Women with rectovaginal fistulae are often stigmatized in developing countries, and become outcasts.Rectovaginal fistula can also be a symptom of various diseases, including infection by lymphogranuloma venereum, or the unintended result of surgery, such as episiotomy or sex reassignment surgery. They may present as a complication of vaginal surgery, including vaginal hysterectomy. They are a recognized presentation of rectal carcinoma or rarely diverticular disease of the bowel or Crohns disease. They are seen rarely after radiotherapy treatment for cervical cancer. Treatment
After diagnosing rectovaginal fistula, it is best to wait for around three months to allow the inflammation to subside. For low fistulae, a vaginal approach is best, while an abdominal repair would be necessary for a high fistula at the posterior fornix.A circular incision is made around the fistula and vagina is separated from the underlying rectum with a sharp circumferential dissection. The entire fistulous tract, along with a small rim of rectal mucosa is incised. The rectal wall is then closed extramucosally.Most rectovaginal fistulas will need surgery to fix. Medications such as antibiotics and Infliximab might be prescribed to help close the rectovaginal fistula or prepare for surgery. References
External links
Rectovaginal fistula at Curlie
In individuals with GRA, there is unequal crossing over so that the 5 regulatory region of the 11-hydroxylase gene is fused to the coding region of the aldosterone synthase.The product of this hybrid gene is aldosterone synthase that is ACTH-sensitive in the zona fasciculata of the adrenal gland.Although in normal subjects, ACTH accelerates the first step of aldosterone synthesis, ACTH normally has no effect on the activity of aldosterone synthase. However, in subjects with glucocorticoid-remediable aldosteronism, ACTH increases the activity of existing aldosterone synthase, resulting in an abnormally high rate of aldosterone synthesis and hyperaldosteronism. Diagnosis
Genetic testing is done to ascertain that the individual in question does indeed have the condition

Treatment
In GRA, the hypersecretion of aldosterone and the accompanying hypertension are remedied when ACTH secretion is suppressed by administering glucocorticoids.Dexamethasone, spironolactone and eplerenone have been used in treatment. See also
Inborn errors of steroid metabolism
Hyperaldosteronism
Pseudohyperaldosteronism
Apparent mineralocorticoid excess syndrome
Aldosterone and aldosterone synthase

References


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