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Infantile vulvar abscess with a normal anus: a suspicious sign of rectovestibular fistula.

Kim SM, Park YJ, Ahn SM, Oh JT, Han SJ - Yonsei Med. J. (2010)

Bottom Line: 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.Fistulotomy and curettage may be an initial treatment and effective as a temporary diverting colostomy and delayed repair of the fistula.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.

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.

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Related in: MedlinePlus

(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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Figure 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.

Mentions: First, we performed barium enemas to rule out fistulae between the anorectum and vagina. Three patients underwent a barium study in which barium sulfate filled the rectum and the fistula was visualized. Additionally, the external genitalia and vagina were stained with barium. All patients also underwent examination under anesthesia (EUA) to delineate the anatomic details of the fistula. For three of the patients, we attempted to directly visualize the anal opening of the fistula with a colonoscopy during EUA, but we were only successful in one patient. However, when careful probing was performed both from the vestibular opening and from the anal opening (12 o'clock direction), the fistula was delineated with ease in all 5 cases. In fact, the anal opening was easily detected with careful probing because of an unusually definite dimpling of the rectal wall located around 12 o'clock within 0.5 cm proximal from the dentate line (Fig. 2). The fistulae did not originate from the crypts of Morgagni in any of the patients. Definitive operative corrections included diverting colostomy and fistula closure (n = 2) (Fig. 3) and fistulotomy and curettage (n = 3) (Fig. 4). After surgery, we instructed the parents to give their infants hot sitz baths to facilitate the healing of the perineal wound. In all of the patients, the perineal wound healed well with normal anal sphincter control. There was no evidence of recurrence during follow-up visits. The fistulae were all considered cured without any functional damage over a median follow-up period of 38 months (range, 33 months to 46 months). A summary of patient characteristics and the outcomes of operations are presented in Table 1.


Infantile vulvar abscess with a normal anus: a suspicious sign of rectovestibular fistula.

Kim SM, Park YJ, Ahn SM, Oh JT, Han SJ - Yonsei Med. J. (2010)

(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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908879&req=5

Figure 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.
Mentions: First, we performed barium enemas to rule out fistulae between the anorectum and vagina. Three patients underwent a barium study in which barium sulfate filled the rectum and the fistula was visualized. Additionally, the external genitalia and vagina were stained with barium. All patients also underwent examination under anesthesia (EUA) to delineate the anatomic details of the fistula. For three of the patients, we attempted to directly visualize the anal opening of the fistula with a colonoscopy during EUA, but we were only successful in one patient. However, when careful probing was performed both from the vestibular opening and from the anal opening (12 o'clock direction), the fistula was delineated with ease in all 5 cases. In fact, the anal opening was easily detected with careful probing because of an unusually definite dimpling of the rectal wall located around 12 o'clock within 0.5 cm proximal from the dentate line (Fig. 2). The fistulae did not originate from the crypts of Morgagni in any of the patients. Definitive operative corrections included diverting colostomy and fistula closure (n = 2) (Fig. 3) and fistulotomy and curettage (n = 3) (Fig. 4). After surgery, we instructed the parents to give their infants hot sitz baths to facilitate the healing of the perineal wound. In all of the patients, the perineal wound healed well with normal anal sphincter control. There was no evidence of recurrence during follow-up visits. The fistulae were all considered cured without any functional damage over a median follow-up period of 38 months (range, 33 months to 46 months). A summary of patient characteristics and the outcomes of operations are presented in Table 1.

Bottom Line: 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.Fistulotomy and curettage may be an initial treatment and effective as a temporary diverting colostomy and delayed repair of the fistula.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.

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.

Show MeSH
Related in: MedlinePlus