Case Introduction
Patient: Female, 49 years old, married.
Chief Complaint: Vaginal fluid discharge for half a year, 25 years after vaginal delivery.
Present History: The patient was diagnosed with third-degree perineal laceration during vaginal delivery in December 2000 and received no treatment. Half a year ago, she developed yellowish vaginal fluid discharge, with a small amount of feces discharging from the vagina during defecation. She did not receive specific diagnosis and treatment previously. Now she complains that vaginal fluid discharge has seriously affected her quality of life and requests surgical treatment. The outpatient department admitted her with a diagnosis of "rectovaginal fistula". Since the onset of illness, the patient has had normal mental status, appetite, sleep and normal urination.
Marital and Childbearing History: Married, gravida 2 para 1, delivered one child via vaginal delivery in 2000.
Menstrual History: Menarche at 13 years old, menstrual cycle 5-7 days/28-30 days.
No special personal or family history.
Gynecological Examination
Vulva: Old laceration was visible.
Vagina: Patulous, with a small amount of white vaginal discharge and no peculiar smell.
Digital Rectal Examination: Mucosal weakness of the rectum was palpable at the 6 o'clock position of the lower posterior vaginal wall, 1.5 cm away from the vaginal orifice; no typical fistula opening was observed.
Methylene Blue Test: Diluted methylene blue solution was injected into the rectum via the anus. Methylene blue fluid was seen flowing out from the weak mucosal area at the 6 o'clock position of the posterior vaginal wall.
Auxiliary Examination
Gynecological pelvic floor ultrasound suggested:Suspected rectovaginal fistula? Correlation with clinical findings is recommended.
Admission Diagnosis
Rectovaginal fistula
Proposed Surgical Method
Transvaginal Rectovaginal Fistula Repair
Postoperative Follow-up
The patient returned for re-examination one month after surgery and reported no discomforts such as vaginal fluid discharge or fecal leakage from the vagina.
Gynecological Examination:Vulva: The surgical wound healed well; the vagina was patulous without abnormal discharge. The wound of rectovaginal fistula healed well with smooth rectal mucosa, and no obvious fistula opening or depression was palpable.
Auxiliary Examination:Gynecological pelvic floor ultrasound indicated:
No obvious fistula opening was found between the rectum and posterior vaginal wall.
Surgeon Profile
Xiao Binmei
Chief Physician, Department of Gynecology, Xiangya Hospital, Central South University
✦ Visiting Scholar at Chemnitz Red Cross Hospital in Germany and UC Davis School of Medicine in the United States✦ Deputy Director of the Youth Committee, the 1st Committee of Gynecology Branch of Chinese Geriatrics Society✦ Expert Member of the Minimally Invasive Treatment Group of Female Reproductive Rehabilitation Branch of Chinese Association of Plastics and Aesthetics✦ Deputy Director of Pelvic Floor Professional Group, Hunan Female Physicians Association✦ Deputy Director of Pelvic Floor Professional Committee, Hunan Rehabilitation Medical Association✦ Deputy Director of Prevention and Treatment Professional Committee of Female Pelvic Floor Dysfunction Diseases of Hunan Province
Her major research focuses on gynecological urology. She is proficient in surgical treatment and individualized rehabilitation therapy for difficult and recurrent pelvic floor diseases such as uterine prolapse, urinary incontinence and genital fistula.
Editor-in-charge: QinghuanReviewer: Ma Ye
