title: Vaginal agenesis and rectovestibular fistula. Experience utilizing distal ileum for the vaginal replacement in these patients, preserving the natural fecal reservoir.
abstract: BACKGROUND
  The association of rectovestibular fistula (RVF) and vaginal agenesis (VA) presents a diagnostic and management challenge. The vaginal replacement is usually performed with rectum or sigmoid, which are the natural fecal reservoirs; thus, the fecal control could be affected. We present our experience utilizing ileum to preserve the rectum and sigmoid.
  
  
  METHODS
  We performed a retrospective study of eight patients with RVF and VA treated from May 2011 to June 2015 at two colorectal centers, at Pittsburgh and Mexico. We recorded the age at diagnosis of VA, treatment, presence of other associated malformations and outcome.
  
  
  RESULTS
  Eight of forty-nine girls with RVF had an associated VA (16.3%). Three patients had a timely diagnosis and five a delayed diagnosis. Six patients were submitted to a vaginal replacement with ileum and achieved fecal control. Two are waiting for surgery.
  
  
  CONCLUSIONS
  A high index of suspicion of vaginal agenesis helps in a timely diagnosis in girls with RVF. The use of ileum allows for preservation of the fecal reservoirs, thus optimizing the chance for fecal control in patients with anorectal malformations.
authors: Colorectal Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA. Electronic address: luis.delatorre@chp.edu.
authors: Luis
authors: L
authors: De la Torre
authors: Colorectal Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA. Electronic address: kimberly.Cogley@chp.edu.
authors: Kimberly
authors: K
authors: Cogley
authors: Colorectal Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA. Electronic address: juan.calisto@chp.edu.
authors: Juan L
authors: JL
authors: Calisto
authors: Centro Colorrectal para Niños de México y Latino America, Hospital para el Nino Poblano, Universidad Nacional Autónoma de México, Puebla, Mexico. Electronic address: santosjasso@hotmail.com.
authors: Karla
authors: K
authors: Santos
authors: Centro Colorrectal para Niños de México y Latino America, Hospital para el Nino Poblano, Universidad Nacional Autónoma de México, Puebla, Mexico. Electronic address: cirugiapediatrica@msn.com.
authors: Alejandro
authors: A
authors: Ruiz
authors: Centro Colorrectal para Niños de México y Latino America, Hospital para el Nino Poblano, Universidad Nacional Autónoma de México, Puebla, Mexico. Electronic address: mariazornoza@gmail.com.
authors: María
authors: M
authors: Zornoza
mesh_terms: D000015:Abnormalities, Multiple; D001003:Anal Canal / Q000002:abnormalities / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000601:surgery*; D003430:Cross-Sectional Studies; D003672:Defecation; D005260:Female; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D007223:Infant; D007231:Infant, Newborn; D019651:Plastic Surgery Procedures / Q000379:methods*; D012006:Rectovaginal Fistula / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D014621:Vagina / Q000002:abnormalities* / Q000601:surgery*
keywords: Anorectal malformation; Posterior sagittal anorectoplasty; Rectovestibular fistula; Vaginal agenesis; Vaginal replacement; Vaginoplasty