Traumatic anovulval fistula

Case contributed by Dr Husien Ahmad Hasan

Presentation

History of vulva rupture 3 years ago, which was closed surgically by interrupted suture. The patient complains of chronic fecal discharge from the perineum.

Patient Data

Age: 25 years
Gender: Female
Fluoroscopy

Linear extraluminal contrast leakage, at the level of the upper anal canal anteriorly compatible with a fistula.

Annotated image

Yellow arrow 1 point to contrast in the vagina and vulva.

Yellow arrow 2 points to the fistulous tract.

Yellow arrow 3 with a metal marker at the vulval opening of the fistula.

mri

Linear T2 bright transsphincteric fistulous tract, connecting the upper portion of the anal canal at 12 o'clock position to the upper part of the posterior vulval wall.

Annotated image

The yellow arrows point to the transsphincteric fistulous tract, connecting the upper portion of the anal canal at 12 o'clock position to the upper part of the posterior vulval wall.

Case Discussion

The patient history was  chronic fecal discharges from the perineum. The primary diagnosis was an anovaginal fistula, she was referred for a fluoroscopy exam.

The fluoroscopy exam findings were not so obvious, because the fistulous tract length was short (less than 10mm), and its diameter was wide measuring 4 mm, so that the contrast leaked quickly into the perineum. Gynecological exam reveals a vulval fistulous opening at the posterior valval wall. MRI for anovulval fistula is more sensitive than fluoroscopy.

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