Permacol™ collagen paste for treating a rectovaginal fistula following anterior rectal prolapsectomy

Excerpt

A 50-year-old female admitted for obstructed defection, with no comorbidities, underwent an anterior rectal prolapsectomy with plication of the rectal muscle, i.e., a Sarles operation or anterior hemi-Delorme. At the end, the vagina was intact. The rectoanal suture, felt at digital palpation and seen at proctoscopy with a pediatric instrument (Sef light Sapimed, Alessandria, Italy), was also intact after 10 days. Nine days later, the patient reported passage of air and fecal matter through the vagina and a rectovaginal fistula (RVF) was detected examination under anesthesia. The rectal orifice of the fistula was evident at the level of the rectoanal suture, and the vaginal orifice was 6 cm above the vaginal introitus. It was so small that it could be seen only after introducing methylene blue into the rectum. The etiology of RVF in this patient is rather obscure, and the presentation unusually delayed. Either late suture dehiscence and local sepsis or chronic ischemia might have occurred. …