Download PDF
Open Access
CC BY 4.0 · Endoscopy 2024; 56(S 01): E580-E581
DOI: 10.1055/a-2344-8608
E-Videos

Endoscopic management of long-standing rectovaginal fistula caused by foreign bodies

Authors

  • Li Wang‡

    1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China (Ringgold ID: RIN92323)
    2   Endoscopy Center, Shanghai Geriatric Medical Center, Shanghai, China
    3   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China

  • Zu-Qiang Liu‡

    1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China (Ringgold ID: RIN92323)
    3   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China

  • Pei-Rong Xu

    1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China (Ringgold ID: RIN92323)
    3   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China

  • Lu Yao

    1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China (Ringgold ID: RIN92323)
    3   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China

  • Hao Hu

    1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China (Ringgold ID: RIN92323)
    3   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China

  • Quan-Lin Li

    1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China (Ringgold ID: RIN92323)
    3   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China

  • Ping-Hong Zhou

    1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China (Ringgold ID: RIN92323)
    3   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China

Supported by: Shanghai Rising Stars of Medical Talent Youth Development Program 20224Z0005
Supported by: Ministry of Science and Technology of the Peopleʼs Republic of China > National Natural Science Foundation of China 82170555,82300614,82370546
Further Information
Also available at
 
 PDF Download Permissions and Reprints

A 32-year-old woman was admitted, presenting with a 30-year history of rectovaginal fistula (RVF). At the age of 1 year, the patient inadvertently ingested a paperclip, resulting in fecal discharge from the vagina, and no intervention was implemented.

Colonoscopy revealed a 0.8-cm fistula above the dentate line on the anterior rectal wall ([Fig. 1Fig. 1] a). Transanal endoscopic closure was proposed after a multidisciplinary evaluation ([Video 1Video 1]).

Zoom
Fig. 1 Fig. 1 Endoscopic management of rectovaginal fistula. a Colonoscopy revealed a 0.8-cm fistula (arrowhead) above the dentate line on the anterior rectal wall. b, c A bougie inserted through the rectal fistula opening was exposed within the vagina. d The mucosal epithelium and scar tissue within the fistula orifice and sinus tract were destroyed with argon ion coagulation. e, f After confirming no bleeding, purse-string suturing was used to close the rectal fistula.
Download
A long medical history of rectovaginal fistula caused by swallowing a foreign body was successfully treated with endoscopic purse-string suturing.Video 1Video 1

Upon bimanual examination, a cord-like structure extending from the anterior wall of the rectum to the posterior wall of the vagina was palpable. A bougie inserted through the rectal fistula opening was exposed within the vagina ([Fig. 1Fig. 1] b, c). Argon ion coagulation was used to destroy the mucosal epithelium and scar tissue within the fistula orifice and sinus tract ([Fig. 1Fig. 1] d). After confirming no bleeding, purse-string suturing was used to close the rectal fistula ([Fig. 1Fig. 1] e, f). The procedure duration was 30 minutes.

The patient recovered uneventfully and was discharged on postoperative day 2. The patient did not experience any discomfort during the 2-year postoperative follow-up.

The main causes of RVF are obstetric trauma, chronic inflammatory bowel disease, pelvic floor or rectal surgery, trauma, or radiation therapy, and swallowed foreign bodies are a rare cause [11]. Although various medical and surgical (including transanal, transvaginal, and transperineal) methods have been used to manage RVFs, the treatment remains a challenge due to its tendency to recur. Innovative transanal endoscopic surgery has been proposed for the treatment of RVF, but endoscopic purse-string suturing has not previously been reported for the treatment of RVF [22]. Here, we present the first report of a case of a long medical history of RVF caused by swallowing a foreign body, which was successfully treated with endoscopic purse-string suturing. This report provides an innovative, minimally invasive treatment approach for patients with RVF.

Endoscopy_UCTN_Code_TTT_1AQ_2AB

Endoscopy E-Videos https://eref.thieme.de/e-videos

E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).

This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.


 

Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Ping-Hong Zhou, MD
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University
180 Fenglin Road
Shanghai 200032
China   

Publication History

Article published online:
03 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany


  Permissions and Reprints
Zoom
Fig. 1 Fig. 1 Endoscopic management of rectovaginal fistula. a Colonoscopy revealed a 0.8-cm fistula (arrowhead) above the dentate line on the anterior rectal wall. b, c A bougie inserted through the rectal fistula opening was exposed within the vagina. d The mucosal epithelium and scar tissue within the fistula orifice and sinus tract were destroyed with argon ion coagulation. e, f After confirming no bleeding, purse-string suturing was used to close the rectal fistula.