Delayed presentation of a congenital recto-vaginal fistula associated witha recto-sigmoid tubular duplication and spinal cord and vertebral anomalies

Tubular duplication of the recto-sigmoid colon is a rare entity. Associated anomalies including fistulae to the genitourinary tract may be found. A ba by girl was found to have duplication of the recto-sigmoid colon, anomalies of sacral vertebra from S-1 to S-5, and solitary right kidney. The septum of this duplication was divided using staplers. Because of a history of sto ol coming from the vagina, a meticulous examination perioperatively was per formed, but no fistula could be found. Further extensive investigation fail ed to show any fistula. At the age of 10 she was operated on for a tethered cord. At age 14, she experienced passage of a small amount of liquid stool per vaginum. A recto-vaginal fistula was found. Via a posteCopyright (C) 2 000 by W.B. Saunders Company.rior sagittal incision, the fistula was closed by a transrectal approach. She remained asymptomatic for 16 months until t he fistula recurred. Using a perineal approach, a very short fistula betwee n the vagina and the rectum was closed. The closure was reinforced by a vag inal flap. Four months later, she remains without signs of recurrence.