Vaginal agenesis and rectovestibular fistula. Experience utilizing distal ileum for the vaginal replacement in these patients, preserving the natural fecal reservoir

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• 作者：Luis De la Torre^a ; ^{luis.delatorre@chp.edu" class="auth_mail" title="E-mail the corresponding author} ; Kimberly Cogley^a ; ^{kimberly.Cogley@chp.edu" class="auth_mail" title="E-mail the corresponding author} ; Juan L. Calisto^a ; ^{juan.calisto@chp.edu" class="auth_mail" title="E-mail the corresponding author} ; Karla Santos^b ; ^{santosjasso@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Alejandro Ruiz^b ; ^{cirugiapediatrica@msn.com" class="auth_mail" title="E-mail the corresponding author} ; Marí ; a Zornoza^b ; ^{mariazornoza@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Anorectal malformation ; Rectovestibular fistula ; Vaginal agenesis ; Vaginoplasty ; Posterior sagittal anorectoplasty ; Vaginal replacement
• 刊名：Journal of Pediatric Surgery
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：51
• 期：11
• 页码：1871-1876
• 全文大小：657 K

文摘

The association of rectovestibular fistula (RVF) and vaginal agenesis (VA) presents a diagnostic and management challenge. The vaginal replacement is usually performed with rectum or sigmoid, which are the natural fecal reservoirs; thus, the fecal control could be affected. We present our experience utilizing ileum to preserve the rectum and sigmoid.

Methods

We performed a retrospective study of eight patients with RVF and VA treated from May 2011 to June 2015 at two colorectal centers, at Pittsburgh and Mexico. We recorded the age at diagnosis of VA, treatment, presence of other associated malformations and outcome.

Results

Eight of forty-nine girls with RVF had an associated VA (16.3%). Three patients had a timely diagnosis and five a delayed diagnosis. Six patients were submitted to a vaginal replacement with ileum and achieved fecal control. Two are waiting for surgery.

Conclusions

A high index of suspicion of vaginal agenesis helps in a timely diagnosis in girls with RVF. The use of ileum allows for preservation of the fecal reservoirs, thus optimizing the chance for fecal control in patients with anorectal malformations.