolectomy. Dis Colon Rectum 48: 451–458

    Article  PubMed  Google Scholar 

  32. Tsujinaka S, Ruiz D, Wexner SD, et al. (2006) 3rd: surgical management of pouch-vaginal fistula after restorative proctocolectomy. J Am Coll Surg 202: 912–918

    Article  PubMed  Google Scholar 

  33. Hilger WS, Cornella JL (2006) Rectovaginal fistula after posterior intravaginal slingplasty and polypropylene mesh augmented rectocele repair. Int Urogynecol J Pelvic Floor Dysfunct 17: 89–92

    Article  PubMed  Google Scholar 

  34. McDonald PJ, Bona R, Cohen CR (2004) Rectovaginal fistula after stapled haemorrhoidopexy. Colorectal Dis 6: 64–65

    Article  PubMed  CAS  Google Scholar 

  35. Pescatori M, Dodi G, Salafia C, et al. (2005) Rectovaginal fistula after double-stapled transanal rectotomy (STARR) for obstructed defecation. Int J Colorectal Dis 20: 83–85

    Article  PubMed  Google Scholar 

  36. Lynch CM, Felder TL, Schwandt RA, et al. (1999) Lymphogranuloma venereum presenting as a rectovaginal fistula. Infect Dis Obstet Gynecol 7: 199–201

    Article  PubMed  CAS  Google Scholar 

  37. Kunin J, Bejar J, Eldar S (1996) Schistosomiasis as a cause of rectovaginal fistula: a brief case report. Isr J Med Sci 32: 1109–1111

    PubMed  CAS  Google Scholar 

  38. Fadiran OA, Dare FO, Jeje EA, et al. (1993) Amoebic rectovaginal fistula-a case report and review of literature. Cent Afr J Med 39: 172–175

    PubMed  CAS  Google Scholar 

  39. Piekarski JH, Jereczek-Fossa BA, Nejc D, et al. (2007) Does fecal diversion offer any chance for spontaneous closure of the radiation-induced rectovaginal fistula? Int J Gynecol Cancer

  40. Nasu K, Ueda T, Kai S, et al. (2004) Gastrointestinal stromal tumor arising in the rectovaginal septum. Int J Gynecol Cancer 14: 373–377

    Article  PubMed  CAS  Google Scholar 

  41. Shimoyama S, Konishi T,KawaharaM, et al. (1998)A rare case of primary malignant mesothelioma originating from the rectovaginal tissue. Hepatogastroenterology 45: 1593–1597

    PubMed  CAS  Google Scholar 

  42. Singhal SR, Nanda S, Singhal SK (2007) Sexual intercourse: an unusual cause of rectovaginal fistula. Eur J Obstet Gynecol Reprod Biol 131: 243–244

    Article  PubMed  Google Scholar 

  43. Rogenhofer K, Scharl A, Spath G, et al. (2005) Vaginal foreign body-cause for a rectovaginal fistula. Zentralbl Gynakol 127: 96–98

    Article  PubMed  CAS  Google Scholar 

  44. Ley EJ, Vukasin P, Kaiser AM, et al. (2007) Delayed rectovaginal fistula: a potential complication of bevacizumab (avastin). Dis Colon Rectum 50: 930

    Article  PubMed  Google Scholar 

  45. Abdul-Wahid FS, Qureshi A, Soon-Keng C (2002) Indomethacin-induced rectovaginal fistula in a postpartum patient. Dis Colon Rectum 45: 843–844

    PubMed  Google Scholar 

  46. Pfeifer J, Reissman P, Wexner SD (1995) Ergotamineinduced complex rectovaginal fistula. Report of a case. Dis Colon Rectum 38: 1224–1226

    Article  CAS  Google Scholar 

  47. Yee LF, Birnbaum EH, Read TE, et al. (1999) Use of endoanal ultrasound in patients with rectovaginal fistulas. Dis Colon Rectum 42: 1057–1064

    Article  PubMed  CAS  Google Scholar 

  48. Tsang CB, Madoff RD, Wong WD, et al. (1998) Anal sphincter integrity and function influences outcome in rectovaginal fistula repair. Dis Colon Rectum 41: 1141–1146.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service de coloproctologie, hôpital Léopold-Bellan, 21, rue Vercingétorix, F-75014, Paris, France

    D. Soudan

Authors
  1. D. Soudan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Soudan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Soudan, D. Fistules rectovaginales : classifications, clinique et examens complémentaires. Pelv Perineol 2, 270–274 (2007). https://doi.org/10.1007/s11608-007-0146-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11608-007-0146-9

Mots clés

Keywords

Search

Navigation