title: Anovestibular fistula with normal anal opening: Is it always congenital?
abstract: OBJECTIVE
  To review 12 cases of anovestibular fistula with normal anal opening.
  
  
  METHODS
  Retrospective analysis of 12 children with anovestibular fistula and normal anal opening were treated between the years 2000 and 2007. Of these, 11 patients were diagnosed as having acquired anovestibular fistula with normal anal opening and were managed by conservative management.
  
  
  RESULTS
  Most of them presented with diarrhea and labial redness. One patient was considered to have fistula of congenital origin and was managed surgically. Eleven patients presented between the ages of 1.5-11 months and were considered as cases of acquired anovestibular fistula and only two of them required surgical management in the form of colostomy and fistula excision. Others were successfully managed by conservative treatment; the fistulous output and labial redness decreased gradually within a period of 5-19 (average 11.5) days.
  
  
  CONCLUSIONS
  Not all presentations of anovestibular fistula with normal anal opening can be considered as congenital. Presence of inflammation, paramedian fistula, and a favourable response to conservative management/colostomy suggest acquired etiology. Trial of conservative management should be given in the acquired variety.
authors.affiliation: Department of Pediatric Surgery, KEM Hospital, Parel, Mumbai, India.
authors.forename: Prashant
authors.initials: P
authors.lastname: Jain
authors.forename: Pankaj
authors.initials: P
authors.lastname: Mishra
authors.forename: Hemanshi
authors.initials: H
authors.lastname: Shah
authors.forename: Sandesh
authors.initials: S
authors.lastname: Parelkar
authors.forename: S S
authors.initials: SS
authors.lastname: Borwankar