Diagnosis and Treatment of Congenital H-type Rectovestibular Fistula

Youn-Jeong Kim, Min Jung Kim, S. H. Lee, Jeong-Meen Seo, S. Lee
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Abstract

Purpose: The congenital H-type rectovestibular fistula, a fistula between the anorectum and genital tract besides a normal anus is a rare variant of anorectal deformities. This disease needs proper treatment but there are no standard of diagnosis and treatment. The purpose of this report is to review a 13-year experience of approach and management for H-type rectovestibular fistula at a single institution. Methods: From February 2002 to August 2015, we cared for 11 patients who had congenital H-type rectovestibular fistula and reviewed their clinical presentation, accompanied anomalies, diagnostic modalities, operative technique, and postoperative progress. Results: Most patients with H-type rectovestibular fistula presented with symptoms including vestibular defecation and major labial abscess. We could find the fistula tract in most of patients by fistulography using contrast dye. All of the patients had been operated. There were 2 recurrences after surgical treatment who had inflammation and infection associated with the fistula. All other patients recovered without complications. Conclusion: We think the operation including fistulectomy and repair of perineal body through a transanal approach can be a feasible option to the congenital H-type rectovestibular fistula. Also, combined inflammation and infection should be treated prior to surgery to reduce postoperative complications.
先天性h型直肠前庭瘘的诊断与治疗
目的:先天性h型直肠前庭瘘是一种罕见的肛肠畸形,它位于正常肛门之外的肛肠和生殖道之间。这种疾病需要适当的治疗,但目前尚无诊断和治疗标准。本报告的目的是回顾13年的经验,入路和管理的h型直肠前庭瘘在单一机构。方法:回顾2002年2月至2015年8月收治的11例先天性h型直肠前庭瘘患者的临床表现、伴发异常、诊断方式、手术技术及术后进展。结果:h型直肠前庭瘘患者多表现为前庭排便和唇大脓肿。大多数患者采用造影剂进行瘘管造影均可发现瘘管道。所有的病人都做过手术。术后复发2例,均伴有瘘道炎症和感染。其余患者均无并发症。结论:经肛门入路行会阴体修复及瘘管切除术是治疗先天性h型直肠前庭瘘的可行方法。同时,应在手术前治疗合并炎症和感染,以减少术后并发症。
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