Related Experiment Video
Updated: Aug 19, 2026
Sequencing of Bacterial Microflora in Peripheral Blood: our Experience with HIV-infected Patients
Published on: June 11, 2011
HIV-positive African children with rectal fistulae
1Department of Paediatric Surgery, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa.
Insights
Human immunodeficiency virus (HIV) related rectal fistulae are increasingly seen in children in sub-Saharan Africa. This study describes the condition in both boys and girls, noting differences in presentation and treatment outcomes.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Public Health
Background:
- Human immunodeficiency virus (HIV) infection is prevalent in children in sub-Saharan Africa.
- Rectal fistulation is a recognized complication in pediatric HIV patients.
- Previously, acquired rectal fistulae were considered exclusive to females.
Purpose of the Study:
- To describe the spectrum of HIV-related acquired rectal fistulae in children.
- To report the presentation and surgical outcomes in male patients with rectal fistulae.
- To highlight the increasing incidence of these conditions in pediatric populations.
Main Methods:
- A retrospective study of 39 children with HIV-related rectal fistulae from 1996-2001.
- Analysis of patient demographics, fistula characteristics, and treatment outcomes.
- Inclusion of two male patients previously undescribed with this condition.
Main Results:
- Thirty-seven girls presented with rectovaginal fistulae (RVF).
- Two boys presented with large rectal fistulae extending to the prostatic urethra.
- Surgical repair was successful in one of the two male patients.
Conclusions:
- HIV disease impacts a growing number of children, presenting with a spectrum of rectal fistulae.
- Acquired rectal fistulae in HIV-infected children occur at the dentate line in both genders.
- Treatment success for these fistulae, particularly in boys, requires further investigation.
Background/Purpose:
Human immunodeficiency virus (HIV) disease is an increasingly common infection in children in sub-Sahara Africa. Rectal fistulation is one such condition with which these patients present to the paediatric surgeon. This appeared to be an exclusively female condition until 2 male patients were treated recently.
Methods:
A 6-year (1996 through 2001) retrospective study found 39 children presenting with HIV-related rectal fistulae. Thirty-seven girls were seen with rectovaginal fistulae (RVF), and there is supportive documentation showing an increase in this condition throughout Southern Africa. Until now, boys have not been described with this condition. The author presents 2 boys who complete this spectrum of HIV-related acquired rectal fistulae.
Results:
All patients were found to have rectal fistula at the dentate line. In girls it varied in size from pin-point to 5 mm diameter, tracking anteriorly into the vagina. When closure of the fistula was attempted, it broke down. The 2 boys had a large fistula, which tracked to the prostatic urethra on the right of the verumontanum. The first patient underwent a successful repair. The second patient had a "Y"-shaped fistula based at the dentate line, with the second limb passing into the bladder. The parents refused further treatment and took the child home.
Conclusions:
HIV disease affects increasing numbers of children. A spectrum of rectal fistulae now has been seen in both girls and boys. These acquired rectal fistulae arise at the dentate line in both genders. Girls with these fistulae are seen more commonly, presenting with RVF. The closure of a fistula has only been successful in one boy.
Related Concept Videos
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:28Amebiasis