Case One: Rectal Stenosis, Rectovaginal Fistula and Presacral Mass
The figure below illustrates the anatomy of a female patient with a presacral mass that proved to be a dermoid cyst.
In addition, the rectum had a stricture about two and a half centimeters from the anal margin and there was an "H" type of rectovaginal fistula at the same site of the stricture.
This type of defect is interesting because it is similar to the rectal atresia type of defect and it could be postulated that the presence of that presacral mass as a provoking factor may have led to the stenosis.
Presacral Mass |
Rectal atresia and rectal stenosis are related to some sort of vascular insult suffered during the intrauterine life. It always occurs at the junction between the anal canal and the rectum itself. The posterior sagittal approach in this particular case allowed for:
- A resection of the presacral mass
- Closure of the vaginal fistula
- Further mobilization of the rectum to leave an intact rectal wall in front of the vaginal suture
The rectum was then closed in a Heinecke-Mikulicz fashion in order to have a wide communication between the rectum and the anal canal.
The muscles were reconstructed meticulously with the aid of the muscle stimulator to ensure suturing together corresponding portions of the muscle structures.
Reconstructed Muscle |
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
