case_images: PMC10483572_01
case_images: Endoanal ultrasound. The opening of the fistula on the anterior wall was shown on the ultrasound picture above the probe (black circle).
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case_images: F1
case_images: The ultrasound images revealed that the external and internal sphincters appeared optimally repaired, indicating the successful reconstruction of these critical structures during the initial repair of the obstetric anal sphincter injury (Figure 1).
case_images: The location of rectovaginal fistula. The fistula is on the anterior wall of the rectum cranially from the anal sphincter.
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case_images: F2
case_images: The combination of the ultrasound findings and the dye confirmation provided a comprehensive understanding of the fistula's location and allowed for accurate diagnosis and treatment planning (Figure 2).
case_images: Probe position. The probe is inserted inside the rectovaginal fistula.
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case_images: F3
case_images: In response, we performed a repeat transanal fistula repair with a more extensive excision of the fistula tract (Figures 3-5).
case_images: Fistula excision. The picture shows the result of the minial excision performed during the first surgery.
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case_images: F4
case_images: However, considering the proximity of the anal sphincter and the potential risk of compromising its integrity and subsequent anal incontinence, the width of the excision was deliberately limited (Figure 4). In response, we performed a repeat transanal fistula repair with a more extensive excision of the fistula tract (Figures 3-5).
case_images: Fistula Closure. Monofilamente absorbable sutures in places before final closing of the excised fistula.
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case_images: F5
case_images: Simultaneously, the excised fistula was closed with interrupted sutures using the same absorbable sutures (Figure 5). In response, we performed a repeat transanal fistula repair with a more extensive excision of the fistula tract (Figures 3-5).