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Endoscopy 2015; 47(S 01): E149-E150
DOI: 10.1055/s-0034-1377497
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

Recurrent rectovaginal fistula: treatment with self-expanding metal stents

Antonietta Lamazza
1   University of Rome La Sapienza, Department of Surgery, Istituto Pietro Valdoni, Rome, Italy
,
Enrico Fiori
1   University of Rome La Sapienza, Department of Surgery, Istituto Pietro Valdoni, Rome, Italy
,
Alberto Schillaci
1   University of Rome La Sapienza, Department of Surgery, Istituto Pietro Valdoni, Rome, Italy
,
Antonio V. Sterpetti
1   University of Rome La Sapienza, Department of Surgery, Istituto Pietro Valdoni, Rome, Italy
,
Emanuele Lezoche
2   University of Rome, Department of General Surgery, Surgical Specialties and Organ Transplantation Paride Stefanini, Rome, Italy
› Author Affiliations
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Corresponding author

Antonio V. Sterpetti, MD
Istituto Pietro Valdoni
Viale del Policlinico
00167 Rome
Italy   
Fax: +39-6-49972245   

Publication History

Publication Date:
21 April 2015 (online)

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Postoperative rectovaginal fistula is a rare complication after colorectal resection for cancer. This adverse event results in a scenario of fear and misunderstanding for the patient [1] [2] [3] [4] [5] [6]. Often, local inflammation, widespread infection, friability of the vaginal and rectal tissue, and the inevitably reduced perfusion of blood to the lower end of the rectum make any form of treatment hazardous and likely to cause complications. Even in cases in which the fistula heals, altered colorectal motility is common.

Self-expandable metal stents can be used to treat patients with rectovaginal fistula after colorectal resection for cancer. Of 10 patients who had rectovaginal fistula after colorectal resection for cancer and were treated with endoscopic placement of a self-expandable metal stent, three had been referred after multiple failed operations. All three patients had a diverting proximal stoma. We used fully covered colonic stents 10 cm in length and 28 mm in diameter (Tae Woong Medical, Gimpo Si, Gyeonggi-do, South Korea) in all of them. There were no complications after the procedures. In one patient, the rectovaginal fistula healed without evidence of major fecal incontinence 8 months after stent insertion ([Fig. 1 a – f]). In the remaining two patients, the fistula decreased significantly in size (from 4 × 4 cm to 1 × 1 cm) without evidence of local tissue inflammation; both of these patients underwent a successful flap transposition 8 months after stent placement. In all three patients, the stent dislodged 3 months after placement, and a new stent was placed.

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Fig. 1 Recurrent rectovaginal fistula. a View from the rectal lumen. b Same patient; view from the vaginal lumen. c Insertion of a self-expanding metal stent. View from the rectal lumen. d Insertion of a self-expanding metal stent. View from the vaginal wall. e Complete healing of the fistula. There is still some inflammation immediately after removal of the stent. f Resolution of the inflammation 2 weeks after stent removal.

Self-expandable metal stents are a valid adjunct to the treatment of patients with complex, recurrent rectovaginal fistula after colorectal resection for cancer.

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Competing interests: None


Corresponding author

Antonio V. Sterpetti, MD
Istituto Pietro Valdoni
Viale del Policlinico
00167 Rome
Italy   
Fax: +39-6-49972245   


  Permissions and Reprints
Zoom
Fig. 1 Recurrent rectovaginal fistula. a View from the rectal lumen. b Same patient; view from the vaginal lumen. c Insertion of a self-expanding metal stent. View from the rectal lumen. d Insertion of a self-expanding metal stent. View from the vaginal wall. e Complete healing of the fistula. There is still some inflammation immediately after removal of the stent. f Resolution of the inflammation 2 weeks after stent removal.