Rectovaginal Fistula

  • Jeong Eun Lee


The most common cause of rectovaginal fistula is birth injury although anorectal surgeries performed in women can cause rectovaginal fistula. In the case of fistula not identified by physical examination, contrast medium should be used to check for fistula tract in the high rectovaginal fistula. Successful treatment of rectovaginal fistula depends greatly on the cause, especially when developed from Crohn’s disease or radiation injury, the prognosis is poor. To increase success rate, surgical method should be selected depending on the RVF location, cause, degree of infection on the surrounding tissue, history of treatment, and sphincter function. Transanal, transvaginal, and transperineal approaches are main surgical options for rectovaginal fistula.


Rectovaginal fistula Etiology Crohn’s disease Operative treatment 


  1. 1.
    Saclarides TJ. Rectovaginal fistula. Surg Clin North Am. 2002;82:1261–72.CrossRefGoogle Scholar
  2. 2.
    Venkatesh KS, Ramanujam PS, Larson DM, Haywood MA. Anorectal complications of vaginal delivery. Dis Colon Rectum. 1989;32:1039–41.CrossRefGoogle Scholar
  3. 3.
    Radcliffe AG, Ritchie JK, Hawley PR, Lennard-Jones JE, Northover JM. Anovaginal and rectovaginal fistulas in Crohn’s disease. Dis Colon Rectum. 1988;31(2):94–9.CrossRefGoogle Scholar
  4. 4.
    Goldberg SM, Gordon PM, Nivastvongs S. Essentials of anorectal surgery. Philadelphia and Toronto: KB Lippincott Company; 1980. p. 316.Google Scholar
  5. 5.
    Baig MK, Zhao RH, Yuen CH, Nogueras JJ, Singh JJ, Weiss EG, Wexner SD. Simple rectovaginal fistulas. Int J Color Dis. 2000;15:323–7.CrossRefGoogle Scholar
  6. 6.
    Beck DE, Roberts PL, Saclarides TJ, Senagore AJ, Stamos KN, Seds W. The ASCRS textbook of colon and rectal surgery. 2nd ed. New York: Springer; 2011. p. 245–60.CrossRefGoogle Scholar
  7. 7.
    Das B, Snyder M. Rectovaginal Fistulae. Clin Colon Rectal Surg. 2016;29:50–6.CrossRefGoogle Scholar
  8. 8.
    Wise WE, Aguilar PS, Padmanabtan A, et al. Surgical treatment of low rectal vaginal fistulas. Dis Colon Rectum. 1991;34:271–41.CrossRefGoogle Scholar
  9. 9.
    Ozuner G, Hull TL, Cartmill J, Fazio VW. Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas. Dis Colon Rectum. 1996;39:10–4.CrossRefGoogle Scholar
  10. 10.
    Lowry AC, Thorson AG, Rothenberger DA, Goldberg SA. Repair of simple rectovaginal fistulas: influence of previous repairs. Dis Colon Rectum. 1983;31:676–8.CrossRefGoogle Scholar
  11. 11.
    Kniery K, Johnson EK, Steele SR. How I do it: Martius flap for rectovaginal fistulas. J Gastrointest Surg. 2015;19:570–4.CrossRefGoogle Scholar
  12. 12.
    Russell TR, Gallagher DM. Low rectovaginal fistulas. Approach and treatment. Am J Surg. 1977;134:13–8.CrossRefGoogle Scholar
  13. 13.
    White AJ, Buchsbaum HJ, Blythe JG, Lifshitz S. Use of the bulbocavernosus muscle (Martius procedure) for repair of radiation-induced rectovaginal fistulas. Obstet Gynecol. 1982;60:114–8.PubMedGoogle Scholar
  14. 14.
    Wexner SD, Ruiz DE, Genua J, Nogueras JJ, Weiss EG, Zmora O. Gracilis muscle interposition for the treatment of rectourethral, rectovaginal, and pouch-vaginal fistulas: results in 53 patients. Ann Surg. 2008;248:39–43.CrossRefGoogle Scholar
  15. 15.
    de Parades V, Far HS, Etienney I, Zeitoun JD, Atienza P, Bauer P. Seton drainage and fibrin glue injection for complex anal fistulas. Color Dis. 2010;12:459–63.CrossRefGoogle Scholar
  16. 16.
    Ellis CN. Outcomes after repair of rectovaginal fistulas using bioprosthetics. Dis Colon Rectum. 2008;51:1084–8.CrossRefGoogle Scholar
  17. 17.
    Homsi R, Daikoku NH, Littlejohn J, Wheeless CR Jr. Episiotomy: risks of dehiscence and rectovaginal fistula. Obstet Gynecol Surv. 1994;49:803–8.CrossRefGoogle Scholar
  18. 18.
    Tsang CBS, Madoff RD, Wong WD, et al. Anal sphincter integrity and function influences outcome in recto vaginal fistula repair. Dis Colon Rectum. 1998;41:1141–6.CrossRefGoogle Scholar
  19. 19.
    Sudol-Szopinska I, Jakubowski W, Szczepkowski M. Contrast-enhanced endosonography for the diagnosis of anal and anovaginal fistulas. J Clin Ultrasound. 2002;30(3):145–50.CrossRefGoogle Scholar
  20. 20.
    Löffler T, Welsch T, Mühl S, Hinz U, Schmidt J, Kienle P. Long-term success rate after surgical treatment of anorectal and rectovaginal fistulas in Crohn’s disease. Int J Color Dis. 2009;24:521–6.CrossRefGoogle Scholar
