ILEAL STOMA COMPLICATED WITH FISTULA TO THE VAGINA IN A PATIENT WITH FAMILIAL ADENOMATOUS POLYPOSIS: CASE REPORT

Case Presentation A 40-year-old woman diagnosed with Familial Adenomatous Polyposis (FAP) was identified through screening due to a family history of polyposis. In September 2019, she underwent restorative proctocolectomy with a J-pouch ileal reservoir and a protective ileostomy. The patient developed a fistula between the ileal pouch and the posterior vaginal wall, which was surgically repaired via a perineal approach in September 2020. However, the fistula recurred. A decision was made to resect the ileal pouch and create a new one, with simultaneous correction of the enterovaginal fistula during the surgery. The patient continued to experience fecal leakage through the vaginal canal, accompanied by abdominal pain. A second ileal pouch resection and definitive terminal ileostomy were performed.

Discussion FAP is an autosomal dominant disease affecting 1 in 16,000 individuals in Brazil. It is rare but significant due to its potential for colorectal cancer development, requiring surgical intervention, often prophylactically. Surgical options include restorative proctocolectomy with an ileal pouch, total colectomy with ileorectal anastomosis, and proctocolectomy with a definitive ileostomy. For patients with fewer than 20 rectal polyps, ileorectal anastomosis is preferred. In this context, restorative proctocolectomy with an ileal pouch is indicated for patients with more than 20 rectal polyps, maintaining intestinal transit. However, in this case, an uncommon complication occurred: the development of a fistula between the pouch and the vagina. This complication can result from inclusion of the posterior vaginal wall in the stapling during the anastomosis or from an anastomotic dehiscence leading to fistulization into the vagina. In this case, the former was detected on the fourth postoperative day.

Conclusion Surgical treatment for FAP is a major procedure, which can be performed via laparoscopic, robotic, or laparotomic approaches. When performing the anastomosis, it is crucial to visualize the posterior vaginal wall to prevent its inclusion in the stapling, which could result in an enterovaginal fistula.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025