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Case Reports in Obstetrics and Gynecology
Volume 2014, Article ID 578048, 3 pages
http://dx.doi.org/10.1155/2014/578048
Case Report

Unusual Presentation of a Rectovestibular Fistula as Gastrointestinal Hemorrhage in a Postmenopausal Woman

1Department of Obstetrics, Gynecology and Reproductive Science, Yale University School of Medicine, 333 Cedar Street-FMB307, New Haven, CT 06520, USA
2Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street-FMB307, New Haven, CT 06520, USA

Received 31 October 2014; Accepted 5 December 2014; Published 22 December 2014

Academic Editor: Erich Cosmi

Copyright © 2014 Olga Grechukhina et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Anorectal malformations (ARMs) are extremely rare and are usually identified neonatally. It is unusual for these cases to present in the postmenopausal period. This case report describes a postmenopausal patient with ARM and rectovaginal hemorrhage. Case. An 86-year-old, gravida 11, para 9, presented to the emergency department complaining of profuse postmenopausal vaginal bleeding. Her gynecologic history was significant only for an unclear history of an anal abnormality that was noted at birth. Speculum examination revealed profuse rectal bleeding from a rectovestibular fistula exterior to her hymenal ring. Colonoscopic examination revealed severe diverticular disease. Conclusion. This patient was born with an imperforate anus which resolved as rectovestibular fistula and ectopic anus. This case presents a rare clinical circumstance which integrates the fields of obstetrics, gynecology, gastroenterology, and embryology alike.