Uncorrected Rectovestibular Fistula and Pregnancy: A Management Dilemma

Abstract

Abstract

Background: Anorectal malformations (ARM) represent a wide spectrum of congenital anomalies in which the anus fails to open normally onto the perineum. In females, the most common ARM is an imperforate anus with a rectovestibular fistula. There are limited data available on the optimal management of an uncorrected rectovestibular fistula in pregnancy. Case: A 23-year-old gravida 3_, para 2, living, 1, with a history of fecal incontinence since birth and of passing stools through the orifice near the vestibular region, was admitted at 34+3 weeks' gestation for evaluation of ARM. On examination, a prominent skin tag was present at the anal dimple with normal gluteal fold and a fistulous opening in the region of vestibule with minimal prolapse of rectal mucosa. The patient underwent an elective cesarean section with sterilization at 38+3 weeks' gestation in view of having had two previous cesarean sections. Results: Her postnatal period was uneventful and she was discharged on the 7th postoperative day in a satisfactory condition with subsequent follow-up in the department of surgery. Conclusions: In general, those with a history of an imperforate anus and a rectovestibular or rectoperineal fistula are candidates for a vaginal delivery. The size and scarring of the perineal body should be assessed by the obstetrician before making the decision. Cesarean section is recommended for women with a history of a cloacal anomaly. (J GYNECOL SURG 28:55)