Rectovaginal fistulae are a type of colovaginal fistula where there is an abnormal fistulous connection between the rectum and the vagina. It is considered the most common gastrointestinal fistula involving the female genital tract 1.
They can occur from a number causes that include:
- complication of childbirth
- pelvic malignancy
- pelvic radiation therapy
- infectious processes within the rectovaginal septum
- operative trauma
- inflammatory bowel disease, e.g. Crohn disease
This may be seen as direct breach of the wall between the rectum and the vagina. An examination with contrast within the rectum is more help to confirm a tract. Some authors propose the use of CT vaginography 7.
Endoluminal sonography and endoluminal MR imaging are thought to have comparable positive predictive values in revealing the location of rectovaginal fistulas 2.
In the case of small amounts of intravaginal gas, this can often be seen with physiological situations 6 and rectal contrast examination is often useful for differentiation in clinically suspected cases.
- 1. Pickhardt PJ, Bhalla S, Balfe DM. Acquired gastrointestinal fistulas: classification, etiologies, and imaging evaluation. (2002) Radiology. 224 (1): 9-23. doi:10.1148/radiol.2241011185 - Pubmed
- 2. Jaap Stoker, Elena Rociu, W. Ruud Schouten, Johan S. Laméris. Anovaginal and Rectovaginal Fistulas. (2012) American Journal of Roentgenology. 178 (3): 737-41. doi:10.2214/ajr.178.3.1780737 - Pubmed
- 3. Wendaline M. VanBuren, Amy L. Lightner, Sarasa T. Kim, Shannon P. Sheedy, Madeline C. Woolever, Christine O. Menias, Joel G. Fletcher. Imaging and Surgical Management of Anorectal Vaginal Fistulas. (2018) RadioGraphics. 38 (5): 1385-1401. doi:10.1148/rg.2018170167 - Pubmed
- 4. VanBuren WM, Lightner AL, Kim ST, Sheedy SP, Woolever MC, Menias CO, Fletcher JG. Imaging and Surgical Management of Anorectal Vaginal Fistulas. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1385-1401. doi:10.1148/rg.2018170167 - Pubmed
- 5. Debeche-Adams TH, Bohl JL. Rectovaginal fistulas. (2010) Clinics in colon and rectal surgery. 23 (2): 99-103. doi:10.1055/s-0030-1254296 - Pubmed
- 6. Nokes SR, Martinez CR, Arrington JA, Dauito R. Significance of vaginal air on computed tomography. (1986) Journal of computer assisted tomography. 10 (6): 997-9. Pubmed
- 7. Botsikas D, Pluchino N, Kalovidouri A, Platon A, Montet X, Dallenbach P, Poletti PA. CT vaginography: a new CT technique for imaging of upper and middle vaginal fistulas. (2017) The British journal of radiology. 90 (1073): 20160947. doi:10.1259/bjr.20160947 - Pubmed