Management of enema tip-induced rectourethral fistula with gluteus maximus flap: report of a case.

Rectourethral fistulas are uncommon and pose a challenging treatment problem. We report the case of 68-year-old man with rectourethral fistula following enema tip-induced rectal injury. We treated the patient with an alternative surgical method used to close poorly healing defects between the urethra and rectum, by means of a muscular flap of the gluteus maximus muscle. The postoperative course was uneventful. He remained well and asymptomatic 6 months after the surgery. This technique is superior to gracilis muscle transposition, regarding the richer blood supply, anatomic neighborhood, technical simplicity, and avoidance of unnecessary incisions. Gluteus maximus muscle flap seems to be a good alternative technique in the treatment of iatrogenic rectourethral fistula.