PMC8264442_01
Pre-operative examination for the diagnosis of rectoperineal fistula (A) Magnetic resonance imaging (sagittal view) showing a small tract from the lower rectum. Arrow, small tract. Arrowhead, rectum. (B) Small fistula on the perineal skin visualized after insertion of indigo carmine poured into the rectum (arrow). Arrowhead, vaginal orifice.
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F1
Magnetic resonance imaging revealed a small fistula tract from the lower rectum, but an external opening or perianal abscess was not revealed (Figure 1A). Colonoscopy also showed a small orifice at the anterior wall of the lower rectum (above the dentate line), and indigo carmine poured into the rectum was discharged from the perineal opening (Figure 1B).
Anatomical schema of the rectoperineal fistula. (A) Sagittal image showing the position of fistula tract (arrow). (B) Image of perineal surface. The fistula opened nearby the vaginal orifice. Perineal approach with transverse incision was placed at the surgery (dotted arrow).
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F2
Anatomical schema demonstrating the position of fistula tract was shown in Figure 2. Seven months after the first operation, a second operation, transperineal repair for rectoperineal fistula was performed (Figures 2B, 3).
Surgical procedure of rectoperineal fistula repair. (A) Identification of rectoperineal fistula with a probe through the fistula tract. (B) Transverse perineal incision and dissection of rectovaginal septum exposing fistula tract. (C) Fistula tract is completely excised from the rectovaginal septum. Small box, macroscopic feature of fistula tract (2 x 1 cm). (D) Layered closure of rectum, perineal body, vagina, and skin are performed, respectively. The skin was closed along vertical direction (dotted arrow).
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F3
Seven months after the first operation, a second operation, transperineal repair for rectoperineal fistula was performed (Figures 2B, 3).