Welcome to the ePoster Viewing Panel of AICOG 2025

A LATE PRESENTATION OF OBSTETRIC FISTULA Introduction Rectovaginal fistulas are uncommon, accounts for less than 5% of all anorectal fistulas. Obstetric causes such as perineal laceration or episiotomy , assisted vaginal delivery,prolonged labour, trauma to genital tract. Usually presents with fecal incontinence immediately or within 7-10 days. Other causes like inflammatory Bowel disease, diverticulitis, gynecological surgeries, malignancy, postirradiation. CASE REPORT A 37 year old, P3L2D1A3, previous 3 normal vaginal deliveries, last child birth - 1year,came with complaints of passage of stops through vagina for past 1 month. Patient underwent spontaneous vaginal delivery with episiotomy 1 year back with baby's birth weight-3.025 kg, total hours of labour - 14 hours. For past 1 month, patient noticed soiling of clothes with stools from vagina and Stool stained discharge from vagina. Complaints of involuntary passage of stools during urgency. No altered Bowel habits. History of trauma to genital area in childhood and suturing done. With adequate Bowel preparation and antibiotic coverage, rectovaginal fistula repair done. Intraoperatively, fistulous tract noted between vagina and rectum at 2'O clock position of 0.5 cm diameter and 1 cm long. Fistulous tract removed by dissection of vaginal mucosa, rectovaginal fascia, anal mucosa, dissected separately, ends freshened and sutured in layers using 2-0 vicryl.Postoperatively,patient kept Nil Per oral for 24 hours, followed by clear liquids for 48 hours and then started on solid diet. CONCLUSION To conclude, Acute Fistulas resulting from Obstetric and operative trauma heal on its own within 6-12 weeks. Physical Examination confirms diagnosis. Endoscopy is done to rule out other causes. Low RVF is between lower 1/3rd of rectum and lower half of vagina, close to anus and corrected by perineal approach. High RVF is between middle third of rectum and posterior vaginal fornix, corrected by transabdominal approach.