A Case Report of Rectal Herniation through Rectovaginal Fistula Associated with Uterine Prolapse

Lee, Sang Jeon

Abstract

A rectovaginal fistula, associated with a uterine prolapse, is a very rare entity. The case presented here is that of an elderly woman with a uterine prolapse, associated with an anterior rectal wall herniation through a rectovaginal fistula just above the anorectal ring. It was thought the uterine prolapse had caused the weakness, and long diastasis, of the posterior vaginal wall and the rectovaginal fistula, and then the anterior rectal wall became herniated, with eversion through the rectovaginal fistula. A total abdominal hysterectomy, with bilateral salpingo-oophorectomy, was performed. The rectum was mobilized just beyond the level of the rectovaginal fistula, and resected at that point. Then, from a perineal approach, a coloanal anastomosis was performed using the Parks' sleeve anastomosis technique. After the repair of the long diastasis of the posterior vaginal wall, with inclusion of the fistula opening, a portion of the omentum was interposed between the posterior vaginal wall and the coloanal anastomosis site.