{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T08:26:17Z","timestamp":1771921577382,"version":"3.50.1"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Rectovaginal fistula (RVF) is a severe gynecological complication that can arise from obstetric trauma, surgical injury, infection, or physical trauma. RVF resulting from childhood sexual assault accompanied by extensive perineal injury is uncommon in clinical practice, and its management is particularly complex, as it requires not only meticulous anatomical reconstruction but also sustained attention to long-term psychological sequelae. This report presents the case of a patient with RVF secondary to childhood sexual assault. The patient underwent two unsuccessful repair attempts and subsequently developed a complex RVF associated with an old grade IV perineal laceration. At presentation, she reported intermittent passage of fecal material through the vagina. Physical examination showed a complete loss of the perineal body and central tendon, along with the absence of the rectovaginal septum. Pelvic magnetic resonance imaging revealed an incomplete posterior vaginal wall measuring 3.4\u202fcm, extending from the lower vaginal segment to the vaginal introitus, consistent with RVF. Definitive anatomical reconstruction was achieved through close intraoperative collaboration among gynecology, colorectal surgery, and anesthesiology. Comprehensive perioperative psychological evaluation and psychiatric support alleviated trauma-related distress, improved treatment adherence, and facilitated postoperative recovery. Specialized nursing care optimized perioperative management and supported functional rehabilitation. Within this multidisciplinary team (MDT) framework, a successful single-stage surgical repair was accomplished. This case highlights the value of an individualized, MDT-based approach that integrates surgical reconstruction with psychological intervention in the management of complex RVF. Despite previous failed repairs and delayed intervention, a coordinated single-stage MDT strategy resulted in a favorable outcome. We further analyze the potential causes of previous surgical failure, identify key determinants of successful repair, and provide practical insights to guide the management of similar complex cases in clinical practice.<\/jats:p>","DOI":"10.3389\/fmed.2026.1753114","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T06:46:43Z","timestamp":1771915603000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A multidisciplinary collaborative case of complex rectovaginal fistula resulting from childhood sexual trauma"],"prefix":"10.3389","volume":"13","author":[{"given":"Xin","family":"Du","sequence":"first","affiliation":[{"name":"Guang'anmen Hospital, China Academy of Traditional Chinese Medicine","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuemei","family":"Sun","sequence":"additional","affiliation":[{"name":"Beijing Chaoyang District Maternal and Child Health Care Hospital","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yujing","family":"Zhao","sequence":"additional","affiliation":[{"name":"Guang'anmen Hospital, China Academy of Traditional Chinese Medicine","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiuhua","family":"Fan","sequence":"additional","affiliation":[{"name":"Guang'anmen Hospital, China Academy of Traditional Chinese Medicine","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.3760\/cma.j.cn441530-20220823-00355","article-title":"Chinese experts consensus on diagnosis and treatment of rectovaginal fistula (2022 edition)","volume":"25","year":"2022","journal-title":"Zhonghua Wei Chang Wai Ke Za Zhi"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"269","DOI":"10.31662\/jmaj.2023-0131","article-title":"Risk factors for intrapartum anorectal mucosal lacerations and rectovaginal fistula: a retrospective comparative study","volume":"7","author":"Suzuki","year":"2024","journal-title":"Jma J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1055\/s-2007-977487","article-title":"Rectovaginal fistulas: current surgical management","volume":"20","author":"Rivadeneira","year":"2007","journal-title":"Clin Colon Rectal Surg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e27","DOI":"10.1055\/s-0039-1695048","article-title":"A surgical technique to repair perineal body disruption secondary to sexual assault","volume":"8","author":"Brisighelli","year":"2020","journal-title":"European J Pediatr Surg Rep"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1260355","DOI":"10.3389\/fsurg.2023.1260355","article-title":"Delayed surgical management of rectovaginal fistula: a case report highlighting challenges and lessons learned","volume":"10","author":"Drusany Stari\u010d","year":"2023","journal-title":"Front Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1007\/s11605-010-1167-1","article-title":"Analysis of function and predictors of failure in women undergoing repair of Crohn's related rectovaginal fistula","volume":"14","author":"El-Gazzaz","year":"2010","journal-title":"J Gastrointest Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"52","DOI":"10.23922\/jarc.2023-007","article-title":"Treatment of rectovaginal fistula","volume":"7","author":"Maeda","year":"2023","journal-title":"J Anus Rectum Colon."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/j.ajog.2024.04.029","article-title":"Multidisciplinary approach to evaluation of rectovaginal fistulas","volume":"231","author":"Mu\u00f1oz","year":"2024","journal-title":"Am J Obstet Gynecol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1429137","DOI":"10.3389\/fmed.2024.1429137","article-title":"Adverse childhood experiences and health outcomes: a 20-year real-world study","volume":"11","author":"Martins","year":"2025","journal-title":"Front Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.1177\/15248380211066100","article-title":"Meaning making mechanisms in women survivors of childhood sexual abuse: a scoping review","volume":"24","author":"van der Westhuizen","year":"2023","journal-title":"Trauma Violence Abuse"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"7468","DOI":"10.3390\/ijerph19127468","article-title":"Psychological intervention in women victims of childhood sexual abuse: an open study-protocol of a randomized controlled clinical trial comparing emdr psychotherapy and trauma-based cognitive therapy","volume":"19","author":"Molero-Zafra","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"4808","DOI":"10.7150\/thno.106751","article-title":"Acupuncture alleviates csds-induced depressive-like behaviors by modulating synaptic plasticity in vca1","volume":"15","author":"Cong","year":"2025","journal-title":"Theranostics"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1016\/j.bbi.2021.02.003","article-title":"Lipidomics reveals that acupuncture modulates the lipid metabolism and inflammatory interaction in a mouse model of depression","volume":"94","author":"Jung","year":"2021","journal-title":"Brain Behav Immun"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1016\/j.dcmed.2025.12.010","article-title":"The study of traditional Chinese medicine five-element music therapy for depression: a bibliometric analysis","volume":"8","author":"Xiao","year":"2025","journal-title":"Digital Chin Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e39681","DOI":"10.1097\/MD.0000000000039681","article-title":"Effectiveness of acupuncture plus music therapy for post-stroke depression: systematic review and meta-analysis","volume":"103","author":"Zhang","year":"2024","journal-title":"Medicine"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1097\/GRF.0b013e3181cf7488","article-title":"Surgical approaches to postobstetrical perineal body defects (rectovaginal fistula and chronic third and fourth-degree lacerations)","volume":"53","author":"Delancey","year":"2010","journal-title":"Clin Obstet Gynecol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1007\/BF02049726","article-title":"Treatment of rectovaginal fistulas that has failed previous repair attempts","volume":"38","author":"MacRae","year":"1995","journal-title":"Dis Colon Rectum"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1699","DOI":"10.1007\/s00384-022-04206-7","article-title":"Surgical treatment of rectovaginal fistula-predictors of outcome and effects on quality of life","volume":"37","author":"S\u00f6derqvist","year":"2022","journal-title":"Int J Color Dis"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.1097\/DCR.0000000000003148","article-title":"Rectovaginal fistula: what is the role of martius flap and gracilis muscle interposition in the therapeutic strategy?","volume":"67","author":"Pastier","year":"2024","journal-title":"Dis Colon Rectum"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1753114\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T06:46:47Z","timestamp":1771915607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1753114\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,24]]},"references-count":19,"alternative-id":["10.3389\/fmed.2026.1753114"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1753114","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,24]]},"article-number":"1753114"}}