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

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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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Most cited references 17

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H-type anorectal malformations: incidence and clinical characteristics.

R.J Rintala, L Mildh, H Lindahl (1996)

To establish the incidence of H-type anorectal malformations (ARM), the hospital records of 629 patients with ARM were studied. Patients who had a congenital rectourogenital connection and an external anal opening in a normal or ectopic position were considered to have an H-type malformation. Twenty (3.2%; 14 females, 6 males) of the 629 patients studied had an H-type ARM. Major associated anomalies were found in 60% of these patients. Thirteen patients (12 females, 1 male) had a normally placed anus; the H fistula was low rectovestibular in 10, rectovaginal in 2, and rectourethral in 1. Seven patients had an ectopic anal opening. Three males had a rectourethral H fistula; in two of these there was a double fistula. Two males had a rectovesical H fistula. Of the two females with ectopic anal openings, one had a high rectovaginal H fistula and the other had a low fistula. In only one case was the diagnosis of H fistula made immediately after birth. Three patients died of severe cardiac abnormalities during the neonatal period or early infancy. Primary perineal repair or a limited posterior surgical anorectoplasty (PSARP) was used in 15 cases; formal PSARP was used for the other two. Four patients had between one and 4 recurrences; all but one of these fistulas were repaired subsequently. Long term (median follow-up period, 12 years; range, 4 to 38 years), 12 patients had good bowel function and no faecal soiling; four of these had constipation that was manageable with laxatives. Two patients (aged 10 and 12 years) had daily soiling. Two others were too young to evaluate, and one (with severe mental retardation) has a permanent colostomy.

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HIV-positive African children with rectal fistulae.

Valerie R. Wiersma (2002)

Human immunodeficiency virus (HIV) disease is an increasingly common infection in children in sub-Sahara Africa. Rectal fistulation is one such condition with which these patients present to the paediatric surgeon. This appeared to be an exclusively female condition until 2 male patients were treated recently. A 6-year (1996 through 2001) retrospective study found 39 children presenting with HIV-related rectal fistulae. Thirty-seven girls were seen with rectovaginal fistulae (RVF), and there is supportive documentation showing an increase in this condition throughout Southern Africa. Until now, boys have not been described with this condition. The author presents 2 boys who complete this spectrum of HIV-related acquired rectal fistulae. All patients were found to have rectal fistula at the dentate line. In girls it varied in size from pin-point to 5 mm diameter, tracking anteriorly into the vagina. When closure of the fistula was attempted, it broke down. The 2 boys had a large fistula, which tracked to the prostatic urethra on the right of the verumontanum. The first patient underwent a successful repair. The second patient had a "Y"-shaped fistula based at the dentate line, with the second limb passing into the bladder. The parents refused further treatment and took the child home. HIV disease affects increasing numbers of children. A spectrum of rectal fistulae now has been seen in both girls and boys. These acquired rectal fistulae arise at the dentate line in both genders. Girls with these fistulae are seen more commonly, presenting with RVF. The closure of a fistula has only been successful in one boy. Copyright 2003, Elsevier Science (USA). All rights reserved.

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Rectovestibular fistula with normal anus: a simple resection or an extensive perineal dissection?

Zhe Zhang, Le Li, Bo Pang … (2010)

The purpose of the study was to review a 10-year experience of operative procedures for rectovestibular fistula with normal anus (RVFNA) at one institution. From January 1999 to December 2008, 182 female patients of RVFNA were treated surgically in the Department of Surgery, Beijing Children's Hospital, Capital Medical University, China. The patients' age ranged from 4 months to 15 years, with a mean age of 3.4 years. Fourteen children had a failed previous operation in other institutions. One hundred fifty-six patients (85.71%) had a definite history of vulvar inflammation within 3 months after birth and fecal leakage thereafter. In 61 of the 156 patients, a perineal abscess appeared after an episode of diarrhea. Four cases (2.20%) had associated anomalies of the VACTERL type. One hundred seventy-three patients (95.05%) had 1 external opening, whereas 9 others (4.95%) had 2 external openings separated by a skin bridge. In all cases, the internal orifice opened above the dentate line. The fistula in 135 cases (74.18%) presented as an opening with a small diameter (<5 mm). In our series, vestibular-rectal pull-through procedure was performed in 98 cases, transanal procedure in 69 cases, and anterior perineal anorectoplasty in 15 cases. None had a diverting colostomy. Recurrence of fistula occurred in 5 to 10 days after operation in 21 cases (11.54%). Eight of them healed spontaneously after daily sitz bath with 3% boric acid, whereas other 13 patients (7.14%) required reoperation. Follow-up was obtained by telephone or by personal visit in the outpatient department, from 3 months to 10 years (median, 5.7 years). All the patients were continent and had regular bowel movement. Most RVFNA was acquired after infection. Procedure requiring extensive perineal dissection and diverting colostomy are unnecessary in most RVFNA cases. We performed simple resection in most patients with satisfactory results. In the cases with a large external opening and abnormal perineal appearance, a more extensive perineal dissection might be necessary.

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Author and article information

Journal

Journal ID (nlm-ta): Yonsei Med J

Journal ID (publisher-id): YMJ

Title: Yonsei Medical Journal

Publisher: Yonsei University College of Medicine

ISSN (Print): 0513-5796

ISSN (Electronic): 1976-2437

Publication date (Print): 01 September 2010

Publication date (Electronic): 15 July 2010

Volume: 51

Issue: 5

Pages: 717-721

Affiliations

[1 ]Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.

[2 ]Department of Pediatric Surgery, Dankook University Medical College, Cheonan, Korea.

[3 ]Department of Pediatric Surgery, Hallym University Sacred Medical Center, Hallym University College of Medicine, Anyang, Korea.

[4 ]Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

Author notes

Corresponding author: Dr. Seok Joo Han, Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: 82-2-2228-2130, Fax: 82-2-313-8289, sjhan@ 123456yuhs.ac

Article

DOI: 10.3349/ymj.2010.51.5.717

PMC ID: 2908879

PubMed ID: 20635446

SO-VID: 9daf8579-5536-4df6-911f-8f598157403e

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 04 February 2010

Date revision received : 22 March 2010

Date accepted : 22 March 2010

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

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Abstract

Purpose

Materials and Methods

Results

Conclusion

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Karger: Coronavirus / COVID-19

Most cited references 17

H-type anorectal malformations: incidence and clinical characteristics.

HIV-positive African children with rectal fistulae.

Rectovestibular fistula with normal anus: a simple resection or an extensive perineal dissection?

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