Infantile Vulvar Abscess with a Normal Anus: A Suspicious Sign of Rectovestibular Fistula

Purpose: We investigated whether infantile vulvar abscesses are predictable features of rectovestibular fistula with a normal anus. Materials and Methods: A retrospective analysis of five infants with vulvar abscesses and rectovestibular fistulae with normal anuses was performed. Results: Four cases had a left vulvar abscess, and in one case the vulvar abscess was on the right side. All caregivers reported passage of stool from the vagina. The fistulae were almost uniformly located from the vestibule to the rectum above the anal dentate line, observable by visual inspection and probing under anesthesia. The first two cases were treated with division and closure of the fistulae after a diverting loop colostomy, and the remaining three cases with fistulotomy and curettage. There was no recurrence during the median follow-up period of 38 months. Conclusion: This unique rectovestibular fistula should be suspected in female infants with vulvar abscesses, especially when parents report passage of stool from the vagina. Fistulotomy and curettage may be an initial treatment and effective as a temporary diverting colostomy and delayed repair of the fistula.