  21. 21.
    Khanduja KS, Yamashita HJ, Wise WE Jr, et al. Delayed repair of obstetric injuries of the anorectum and vagina. A stratified surgical approach. Dis Colon Rectum. 1994;37:344–9.CrossRefGoogle Scholar
  22. 22.
    Tancer ML, Lasser D, Rosenbleum N. Rectovaginal fistula or perineal and anal sphincter disruption or both after vaginal delivery. Surg Gynecol Obstet. 1990;171:43–6.PubMedGoogle Scholar
  23. 23.
    Sonada T, Hull T, Piedmonte MR, Fazio VW. Outcomes of primary repair of anorectal and rectovaginal fistulas using endorectal advancement flap. Dis Colon Rectum. 2002;45:1622–8.CrossRefGoogle Scholar
  24. 24.
    Stoker J, Rociu E, Schouten WR, Laméris JS. Anovaginal and rectovaginal fistulas: endoluminal sonography versus endoluminal MR imaging. AJR Am J Roentgenol. 2002;178:737–41.CrossRefGoogle Scholar
  25. 25.
    Oakley SH, Brown HW, Yurteri-Kaplan L, Greer JA, Richardson ML, Adelowo A, Lindo FM, Greene KA, Fok CS, Book NM, Saiz CM, Plowright LN, Harvie HS, Pauls RN. Practice patterns regarding management of rectovaginal fistulae: a multicenter review from the Fellows’ Pelvic Research Network. Female Pelvic Med Reconstr Surg. 2015;21:123–8.CrossRefGoogle Scholar
  26. 26.
    Corte H, Maggiori L, Treton X, Lefevre JH, Ferron M, Panis Y. Rectovaginal fistula: what is the optimal strategy?: an analysis of 79 patients undergoing 286 procedures. Ann Surg. 2015;262:855–60.CrossRefGoogle Scholar
  27. 27.
    Wiskind AK, Thompson JD. Transverse transperineal repair of rectovaginal fistulas in the lower vagina. Am J Obstet Gynecol. 1992;167:694–9.CrossRefGoogle Scholar
  28. 28.
    Fürst A, Schmidbauer C, Swol-Ben J, Iesalnieks I, Schwandner O, Agha A. Gracilis transposition for repair of recurrent anovaginal and rectovaginal fistulas in Crohn’s disease. Int J Color Dis. 2008;23:349–53.CrossRefGoogle Scholar
  29. 29.
    Yamamoto T. Disappointing results following proctectomy with end-colostomy for anorectal Crohn’s disease. J Crohns Colitis. 2013;7(4):e150.CrossRefGoogle Scholar
  30. 30.
    Mazier WP, Senagore AJ, Schiesel EC. Operative repair of anovaginal and rectovaginal fistulas. Dis Colon Rectum. 1995;38:4–6.CrossRefGoogle Scholar
  31. 31.
    Rothenberger DA, Christenson CE, Balcos EG, Schottler JL, Nemer FD, Nivatvongs S, Goldberg SM. Endorectal advancement flap for treatment of simple rectovaginal fistula. Dis Colon Rectum. 1982;25:297–300.CrossRefGoogle Scholar
  32. 32.
    Sands BE, Blank MA, Patel K, et al. Long–term treatment of rectovaginal fistula in Crohn’s disease’ response to infliximab in the ACCENT II Study. Clin Gastroenterol Hepatol. 2004;2:912–20.CrossRefGoogle Scholar
  33. 33.
    MacRae HM, McLeod RS, Cohen Z, Stern H, Reznick R. Treatment of rectovaginal fistulas that has failed previous repair attempts. Dis Colon Rectum. 1995;38:921–5.CrossRefGoogle Scholar
  34. 34.
    Pinto RA, Peterson TV, Shawki S, Davila GW, Wexner SD. Are there predictors of outcome following rectovaginal fistula repair? Dis Colon Rectum. 2010;53:1240–7.CrossRefGoogle Scholar
  35. 35.
    Hull TL, fazio VW. Surgical approaches to low anovagi9nal fistula in Crohn’s disease. Am J Surg. 1997;173:95–8.CrossRefGoogle Scholar
  36. 36.
    Bhome R, Monga A, Nugent KP. A transvaginal approach to rectovaginal fistulae for the colorectal surgeon; technical notes and cse series. Tech Coloproctol. 2018;22:305–11.CrossRefGoogle Scholar
  37. 37.
    Champagne BJ, McGee MF. Rectovaginal fistula. Surg Clin N Am. 2010;90:69–82.CrossRefGoogle Scholar
  38. 38.
    Chung CS, Lee DK, George BD, Mortensen NJ. Clinical outcome of rectovaginal fistula in Crohn’s disease. J Coloproctol. 2008;23:10–5.Google Scholar
  39. 39.
    McNevin MS, Lee PY, Bax TW. Martius flap: an adjunct for repair of complex, low rectovaginal fistula. Am J Surg. 2007;193:597–9.CrossRefGoogle Scholar
  40. 40.
    Hull TL, Bartus C, Bast J, Floruta C, Lopez R. Multimedia article. Success of episioproctotomy for cloaca and rectovaginal fistula. Dis Colon Rectum. 2007;50:97–101.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Jeong Eun Lee
    • 1
  1. 1.Colorectal Division, Department of SurgeryHansol HospitalSeoulSouth Korea

Personalised recommendations