Yonsei Med J.  2010 Sep;51(5):717-721. 10.3349/ymj.2010.51.5.717.

Infantile Vulvar Abscess with a Normal Anus: A Suspicious Sign of Rectovestibular Fistula

• Kim SM
• Park YJ
• Ahn SM
• Oh JT
• Han SJ

• KMID: 1071423
• DOI: http://doi.org/10.3349/ymj.2010.51.5.717

Abstract

PURPOSE
We investigated whether infantile vulvar abscesses are predictable features of rectovestibular fistula with a normal anus.
MATERIALS AND METHODS
A retrospective analysis of five infants with vulvar abscesses and rectovestibular fistulae with normal anuses was performed.
RESULTS
Four cases had a left vulvar abscess, and in one case the vulvar abscess was on the right side. All caregivers reported passage of stool from the vagina. The fistulae were almost uniformly located from the vestibule to the rectum above the anal dentate line, observable by visual inspection and probing under anesthesia. The first two cases were treated with division and closure of the fistulae after a diverting loop colostomy, and the remaining three cases with fistulotomy and curettage. There was no recurrence during the median follow-up period of 38 months.
CONCLUSION
This unique rectovestibular fistula should be suspected in female infants with vulvar abscesses, especially when parents report passage of stool from the vagina. Fistulotomy and curettage may be an initial treatment and effective as a temporary diverting colostomy and delayed repair of the fistula.

Keyword

Vulvar abscess; anorectal malformation; H-type fistula; rectovestibular fistula

MeSH Terms

Abscess/*pathology
Female
Humans
Infant
Reconstructive Surgical Procedures
Rectovaginal Fistula/diagnosis/*pathology/surgery
Retrospective Studies
Treatment Outcome

Figure

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  Fig. 1 Representative preoperative features of a left-sided vulvar abscess (patient 5). The patient is a 2 month old female referred from a local clinic. Redness and swelling of the left labium was found 10 days prior to the picture. The patient took oral antibiotics prior to the referral, which did not ameliorate the inflammation.

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  Fig. 2 (A) A vessel loop was passed through the anorectal vestibular fistula. (B) The anal opening (AO) was seen. We observed several characteristic features of the anal openings in our series of patients: they were rather wide, located just above the dentate line (D), had definite dimpling around the opening, were always located in the 12 o'clock direction, and did not originate from the anal crypts.

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  Fig. 3 The skin wound after fistula closure with diverting colostomy.

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  Fig. 4 (A) Under lithotomy position and general anesthesia, the entire course of the fistula was identified with lacrimal probes. Probe1: from anal opening to vestibular opening (3 o'clock); Probe2: vestibular opening to abscess cavity (left side labium). (B) Fistulotomy and curettage. A long incision was made from the anus to the left vulvar abscess pocket through the vestibule with a coagulator guided by the probes.

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