Gluteal-fold flap repair of rectovaginal fistula caused by aluminum potassium sulfate hydrate-tannic acid injection for internal hemorrhoids: a case report

Abstract

Background: Rectovaginal fistula (RVF) following aluminum potassium sulfate hydrate-tannic acid (ALTA) injection therapy for hemorrhoids is a rare complication. We report the first case of RVF after ALTA injection therapy successfully treated by gluteal-fold flap. Case presentation: A 49-year-old female suffered from a fever and rectal ulcer after undergoing internal hemorrhoid treatment with a submucosal ALTA injection at a previous clinic. One week after ALTA therapy, she noted obvious passage of flatus and stool through the vagina, and was diagnosed with RVF by anoscope at another clinic. She was referred to our hospital 3 weeks after ALTA therapy. Sigmoid colostomy was performed for fecal diversion as a preliminary step for fistula repair. However, the fistula was scarred and the defect between the rectum and vagina did not improve at all. Ten months after ALTA therapy, we performed fistula repair by glutealfold flap. Seven months later, sigmoid-colostomy reversal was performed. The patient has experienced no RVF in the 3 years since sigmoid-colostomy reversal. Conclusions: The gluteal-fold flap strategy is a useful option for severe RVF management.

Outcomes of Modified Tissue Selection Therapy Stapler in the Treatment of Prolapsing Hemorrhoids

“…A postoperative review was conducted at our outpatient department, and if the following symptoms appeared they were recorded: anastomotic bleeding (anastomotic hemorrhage found by anal examination, surgical intervention with 3#0 absorbable sutures were used for ligation and hemostasis); persistent post stapler pain as evaluated by NRS; anal stenosis [a condition in which the patients have difficulty in defecation and incomplete evacuation with a narrow stools caliber ( 16 )]; anal incontinence [a lack of control over defecation, resulting in involuntary leakage of solid and/or liquid stool, with and without unintentional release of gas ( 17 )]; anal discharge [perianal dampness or anal mucus secretion caused by the scar left by the surgery ( 18 )]; anal tag [a perianal mass was pliable with an obvious foreign body sensation ( 11 )]; tenesmus [the patient had a chief complaint of a sensation of rectal tenesmus ( 19 )]; rectovaginal fistula [an opening allowing the passage of flatus and stool through the vagina ( 20 )]; postoperative recurrence [continuous prolapse of perianal piles that recurred after hemorrhoidectomy ( 21 )].…”