Laparoscopic Treatment Of High Sigmoidovaginal Fistula. Case Report

Abstract

Rectovaginal and/or colovaginal fistulas are difficult-to-treat conditions that can cause vaginitis, abnormal flatulence through the vagina, skin excoriations, and more. Depending on the type of fistula, they can be rectovaginal, anovaginal, colovaginal, enterovaginal, vesicovaginal, ureterovaginal, urethrovaginal, with the most common being vesicovaginal and rectovaginal. In most cases, these conditions present a challenge and require a comprehensive diagnostic approach and treatment. We present a clinical case of a 73-year-old patient manifesting with flatulence through the vagina. During hospitalization, a high sigmoidovaginal fistula was diagnosed. The patient has a history of hysterectomy 17 years ago, due to myomatous uterus. Subsequently, she had three operations for postoperative hernia, two of which involved the placement of synthetic mesh. During the diagnostic plan, diverticulosis of the colon was also detected. This was observed as probable etiological cause for the formation of the fistula. The patient had comorbidities: arterial hypertension and severe obesity (Grade III). A laparoscopic disconnection of the fistula was performed, followed by laparoscopic suturing of the vagina and sigmoid colon, with subsequent omentoplasty. After an uncomplicated postoperative period, the patient was discharged on the 5th postoperative day, fully mobilized, with restored gas and feculent passage. There are few cases of high sigmoidoaginal fistulas described in the medical literature. The treatment in such patients is still unclear and subject to discussion. With the advancement of minimally invasive techniques in medicine, the laparoscopic surgical approach is a suitable option for treatment, but long-term follow-up and in-depth analyses are necessary.