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Unusual presentation of a rectovestibular fistula as gastrointestinal hemorrhage in a postmenopausal woman.

Grechukhina O, Gressel GM, Taylor G, Schwartz JI, Welsh RJ - Case Rep Obstet Gynecol (2014)

Bottom Line: Her gynecologic history was significant only for an unclear history of an anal abnormality that was noted at birth.Conclusion.This case presents a rare clinical circumstance which integrates the fields of obstetrics, gynecology, gastroenterology, and embryology alike.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics, Gynecology and Reproductive Science, Yale University School of Medicine, 333 Cedar Street-FMB307, New Haven, CT 06520, USA.

ABSTRACT
Background. Anorectal malformations (ARMs) are extremely rare and are usually identified neonatally. It is unusual for these cases to present in the postmenopausal period. This case report describes a postmenopausal patient with ARM and rectovaginal hemorrhage. Case. An 86-year-old, gravida 11, para 9, presented to the emergency department complaining of profuse postmenopausal vaginal bleeding. Her gynecologic history was significant only for an unclear history of an anal abnormality that was noted at birth. Speculum examination revealed profuse rectal bleeding from a rectovestibular fistula exterior to her hymenal ring. Colonoscopic examination revealed severe diverticular disease. Conclusion. This patient was born with an imperforate anus which resolved as rectovestibular fistula and ectopic anus. This case presents a rare clinical circumstance which integrates the fields of obstetrics, gynecology, gastroenterology, and embryology alike.

No MeSH data available.


Related in: MedlinePlus

Examination demonstrating cystocele, normal vaginal tissue, and posterior rectovestibular fistula.
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fig2: Examination demonstrating cystocele, normal vaginal tissue, and posterior rectovestibular fistula.

Mentions: On admission, the patient was noted to be tachycardic (heart rate: 94–101 beats per minute) with blood pressure ranging within 164–170/84–123 mmHg. Her other vital signs were unremarkable. She was noted to be pale but had no obvious shortness of breath, chest pain, or dyspnea. A rectal examination was unable to be performed as the patient was noted to have complete absence of an external anal sphincter. The patient's laboratory values at presentation included Hb 10.7 g/dL, Hct 33.1%. The gynecologic team was called for further evaluation of possible vaginal bleeding. Bimanual examination revealed copious bright red blood from the introitus and normal postmenopausal uterus, cervix, and adnexae. However on speculum examination there was no identifiable extravasation of blood from the external cervical os. Further manual examination revealed a 2 cm opening in the posterior vaginal wall about 2-3 cm proximal to the introitus where the blood was coming from. This appeared to be a rectovaginal fistula noted caudal to the hymenal ring but within the vagina itself (Figures 1 and 2). The diagnosis of imperforate anus and subsequent ectopic anus versus rectovestibular fistula was made.


Unusual presentation of a rectovestibular fistula as gastrointestinal hemorrhage in a postmenopausal woman.

Grechukhina O, Gressel GM, Taylor G, Schwartz JI, Welsh RJ - Case Rep Obstet Gynecol (2014)

Examination demonstrating cystocele, normal vaginal tissue, and posterior rectovestibular fistula.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4283261&req=5

fig2: Examination demonstrating cystocele, normal vaginal tissue, and posterior rectovestibular fistula.
Mentions: On admission, the patient was noted to be tachycardic (heart rate: 94–101 beats per minute) with blood pressure ranging within 164–170/84–123 mmHg. Her other vital signs were unremarkable. She was noted to be pale but had no obvious shortness of breath, chest pain, or dyspnea. A rectal examination was unable to be performed as the patient was noted to have complete absence of an external anal sphincter. The patient's laboratory values at presentation included Hb 10.7 g/dL, Hct 33.1%. The gynecologic team was called for further evaluation of possible vaginal bleeding. Bimanual examination revealed copious bright red blood from the introitus and normal postmenopausal uterus, cervix, and adnexae. However on speculum examination there was no identifiable extravasation of blood from the external cervical os. Further manual examination revealed a 2 cm opening in the posterior vaginal wall about 2-3 cm proximal to the introitus where the blood was coming from. This appeared to be a rectovaginal fistula noted caudal to the hymenal ring but within the vagina itself (Figures 1 and 2). The diagnosis of imperforate anus and subsequent ectopic anus versus rectovestibular fistula was made.

Bottom Line: Her gynecologic history was significant only for an unclear history of an anal abnormality that was noted at birth.Conclusion.This case presents a rare clinical circumstance which integrates the fields of obstetrics, gynecology, gastroenterology, and embryology alike.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics, Gynecology and Reproductive Science, Yale University School of Medicine, 333 Cedar Street-FMB307, New Haven, CT 06520, USA.

ABSTRACT
Background. Anorectal malformations (ARMs) are extremely rare and are usually identified neonatally. It is unusual for these cases to present in the postmenopausal period. This case report describes a postmenopausal patient with ARM and rectovaginal hemorrhage. Case. An 86-year-old, gravida 11, para 9, presented to the emergency department complaining of profuse postmenopausal vaginal bleeding. Her gynecologic history was significant only for an unclear history of an anal abnormality that was noted at birth. Speculum examination revealed profuse rectal bleeding from a rectovestibular fistula exterior to her hymenal ring. Colonoscopic examination revealed severe diverticular disease. Conclusion. This patient was born with an imperforate anus which resolved as rectovestibular fistula and ectopic anus. This case presents a rare clinical circumstance which integrates the fields of obstetrics, gynecology, gastroenterology, and embryology alike.

No MeSH data available.


Related in: MedlinePlus