A 34-year-old multipara who had a fourth-degree perineal tear at her last delivery complains of passage of flatus and occasionally liquid stool through the vagina. On examination a small opening is felt in the posterior fornix just below the cervix. The most likely diagnosis is:
- A Anal sphincter injury without fistula
- B Rectocele
- C Rectovaginal fistula ✓
- D Vesicovaginal fistula
Correct answer: C. Rectovaginal fistula
Explanation
Passage of flatus or faeces per vaginum is pathognomonic of a rectovaginal fistula, and the site just below the posterior fornix fits a fistula following an unrecognized or infected fourth-degree perineal tear. C rectocele is a herniation of the rectum into the posterior vaginal wall causing bulging and difficulty in defecation, not faecal leakage. Vesicovaginal fistula leaks urine, not stool. Small rectovaginal fistulas may be confirmed with methylene blue enema and repaired via the perineal or vaginal route after local sepsis settles.
Reference: DC Dutta's Textbook of Gynecology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.