Recto-Vaginal Fistula: A Common Diagnostic Error with Significant Consequences in Female Patients with Anorectal Malformatons
Nelson G. Rosen, MD, Andrew R. Hong, MD, Samuel Z. Soffer, MD, George Rodriguez, BS, and Alberto Peña, MD
Corresponding Author: Alberto Peña MD
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Purpose
Recto-vaginal fistula is a term which continues to be used frequently to describe female patients with anorectal malformations. This study attempts to evaluate the true frequency of this anomaly and the consequences of its mis-diagnosis.
Methods
A retrospective review of all female patients with anorectal malformations treated by the senior author from 1980 through September 2000 was performed, and the pertinent literature was reviewed.
Results
Of the 617 patients identified, only 6 were found to have a true recto-vaginal fistula, an incidence of 1%.
139 of the 617 patients were referred after a previous repair. Of these, 42 were originally diagnosed with a recto-vaginal fistula. The diagnosis was incorrect in all 42.
Twelve patients had a recto-vestibular fistula and 30 had a cloaca. The 30 cloaca patients, because of the misconception they had a recto-vaginal fistula, underwent an initial repair of only the rectal component of the malformation, leaving all patients with a urogenital sinus necessitating a second complete repair.
Conclusion
The use of the term recto-vaginal fistula is common, despite a true incidence of 1% in females with anorectal malformations.
The majority of females will have either a recto-vestibular fistula or a cloaca. Such diagnostic errors may lead to the use of inappropriate surgical techniques, incomplete repair and unnecessary morbidity.
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