The problem: You are visiting a doctor who works with Medecins Sans Frontieres i
ID: 165153 • Letter: T
Question
The problem: You are visiting a doctor who works with Medecins Sans Frontieres in Chad, in her clinic in a rural village. The village is six hours by truck from the nearest hospital, although few of the impoverished villagers have access to automobiles. A young woman, age 18, is brought to the clinic. She is very thin, showing signs of malnourishment, and small for her age. She delivered a stillborn baby two years ago after a prolonged labor that lasted for days. Since then she has suffered from complete incontinence: fecal matter leaks constantly from her vagina. She has been abandoned by her husband and ostracized by her family because of the unpleasant smell and her inability to have more children. The young woman came to the village looking for work, and was referred to the clinic by a local woman. The doctor thinks the young woman can be helped. Based on the young woman's situation and history, what diagnosis will the doctor make? How do you explain the incontinence and fecal matter leaking from the vagina? How can this young woman's condition be treated? Why are cases like this more common in impoverished nations than in wealthy ones?Explanation / Answer
1. This is the case of rectovaginal fistula. In this case a connection develops between the vag*na and rectum and results in stool being passed uncontrollably through the va*ina. The most common cause for this is, birth trauma, In which anu* and va*ina to make sure both are open and in the correct position.
2. - It is characterized by the abnormal connection of the rectum to the vagi*a. This results in the potential of passing gas or feces through the vag*na as it leaks through the fistula.
- Environmental factors such as drug use during pregnancy may be the cause of this.
3. Treatment for recto-vaginal fistulas includes either posterior sagittal anorectoplasty or a minimally invasive (laparoscopic) pull-through procedure. The procedure involves disconnecting the abnormal fistula from va*ina to the rectum, and then bringing the rectum down to a newly created anal opening precisely positioned within the sphincter muscle complex.
4. Recto-vestibular fistulas and recto-vag*nal fistulas are types of anorectal malformations (ARMs) that affect females.
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