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. 2023 Apr 18;9(1):61.
doi: 10.1186/s40792-023-01642-7.

Successful omental flap coverage repair of a rectovaginal fistula after low anterior resection: a case report

Yuta Kuhara  1 , Hiroshi Hotei  2 , Tatsunori Hashimoto  2 , Shingo Seo  2 , Ai Amioka  2 , Naoki Murao  2 , Aki Kuwada  2 , Akira Nakashima  2 , Ryutaro Sakabe  2 , Kou Tahara  2
Affiliations

Successful omental flap coverage repair of a rectovaginal fistula after low anterior resection: a case report

Yuta Kuhara et al. Surg Case Rep. .

Abstract

Background: Rectovaginal fistula (RVF) is a troublesome and refractory complication after low anterior resection (LAR) for rectal cancer. An omental flap repair was performed for the RVF caused due to Crohn's disease and childbirth trauma. However, there are few cases of an omental flap repair for RVF after LAR. Herein, we present a successfully repaired case of RVF by omental flap coverage after LAR for rectal cancer.

Case presentation: A 50-year-old female patient with advanced rectal cancer underwent laparoscopic LAR with double-stapling technique anastomosis and achieved curative resection. She complained of a stool from the vagina and was diagnosed with RVF on the postoperative day (POD) 18. Conservative therapy was ineffective. We performed laparoscopic fistula resection and direct closure of the vagina and rectum, designed the omentum that could reach the pelvis, repaired RVF by omental flap coverage, and performed transverse colostomy on POD 25. She was discharged on initial POD 48. Seven months after the initial operation, colostomy closure was administered. There was no recurrence of RVF found 1 year after the initial operation.

Conclusions: The patient achieved an omental flap coverage for RVF. We successfully performed the omental flap coverage repair in patients with RVF after the leakage of LAR. An omental flap may become an alternative treatment for muscle flap or an effective treatment for RVF.

Keywords: Low anterior resection; Muscle flap; Omental flap; Rectal cancer; Rectovaginal fistula.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A Colonography revealed an advanced rectal cancer. B Computed tomography scan revealed a hypervascular irregular wall thickness in the rectum and swollen lymph node
Fig. 2
Fig. 2
Computed tomography scan revealed a fistula between the vagina and the rectum (arrows)
Fig. 3
Fig. 3
A The leakage point in the rectum was sutured after resecting the fistula (arrow). B We designed the omentum which could reach the pelvis. C After covering the vagina and the rectum with the omentum flap
Fig. 4
Fig. 4
A Gastrografin enema from the anus. B Gastrografin enema from the vagina. These demonstrated no fistula between the vagina and the rectum
See this image and copyright information in PMC

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