Sigmoid–vaginal fistula as a rare complication following vaginal surgery

Excerpt

A 75-year-old woman presented complaining of mucoid, foul-smelling vaginal discharge, and dull lower abdominal pain. She had undergone a vaginal hysterectomy and anterior colporrhaphy for a prolapsed uterus and cystocele 4 years earlier. The same year, 9 months later, vaginal vault prolapse occurred; thus, sacrospinous fixation of the vagina was performed. Examination revealed complete vaginal eversion with enterocele and an unusual circular opening on the vaginal cuff (Fig. 1). The opening was admissible with one finger, and the entered structure squeezed the finger so that a peristaltic wave was considered to have occurred (Fig. 2). MRI examination did not describe the presence of fistula formation. However, as the patient’s symptoms and clinical examination conclusively indicated a diagnosis of fistula, surgical treatment was chosen. Laparotomy was performed, and sigmoid colon was found attached to the vaginal cuff. After dissection, a defect of the sigmoid colon wall appeared (Fig. 3). The bowel portion involved was resected, and primary re-anastomosis was performed. Debridement and layer closure of the vagina were also performed. Vaginal vault prolapse and enterocele were corrected by the interpositioning of Elevate posterior mesh. The patient recovered well. She was last seen 3 months after the operation.

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