African Journal of Paediatric Surgery

LETTER TO THE EDITOR
Year
: 2011  |  Volume : 8  |  Issue : 1  |  Page : 117--118

Anovestibular fistula in otherwise normal anorectum


Sandeep Hambarde, Pradnya Bendre, Rajeev Redkar 
 Department of Paediatric Surgery, B J Wadia Children Hospital, Mumbai, India

Correspondence Address:
Sandeep Hambarde
Room No 110, RMO Quarters, B J Wadia Children Hospital, Parel, Mumbai - 400 012
India




How to cite this article:
Hambarde S, Bendre P, Redkar R. Anovestibular fistula in otherwise normal anorectum.Afr J Paediatr Surg 2011;8:117-118


How to cite this URL:
Hambarde S, Bendre P, Redkar R. Anovestibular fistula in otherwise normal anorectum. Afr J Paediatr Surg [serial online] 2011 [cited 2020 May 29 ];8:117-118
Available from: http://www.afrjpaedsurg.org/text.asp?2011/8/1/117/79075


Full Text

Sir,

Anovestibular fistula in otherwise normal anorectum is a rare anomaly in girls. This presents immediately after birth during episodes of loose stools, with the perineum having an extra opening alondside the normal anorectum. This anomaly can be simply and effectively treated by vestibulo-anal pull through.

We recently managed a 4-month-old girl child who presented with passage of stools from perineum since birth, more during episodes of loose stools. There was no history of distension of abdomen or constipation. The patient was having an extra opening in the midline in fossa navicularis, completely within vestibule and totally surrounded by vestibular mucosa. She was having normally situated anorectum [Figure 1]. Examination under anaesthesia revealed a very tiny opening which we thought could be tackled by simple cauterisation.{Figure 1}

Vestibular opening was cauterised twice under anaesthesia, but there was recurrence in immediate postoperative period. And after second cauterisation, the opening was visibly big [Figure 2]. Hence, vestibulo-anal pull through was done [Figure 3] and [Figure 4]. Histology did not reveal signs of inflamation. The patient is passing stools from normal anorectum with no recurrence of symptoms and other complications in short-term and long-term follow-up.{Figure 2}{Figure 3}{Figure 4}

Anovestibular fistula in otherwise normal anorectum was first reported by Bryndort and Madsen in 1959. [1] It is rarely seen in Europe and America, but is fairly common in Japan, China and India. Twenty-nine cases have been reported by Chartterjee in 1988. [2]

Stephens and Smith in 1971 described two varieties of fistula depending on the posterior opening lying subcutaneously between the fossa navicularis and the anterior wall of the anal canal at or superficial to the anal valves. [2]

In 1948, Keith wrote "In the seventh week, the rectum having reached the anal part of the cloacal membrane forms a new opening, the former opening into the cloaca becoming closed. But if this opening into the cloaca remains patent, its form fistula". [3]

Van der Putte (1986) suggested that interruption of the dorsal part of the cloacal membrane by an isolated defect can lead to the formation of fistula. [4]

Chaterji et al considered fistula to be congenital due to the anteior opening lying either sagitally or parasagittally, presentation immediately after birth, faeces seen at the vestibule for the first time during an episode of diarrhoea or constipation. Histological examination of the excised tracts usually do not reveal any evidence of inflammation. [5]

Vestibulo-anal pull through was performed in the lithotomy position with catheter in the bladder. A circumferential incision is made around the vestibular opening and stay sutures placed at the margins. The canal is dissected from the back of the vagina and the surrounding muscles until the rectum is reached. The fistula is freed, preserving the integrity of both the rectum and vagina. Anus is stretched with the help of stay sutures and fistula is delivered into the bowel inside out. Defect in rectum is closed in two layers and perineal body is reconstructed.

Complications can occur as local suppuration which is treated by antibiotics. Recurrence occurs if some part of tract is left behind. Infected tracts are primarily laid open and definitive management is done later on.

 Acknowledgements



I am indebted to my mentor, Dr. Pradnya Bendre, for her invaluable guidance and inspiration along every step of the work. She had been extremely understanding whenever there were some hardships and extended her whole-hearted support throughout the course of the research. I also thank Dr. Rajiv Redkar, Hon. Associate Professor, for being supportive of the project and giving initial information about the logistics and problems I might face during the project. I appreciate my parents and friends for their unwavering support.

References

1Bryndorf J, Madsen CM. Ectopic anus in the female. Acta Chir Scand 1960;118:466-78.
2Chartterjee SK. Double termination of the alimentary tract: A second look. J Pediatr Surg 1980;15:623-7.
3Keith A. Human embryology and morphology. 6 th ed. London: Arnold co; 1948. p. 536.
4van der Putte SC. Normal and abnormal development of anorectum. J Pediatr Surg 1986;21:434-40.
5Zhang J. Acquired rectoverstibular fistula. Chinese J Pediatr Surg 1984;5:35.