Arch Gynecol Obstet (2009) 279:919–922 DOI 10.1007/s00404-008-0821-2 123 CASE REPORT The repair of rectovaginal Wstulas using a bulbocavernosus muscle-fat Xap Christl Reisenauer · Markus Huebner · Diethelm Wallwiener Received: 26 March 2008 / Accepted: 6 October 2008 / Published online: 1 November 2008  Springer-Verlag 2008 Abstract A 50-year-old woman developed a rectovaginal Wstula after a posterior colporrhaphy for rectocele repair. Her vagina was scarred and narrowed after radiotherapy for cervical cancer 20 years earlier. A second patient with a 23-year history of Crohn’s disease presented with a small low rectovaginal Wstula. The latter appeared spontaneously. Both complained of passing faeces and Xatus through the vagina. Clinical examination conWrmed the symptoms and revealed no signs of sphincter disturbance. As both patients had no other medical problems, we operated on the Wstulas by a vaginal approach using a bulbocavernosus muscle-fat Xap from the right labia majora. A temporary ileo- or colos- tomy could be avoided. Following successful healing, the anatomical and functional results were excellent in both cases. Keywords Rectovaginal Wstula · Bulbocavernosus-fat Xap · Martius Xap Introduction Rectovaginal Wstulas present a distressing problem for the patient and a challenge for the treating physician. The main aetiologies are obstetric trauma, local infection, inXamma- tory disease, post surgery and malignancy. Surgical treat- ment is necessary as the spontaneous healing rate of Wstulas is low. The success rate decreases with repeated attempts at repair. Rothenberger et al. [1] described a way to classify recto- vaginal Wstulas. A simple Wstula is localised in the lower or middle-third of the vagina, its diameter is smaller than 2.5 cm and it is caused by trauma or infection. In contrast, a complex Wstula is localised in the upper-third of the vagina, its diameter is greater than 2.5 cm. The aetiology of com- plex rectovaginal Wstulas includes inXammatory bowel dis- ease (Crohn, Colitis ulcerosa), irradiation or malignancies. We present a primary repair of two low, small-sized but complex rectovaginal Wstulas by the vaginal approach using a bulbocavernosus muscle-fat Xap. The patients were con- sidered high risk as in one case the Wstulas occurred postop- eratively in an irradiated area and in a second case spontaneously in a patient suVering from Crohn’s disease. Flatus and stool incontinence were noted before the opera- tion and were conWrmed by clinical examination. Both patients suVered considerable psychosocial stress. Success- ful anatomical and functional results were achieved in both patients after surgical treatment. Case report A 50-year-old patient developed a symptomatic rectovagi- nal Wstula two weeks after posterior colporrhaphy for a rectocele repair. The patient had undergone radiotherapy for cervical cancer 20 years earlier. A second patient, a 41-year-old lady with an inactive Crohn’s disease, was referred to our department for evaluation and treatment of a rectovaginal Wstula. In the Wrst case the clinical evaluation conWrmed a single midline rectovaginal Wstula, 3 mm in diameter, located in the middle-third of the vagina (Fig. 1). The vagina was nar- rowed and the tissue scarred after radiotherapy and after anterior and posterior colporrhaphy. The 3-mm rectovaginal C. Reisenauer · M. Huebner (&) · D. Wallwiener Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstrasse 7, 72076 Tübingen, Germany e-mail: markus.huebner@med.uni-tuebingen.de