title: Unusual presentation of a rectovestibular fistula as gastrointestinal hemorrhage in a postmenopausal woman.
abstract: Background. Anorectal malformations (ARMs) are extremely rare and are usually identified neonatally. It is unusual for these cases to present in the postmenopausal period. This case report describes a postmenopausal patient with ARM and rectovaginal hemorrhage. Case. An 86-year-old, gravida 11, para 9, presented to the emergency department complaining of profuse postmenopausal vaginal bleeding. Her gynecologic history was significant only for an unclear history of an anal abnormality that was noted at birth. Speculum examination revealed profuse rectal bleeding from a rectovestibular fistula exterior to her hymenal ring. Colonoscopic examination revealed severe diverticular disease. Conclusion. This patient was born with an imperforate anus which resolved as rectovestibular fistula and ectopic anus. This case presents a rare clinical circumstance which integrates the fields of obstetrics, gynecology, gastroenterology, and embryology alike.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Science, Yale University School of Medicine, 333 Cedar Street-FMB307, New Haven, CT 06520, USA.
authors.forename: Olga
authors.initials: O
authors.lastname: Grechukhina
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Science, Yale University School of Medicine, 333 Cedar Street-FMB307, New Haven, CT 06520, USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Gressel
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street-FMB307, New Haven, CT 06520, USA.
authors.forename: Graham
authors.initials: G
authors.lastname: Taylor
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street-FMB307, New Haven, CT 06520, USA.
authors.forename: Jeremy I
authors.initials: JI
authors.lastname: Schwartz
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Science, Yale University School of Medicine, 333 Cedar Street-FMB307, New Haven, CT 06520, USA.
authors.forename: Regan J
authors.initials: RJ
authors.lastname: Welsh