case_images: PMC4619915_01
case_images: Showing anovestibular fistula in an adult female patient with openings of urethra and vagina. Note no separate anal opening.
case_images: CRIS2015-625474.001.jpg
case_images: PMC4619915_01_CRIS2015-625474.001.jpg
case_images: fig1
case_images: Perineal examination revealed no separate anal opening (Figure 1), dry stool seen through an opening in vestibule.
case_images: Exposure of operative area.
case_images: CRIS2015-625474.002.jpg
case_images: PMC4619915_01_CRIS2015-625474.002.jpg
case_images: fig2
case_images: Tractions sutures applied to expose the operative area (Figure 2), Inj. With the help of muscle stimulator sphincter complex was identified in the perineum and an opening made within it (Figure 5); electrocautery use minimized at this stage to prevent injury to sphincter complex (Figure 2).
case_images: Line of incision depicted around the anorectum.
case_images: CRIS2015-625474.003.jpg
case_images: PMC4619915_01_CRIS2015-625474.003.jpg
case_images: fig3
case_images: Circumferential incision was made around fistulous opening, as depicted in Figure 3.
case_images: Circumferential mobilization of anorectum.
case_images: CRIS2015-625474.004.jpg
case_images: PMC4619915_01_CRIS2015-625474.004.jpg
case_images: fig4
case_images: Posterior wall of vagina separated from the anterior wall of rectum anorectum is circumferentially mobilized up to the level of levator muscle (Figure 4).
case_images: New anal opening created.
case_images: CRIS2015-625474.005.jpg
case_images: PMC4619915_01_CRIS2015-625474.005.jpg
case_images: fig5
case_images: With the help of muscle stimulator sphincter complex was identified in the perineum and an opening made within it (Figure 5); electrocautery use minimized at this stage to prevent injury to sphincter complex (Figure 2). Tunnel was created through sphincteric complex and mobilised anorectum pulled down through it, fixed at the new opening within; thus anal transposition was done (Figures 5 and 6).
case_images: Anorectum transposed within sphincteric complex.
case_images: CRIS2015-625474.006.jpg
case_images: PMC4619915_01_CRIS2015-625474.006.jpg
case_images: fig6
case_images: Tunnel was created through sphincteric complex and mobilised anorectum pulled down through it, fixed at the new opening within; thus anal transposition was done (Figures 5 and 6).
case_images: Incision around the fistulous opening.
case_images: CRIS2015-625474.007.jpg
case_images: PMC4619915_01_CRIS2015-625474.007.jpg
case_images: fig7
case_images: Mobilisation of rectum.
case_images: CRIS2015-625474.008.jpg
case_images: PMC4619915_01_CRIS2015-625474.008.jpg
case_images: fig8
case_images: New anal opening marked with the help of muscle stimulator.
case_images: CRIS2015-625474.009.jpg
case_images: PMC4619915_01_CRIS2015-625474.009.jpg
case_images: fig9
case_images: Incision made at proposed new anal opening.
case_images: CRIS2015-625474.010.jpg
case_images: PMC4619915_01_CRIS2015-625474.010.jpg
case_images: fig10
case_images: Tunnel developed for mobilisation of rectum.
case_images: CRIS2015-625474.011.jpg
case_images: PMC4619915_01_CRIS2015-625474.011.jpg
case_images: fig11
case_images: Rectum transposed.
case_images: CRIS2015-625474.012.jpg
case_images: PMC4619915_01_CRIS2015-625474.012.jpg
case_images: fig12
case_images: Anoplasty completed.
case_images: CRIS2015-625474.013.jpg
case_images: PMC4619915_01_CRIS2015-625474.013.jpg
case_images: fig13