Clinical Study on 32 Cases of the Rectovaginal Fistula.

Purpose: Rectovaginal fistulas (RVFs) are relatively uncommon diseases which account for only 5% of anorectal fistulas. The treatment of RVFs is difficult and the results are often unsatisfactory. For proper treatment, many factors must be considered, such as causes, size, location and the general condition of the patients. Generally obstetric injury has been the most common cause, but recently the incidence of RVFs associated with malignant diseases or radiotherapy has been increasing. The purpose of this study was to evaluate the clinical features of RVFs according to causes. Methods: Thirth-two patients with RVF were managed at the Gospel Hospital, Kosin University between Jan. 1989 and Dec. 2000 were retrospectively reviewed. Results: Among RVF associated malignant diseases (26 cases), there were 5 cases due to direct invasion of malignant tumors, all of which were incurable. However, of the 18 cases of radiation induced RVFs (cervical cancer in 13, rectal cancer in 4, vaginal cancer in 1), 2 who received radiotherapy due to cervical cancer and had no residual malignancy were cured with low anterior resection with coloanal anastomosis. All 3 cases of RVFs due to operative complication of malignant diseases were also curable. In RVFs associated with non-malignant diseases (6 cases), there were 2 cases of RVFs due to obstetric injuries, 1 due to trauma, and 3 due to operative complication of nonmalignant diseases such as uterine myoma, hemorrhoids, and uterine prolapse. All 6 cases were curable, but only 3 were treated with single-stage operation, 3 required multiple-stage operation. Other cases frequently featured recurrence. Conclusion: Among many factors, the cause was the most important factor related to treatment in RVFs. Although the cases due to direct invasion of malignant tumors were incurable, the 2 who received radiotherapy due to cervical cancer were treated successfully, and their prognosis remains hopeful. All 6 cases associated with non-malignant disease were also curable. However, because of the high recurrence rate in such those cases, more careful preoperative assessment is required for patients with RVFs.