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Case Reports
. 2017 Jan 27;11(1):17-22.
doi: 10.1159/000455187. eCollection 2017 Jan-Apr.

Simultaneously Diagnosed and Successfully Treated Rectovaginal and Vesicovaginal Fistulae after Low Anterior Resection with Concomitant Resection of Female Genitalia

Chisato Takagi  1 , Hideo Baba  1 , Kazuo Yamafuji  1 , Atsunori Asami  1 , Kaoru Takeshima  1 , Nobuhiko Okamoto  1 , Hidena Takahashi  1 , Kiyoshi Kubochi  1
Affiliations
Case Reports

Simultaneously Diagnosed and Successfully Treated Rectovaginal and Vesicovaginal Fistulae after Low Anterior Resection with Concomitant Resection of Female Genitalia

Chisato Takagi et al. Case Rep Gastroenterol. .

Abstract

Rectovaginal fistula (RVF) and vesicovaginal fistula (VVF) are infrequent but distressing complications after pelvic surgery. However, their adequate treatment is not well described. Here, we simultaneously encountered and successfully treated RVF and VVF after radical surgery for rectal cancer. A 70-year-old woman underwent low anterior resection (LAR) combined with resection of the uterus, the bilateral adnexa, and the upper side of the vagina, as well as diverted ileostomy for rectal cancer. A month after the surgery, she developed urinary incontinence and underwent medical treatment, but her symptoms did not improve. Evaluation with contrast enema before stoma closure revealed the presence of RVF and VVF. We repaired the VVF and RVF via transabdominal and transperineal approaches. After 6 months, ileostomy was closed and the patient had no recurrence of cancer and fistula. In LAR with hysterectomy and resection of the vaginal wall, there is a risk of RVF and VVF. The excision and closure of the fistula tract and omental flap can be effective to treat both fistulae.

Keywords: Omental flap; Rectal cancer; Rectovaginal fistula; Vesicovaginal fistula.

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Figures

Fig. 1
Fig. 1
Contrast enema fistula findings. The contrast enema demonstrated a rectovaginal fistula (yellow arrowhead) and a vesicovaginal fistula (red arrowhead). The remnant vagina was also shown (black arrowhead).
Fig. 2
Fig. 2
Preoperative urological evaluation. a The black arrowhead shows a vesicovaginal fistula. b Retrograde cystography revealed that the vesicovaginal fistula (yellow arrowhead) was near the internal urethral orifice. A urethral catheter (black arrowhead) and a forceps point to the internal urethral orifice and the remnant vagina, respectively.
Fig. 3
Fig. 3
Operative findings. a The bladder was incised sagittally from the dome, and a vesicovaginal fistula was detected (yellow arrowhead). b A rectovaginal fistula was detected in the vagina (yellow arrowhead). c An omental flap (yellow arrowhead) covered the bladder, vagina, and anastomosis of the rectum.
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