Uncorrected Rectovestibular Fistula and Pregnancy: A Management Dilemma

Pramya, Najundan; Sagili, Haritha; Rani, P. Reddi
March 2012
Journal of Gynecologic Surgery;Mar2012, Vol. 28 Issue 1, p55
Academic Journal
Background: Anorectal malformations (ARM) represent a wide spectrum of congenital anomalies in which the anus fails to open normally onto the perineum. In females, the most common ARM is an imperforate anus with a rectovestibular fistula. There are limited data available on the optimal management of an uncorrected rectovestibular fistula in pregnancy. Case: A 23-year-old gravida 3, para 2, living, 1, with a history of fecal incontinence since birth and of passing stools through the orifice near the vestibular region, was admitted at 34+3 weeks' gestation for evaluation of ARM. On examination, a prominent skin tag was present at the anal dimple with normal gluteal fold and a fistulous opening in the region of vestibule with minimal prolapse of rectal mucosa. The patient underwent an elective cesarean section with sterilization at 38+3 weeks' gestation in view of having had two previous cesarean sections. Results: Her postnatal period was uneventful and she was discharged on the 7th postoperative day in a satisfactory condition with subsequent follow-up in the department of surgery. Conclusions: In general, those with a history of an imperforate anus and a rectovestibular or rectoperineal fistula are candidates for a vaginal delivery. The size and scarring of the perineal body should be assessed by the obstetrician before making the decision. Cesarean section is recommended for women with a history of a cloacal anomaly. (J GYNECOL SURG 28:55)


Related Articles

  • Anorectal Anomalies in Adults-Laparoscopic Management and Review of Literature. Miglani, Ripan; Murthy, Divakar; Bhat, Ravi; Ashok, Kumar // Indian Journal of Surgery;Aug2012, Vol. 74 Issue 4, p301 

    Anorectal malformations (ARMs) are one of the most common congenital anomalies dealt by surgeons. The reported incidence of ARMs range between 1:3,300 and 1:5,000 live births. These defects are invariably detected and treated in infancy or early childhood. There is a group of patients among...

  • Sacral nerve stimulation for faecal incontinence secondary to congenital imperforate anus. Thomas, G.; Nicholls, R.; Vaizey, C. // Techniques in Coloproctology;Apr2013, Vol. 17 Issue 2, p227 

    After treatment in infancy, patients with imperforate anus can develop bowel dysfunction in adult life. Low anorectal malformations are often associated with congenital deformity of the sacrum and coccyx (sacrococcygeal agenesis). Sacral nerve stimulation (SNS) is an effective treatment for...

  • Perineal body reconstruction in the management of faecal incontinence in neuropathic and anorectal anomaly patients. Dewan, P. A.; Rao, P. // Australian & New Zealand Continence Journal;Summer2013, Vol. 19 Issue 4, p98 

    An abstract of the article "Perineal body reconstruction in the management of faecal incontinence in neuropathic and anorectal anomaly patients" by P. A. Dewan and P. Rao is presented.

  • Twins Do No Better With Cesarean Birth. Jasmer, Robert // Inside Childbirth Education;Feb2013, p5 

    The article presents a study related to the birth of twin babies through cesarean surgery and vaginal birth, presented at a meeting of the Society for Maternal-Fetal Medicine. According to the study, birth of twins is not safe in the planned cesarean surgery as compared with planned vaginal...

  • Caesarean delivery for twin gestation at 32–38 weeks does not lead to improved clinical outcomes for neonates or mothers. Lee, Henry C.; Blumenfield, Yair J. // Evidence Based Medicine;Jun2014, Vol. 19 Issue 3, p119 

    The author reflects on the article "A randomised trial of planned cesarean or vaginal delivery for twin pregnancy" by J.F. Barret and colleagues which was published in the 2013 issues of the journal New England Journal of Medicine. He discusses the use of caesarean delivery (CD) for twin...

  • Controversies in Fistula in Ano. Sheikh, Parvez // Indian Journal of Surgery;Jun2012, Vol. 74 Issue 3, p217 

    Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications-recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better...

  • Anal incontinence and quality of life following obstetric anal sphincter injury. Kumar, Ranitha // Archives of Gynecology & Obstetrics;Mar2012, Vol. 285 Issue 3, p591 

    Purpose: The objective of our study was to identify the number of women who have long-term ano-rectal symptoms following primary repair of obstetric anal sphincter injury (OASI) and the effect on their quality of life. We also wished to determine the impact of the injury on decision for future...

  • Successful Pregnancy Outcome by Caesarean Section in a Woman with Arthrogryposis Multiple Congenita (AMC). Singhal, Savita Rani; Paul, Anshu; Nanda, Smiti; Singhal, Suresh Kumar // African Journal of Reproductive Health;Sep2010, Vol. 14 Issue 3, p233 

    Arthrogryposis Multiplex Congenita (AMC) is a symptom complex of congenital joint contractures associated with neurogenic and myopathie disorders. It is diagnosed at birth and often progresses to a state of significant disability. Pregnancy in a woman with AMC is at high risk due to diminished...

  • Laparoscopic approach in the management of anorectal malformations. Bischoff, Andrea; Martinez-Leo, Bruno; Peña, Alberto // Pediatric Surgery International;May2015, Vol. 31 Issue 5, p431 

    Seventeen years have passed since the first description of the laparoscopic approach for anorectal malformation and approximately 68 articles have been published on the subject. In this review article, we aim to describe the advantages as well as the indications and contraindications of this...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics