Rectovaginal fistula (RVF) is a severe gynecological complication that can arise from obstetric trauma, surgical injury, infection, or physical trauma. RVF resulting from childhood sexual assault accompanied by extensive perineal injury is uncommon in clinical practice, and its management is particularly complex, as it requires not only meticulous anatomical reconstruction but also sustained attention to long-term psychological sequelae. This report presents the case of a patient with RVF secondary to childhood sexual assault. The patient underwent two unsuccessful repair attempts and subsequently developed a complex RVF associated with an old grade IV perineal laceration. At presentation, she reported intermittent passage of fecal material through the vagina. Physical examination showed a complete loss of the perineal body and central tendon, along with the absence of the rectovaginal septum. Pelvic magnetic resonance imaging revealed an incomplete posterior vaginal wall measuring 3.4 cm, extending from the lower vaginal segment to the vaginal introitus, consistent with RVF. Definitive anatomical reconstruction was achieved through close intraoperative collaboration among gynecology, colorectal surgery, and anesthesiology. Comprehensive perioperative psychological evaluation and psychiatric support alleviated trauma-related distress, improved treatment adherence, and facilitated postoperative recovery. Specialized nursing care optimized perioperative management and supported functional rehabilitation. Within this multidisciplinary team (MDT) framework, a successful single-stage surgical repair was accomplished. This case highlights the value of an individualized, MDT-based approach that integrates surgical reconstruction with psychological intervention in the management of complex RVF. Despite previous failed repairs and delayed intervention, a coordinated single-stage MDT strategy resulted in a favorable outcome. We further analyze the potential causes of previous surgical failure, identify key determinants of successful repair, and provide practical insights to guide the management of similar complex cases in clinical practice.
Du et al. (Tue,) studied this question.