Transvaginal imaging of recto-vaginal fistula aided by water enema

To evaluate transvaginal sonography (TVS) aided by a water enema as a means of detecting recto-vaginal fistulas. TVS with 7 MHz sidefire endorectal probe (Acuson, Mountain View, CA) was performed in 23 women (27-34 y) during the administration of 60-150 cc of sterile water to detect clinically suspected recto-vaginal fistulas. Enemas were administered via 8-10 F catheter during real- time TVS. Recto-vaginal fistulas were surgically confirmed `in 6 of 23 patients with 4 of 6 (>3 mm) detected by water enema. `Pin point' defects were missed in 2 of 6 patients. In 1, a tract was demonstrated but not communicating with the vagina. In the remaining 16, no recto-vaginal fistula was present. Recto-vaginal fistula tracts can be demonstrated with TVS aided water enema. `Pin Point' defects may be missed.