Grechukhina Olga, Gressel Gregory M, Taylor Graham, Schwartz Jeremy I, Welsh Regan J
Department of Obstetrics, Gynecology and Reproductive Science, Yale University School of Medicine, 333 Cedar Street-FMB307, New Haven, CT 06520, USA.
Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street-FMB307, New Haven, CT 06520, USA.
Case Rep Obstet Gynecol. 2014;2014:578048. doi: 10.1155/2014/578048. Epub 2014 Dec 22.
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.
背景。肛门直肠畸形（ARMs）极为罕见，通常在新生儿期被发现。这些病例在绝经后期出现并不常见。本病例报告描述了一名患有肛门直肠畸形和直肠阴道出血的绝经后患者。病例。一名86岁女性，孕11产9，因绝经后大量阴道出血就诊于急诊科。她的妇科病史仅显示出生时曾有不明的肛门异常情况。阴道窥器检查发现处女膜环外的直肠前庭瘘有大量直肠出血。结肠镜检查显示严重的憩室病。结论。该患者出生时患有肛门闭锁，后发展为直肠前庭瘘和异位肛门。本病例呈现了一种罕见的临床情况，融合了产科、妇科、胃肠病学和胚胎学等领域。
