Spontaneous Healing of a Rectovaginal Fistula Developing after Laparoscopic Segmental Bowel Resection for Intestinal Deep Infiltrating Endometriosis

Abstract

The surgical treatment of intestinal deep infiltrating endometriosis has an associated risk of major complications such as dehiscence of the intestinal anastomosis, pelvic abscess, and rectovaginal fistula. The management of postoperative rectovaginal fistula frequently requires a reoperation and the construction of a stoma for temporary fecal diversion. In this paper we describe a 27-year-old woman undergoing laparoscopic treatment of deep infiltrating endometriosis (extramucosal cystectomy, resection of the uterosacral ligaments, resection of the posterior vaginal fornix, and segmental bowel resection) complicated by a rectovaginal fistula, which healed spontaneously with nonsurgical conservative treatment.

Conservative Management of Coloperitoneal-Vaginal Fistula

“…To our knowledge, spontaneous healing of only a simple RVF, developing after laparoscopic segmental resection for intestinal deep infiltrating endometriosis, has been reported. 11 In high RVFs, the preferred transabdominal approach is often cited, with repair involving interposition of healthy tissue between the rectum and vagina with surgical modalities including low anterior resections, abdominal perineal resections, and complex muscle flaps. Successful laparoscopic treatment of mid and high RVFs has been reported.…”

Rectovaginal fistula after low anterior resection: Prevention and management

“…This approach includes bowel rest and total parenteral nutrition. However, it could take up to 2 mo before the fistula heals spontaneously[ 14 - 16 ]. Notably, the diameter of the RVF with spontaneous healing reported in the literature was not larger than 1 cm.…”

Rectovaginal fistula following surgery for deep infiltrating endometriosis: Does lesion size matter?

“… 17 The most worrisome complication associated with the surgical treatment of DIE is the development of a postoperative rectovaginal fistula (PRF), which is defined as an abnormal connection between the rectum and vagina. 18 The reported occurrence rate of PRF after surgical treatment of DIE ranges from 2.9% to 10.6%. 16 , 19 Patients with PRF may require longer hospitalization, experience slower recovery to work, and have a higher risk of the need for multiple surgical repairs.…”