Rectovaginal Fistula Workup

Updated: Apr 24, 2017
  • Author: Dana Taylor, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Workup

Laboratory Studies

Laboratory studies (eg, complete blood count [CBC], blood cultures, electrolytes, blood urea nitrogen [BUN], creatinine, and type and screen) are obtained to assess for sepsis, which is extremely rare in fistulas between the gastrointestinal tract and the female genital tract. Laboratory studies are also helpful in the establishment of preoperative baselines.

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Imaging Studies

Ancillary studies may illustrate a rectovaginal fistula (RVF) that is elusive on physical examination. [13] Barium enema can demonstrate RVF or the more common sigmoid-vaginal cuff fistula observed in diverticulitis. Computed tomography (CT) often shows perifistular inflammation, identifying the responsible digestive organ. Endorectal and transvaginal ultrasonography may be used to help identify low fistulas.

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Endoscopy

Flexible endoscopy (sigmoidoscopy or colonoscopy) is used to fully evaluate the possibility of inflammatory bowel disease (IBD). Because treatment varies according to the diagnosis, endoscopy with biopsies must precede any operative approach to the fistula, when IBD is in the differential diagnosis.

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Histologic Findings

Histology is most important in the evaluation of possible IBD. Neither a diagnosis of ulcerative colitis nor a diagnosis of Crohn disease completely excludes operative repair of an RVF, but operative planning is altered, as is the prognosis. If the rectum is grossly normal in Crohn disease, the prognosis of RVF repair is fair; if the rectum is abnormal, the prognosis is considerably worse. With any fistula considered suggestive of a primary or recurrent neoplasm, the histopathology is of the utmost importance.

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