Post-traumatic rectourethral fistula in an adolescent managed via a transperineal approach using a local gluteal tissue interposition flap: a case report

Shinnosuke Uegami,Norimitsu Shimada,Toshinori Hirano,Shinya Takahashi,Hiroki Ohge,Yusuke Watadani,Ikki Nakashima,Kosuke Yoshimura

doi:10.1186/s40792-021-01335-z

Shinnosuke Uegami, Norimitsu Shimada + Show 6 more

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https://doi.org/10.1186/s40792-021-01335-z

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Abstract

BackgroundRectourethral fistula is a rare disease with a wide variety of etiologies and clinical presentations. A definitive surgical procedure for rectourethral fistula repair has not been established.Case presentationA 13-year-old boy sustained a penetrating injury to the perineum, and developed a symptomatic rectourethral fistula thereafter. Conservative management through urinary diversion and transanal repair was unsuccessful. Fecal diversion with loop colostomy was performed, and three months later, a fistula repair was performed via a transperineal approach with interposition of a local gluteal tissue flap. There were no postoperative complications, and magnetic resonance imaging studies confirmed the successful closure of the fistula. The urinary and fecal diversions were reverted 1 and 6 months after the fistula repair, respectively, and postoperative excretory system complications did not occur.ConclusionsThe transperineal approach with interposition of a local gluteal tissue flap provides a viable surgical option for adolescent patients with rectourethral fistulas who are unresponsive to conservative management.

Highlights

Rectourethral fistula is a rare disease with a wide variety of etiologies and clinical presentations
The transperineal approach with interposition of a local gluteal tissue flap provides a viable surgical option for adolescent patients with rectourethral fistulas who are unresponsive to conservative management
Acquired Rectourethral fistula (RUF) are caused by surgical complications, pelvic irradiation, malignancy, chronic infection, and trauma [1]

Summary

Introduction

Rectourethral fistula is a rare disease with a wide variety of etiologies and clinical presentations. A definitive surgical procedure for rectourethral fistula repair has not been established. Conservative management through urinary diversion and transanal repair was unsuccessful. Fecal diversion with loop colostomy was performed, and three months later, a fistula repair was performed via a transperineal approach with interposition of a local gluteal tissue flap. The urinary and fecal diversions were reverted 1 and 6 months after the fistula repair, respectively, and postoperative excretory system complications did not occur. Rectourethral fistulas (RUFs) are abnormal communications between the rectum and urethra. They induce significant disability and have been associated with marked distress. Conservative management includes urinary diversion (UD) with or without fecal diversion (FD) [2].

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