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Original Article

Diagnosis and Treatment of Congenital H-type Rectovestibular Fistula

Younjung Kim, Minjung Kim, Sanghoon Lee, Jeong-Meen Seo, Suk-Koo Lee
Journal of the Korean Association of Pediatric Surgeons 2016;22(2):19-22.
Published online: December 22, 2016

Division of Pediatric Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence: Jeong-Meen Seo, Division of Pediatric Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel: +82-2-3410-0282, Fax: +82-2-3410-0040, E-mail: jm0815.seo@samsung.com
• Received: May 31, 2016   • Revised: July 2, 2016   • Accepted: July 21, 2016

Copyright © 2016 Korean Association of Pediatric Surgeons

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • 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.
  • Keywords: Anorectal malformation; H-type; Labium major abscess; Fistulectomy
Fig. 1.
Surgical treatment of H-type rectovestibular fistula. (A) Fistulectomy following the fistula tract confirmed by probe. (B) Repair of perineal body by ligation and suture.
jkaps-2016-22-2-19f1.jpg
Fig. 2.
Staged treatment of H-type rectovestibular fistula combined with major labial abscess.
jkaps-2016-22-2-19f2.jpg
Table 1.
Diagnosis and Treatment of H-type Rectovestibular Fistula
Table 1.
Patient No. Age at diagnosis (mo) Age at operation (mo) Chief complaint Diagnostic modality Treatment Recurrence
1 2 6 Vestibular defecation Gross physical examination Fistulectomy & repair of perineal body No
2 0 5 Vestibular defecation Fistulography Fistulectomy & repair of perineal body No
3 2 6 Vestibular defecation Fistulography Fistulectomy & repair of perineal body No
4 1 1 Vestibular defecation Fistulography Fistulectomy & repair of perineal body No
5 3 3 Vestibular defecation Fistulography Fistulectomy & repair of perineal body No
6 0 7 Vestibular defecation Fistulography Fistulectomy & repair of perineal body No
7 0 2 Vestibular defecation Fistulography Fistulectomy & repair of perineal body No
8 2 3 Vestibular defecation Gross physical examination Fistulectomy & repair of perineal body No
9 1 2 Major labial abscess Fistulography Fistulectomy & repair of perineal body Yes
10 1 2 Vestibular defecation & major labial abscess Fistulography Fistulectomy & repair of perineal body Yes
11 2 5 Vestibular defecation & major labial abscess Gross physical examination Abscess drainage → fistulectomy & repair of perineal body No
  • 1. Chatterjee SK, Talukder BC. Double termination of the alimentary tract in female infants. J Pediatr Surg 1969;4:237-243.
  • 2. Tsuchida Y, Saito S, Honna T, Makino S, Kaneko M, Hazama H. Double termination of the alimentary tract in females: a report of 12 cases and a literature review. J Pediatr Surg 1984;19:292-296.
  • 3. Holschneider A, Hutson J, Peña A, Beket E, Chatterjee S, Coran A, et al. Preliminary report on the international conference for the development of standards for the treatment of anorectal malformations. J Pediatr Surg 2005;40:1521-1526.
  • 4. Rintala RJ, Mildh L, Lindahl H. H-type anorectal malformations: incidence and clinical characteristics. J Pediatr Surg 1996;31:559-562.
  • 5. Willems M, Kluth D, Lambrecht W. Anorectal malformation: a new anatomic variant resembling an H-type fistula. J Pediatr Surg 1996;31:1682-1684.
  • 6. Bryndorf J, Madsen CM. Ectopic anus in the female. Acta Chir Scand 1960;118:466-478.
  • 7. Li L, Zhang TC, Zhou CB, Pang WB, Chen YJ, Zhang JZ. Rectovestibular fistula with normal anus: a simple resection or an extensive perineal dissection? J Pediatr Surg 2010;45:519-524.
  • 8. Sun L, Wang YX, Liu Y. Histopathological study of fistula-in-ano in female. Chin J Pediatr Surg 1995;16:136-137.
  • 9. Tsugawa C, Nishijima E, Muraji T, Satoh S, Kimura K. Surgical repair of rectovestibular fistula with normal anus. J Pediatr Surg 1999;34:1703-1705.
  • 10. Lawal TA, Chatoorgoon K, Bischoff A, Peña A, Levitt MA. Management of H-type rectovestibular and rectovaginal fistulas. J Pediatr Surg 2011;46:1226-1230.

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Diagnosis and Treatment of Congenital H-type Rectovestibular Fistula
J Korean Assoc Pediatr Surg. 2016;22(2):19-22.   Published online December 22, 2016
DOI: https://doi.org/10.13029/jkaps.2016.22.2.19
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Diagnosis and Treatment of Congenital H-type Rectovestibular Fistula
J Korean Assoc Pediatr Surg. 2016;22(2):19-22.   Published online December 22, 2016
DOI: https://doi.org/10.13029/jkaps.2016.22.2.19
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Diagnosis and Treatment of Congenital H-type Rectovestibular Fistula
Image Image
Fig. 1. Surgical treatment of H-type rectovestibular fistula. (A) Fistulectomy following the fistula tract confirmed by probe. (B) Repair of perineal body by ligation and suture.
Fig. 2. Staged treatment of H-type rectovestibular fistula combined with major labial abscess.

Fig. 1.

Fig. 2.

Diagnosis and Treatment of Congenital H-type Rectovestibular Fistula
Patient No. Age at diagnosis (mo) Age at operation (mo) Chief complaint Diagnostic modality Treatment Recurrence
1 2 6 Vestibular defecation Gross physical examination Fistulectomy & repair of perineal body No
2 0 5 Vestibular defecation Fistulography Fistulectomy & repair of perineal body No
3 2 6 Vestibular defecation Fistulography Fistulectomy & repair of perineal body No
4 1 1 Vestibular defecation Fistulography Fistulectomy & repair of perineal body No
5 3 3 Vestibular defecation Fistulography Fistulectomy & repair of perineal body No
6 0 7 Vestibular defecation Fistulography Fistulectomy & repair of perineal body No
7 0 2 Vestibular defecation Fistulography Fistulectomy & repair of perineal body No
8 2 3 Vestibular defecation Gross physical examination Fistulectomy & repair of perineal body No
9 1 2 Major labial abscess Fistulography Fistulectomy & repair of perineal body Yes
10 1 2 Vestibular defecation & major labial abscess Fistulography Fistulectomy & repair of perineal body Yes
11 2 5 Vestibular defecation & major labial abscess Gross physical examination Abscess drainage → fistulectomy & repair of perineal body No
Table 1. Diagnosis and Treatment of H-type Rectovestibular Fistula

Table 1.

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