Rectovaginal Fistula: A Common Diagnostic Error With Significant Consequences in Girls With Anorectal Malformations

Background/Purpose: Rectovaginal fistula is a term that con-tinues to be used frequently to describe girls with anorectal malformations. This study attempts to evaluate the true frequency of this anomaly and the consequences of its mis-diagnosis. Methods: A retrospective review of all girls with anorectal malformations treated by the senior author from 1980 through September 2000 was performed, and the pertinent literature was reviewed. Results: Of the 617 patients identified, only 6 were found to have a true rectovaginal fistula, an incidence of 1%. A total of 139 of the 617 patients were referred after a previous repair. Of these, 42 had a diagnosis of recto-vaginal fistula origi-nally. The diagnosis was incorrect in all 42. Twelve patients had a rectovestibular fistula, and 30 had a cloaca. The 30 cloaca patients, because of the misconception that they had a rectovaginal fistula, underwent an initial repair of only the rectal component of the malformation, leaving all patients with a urogenital sinus necessitating a second complete repair. Conclusions: The use of the term rectovaginal fistula is com-mon, despite a true incidence of 1 % in girls with anorectal malformations. The majority of girls will have either a recto-vestibular fistula or a cloaca. Such diagnostic errors may lead to the use of inappropriate surgical techniques, incom-plete repair, and unnecessary morbidity