Rectovaginal fistula after fourth degree perineal tear (transperineal ultrasound)
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On bidigitalbi-digital examination of vagina and rectum ,,, a perineal body defect was detected and stool leakage from vaginal orficeorifice was detected with good levator ani contraction in Keigleon the Kegel test.
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Images of 3D pelvic floor US (images 1 and 2 ) show fusion of vaginal and anal orifices with no separation (internal, external and superficial anal sphincters avulsed with absence of vaginal mucosa and superficial transverse perineii muscle which means perineal body avulsion).
Images of 3D pelvic floor US (images 3 to 7) show discontinuity of rectovaginal separation at the level of puborectalis muscle with separation of both edges of superficial and external anal sphincter in images 3 and 4.
Images 8 to 10 show good rectovaginal separation with preserved rectal mucosa (hypoechoic area).
Last 2The last two images show tomographic US study (the deepest level to the most superficial level), the start of the defect is from the 4th image onwards.