title: Colovaginal fistulas. Etiology and management.
abstract: OBJECTIVE
  To review the diagnosis and treatment of colovaginal fistulas from various causes.
  
  
  METHODS
  Papers on colovaginal fistulas were identified using Ovid and PubMed. The search terms used were as follows: colovaginal fistulas, rectovaginal fistulas, diverticular disease and fistulas.
  
  
  METHODS
  Articles were selected based on their relevance to colovaginal fistulas and were then further subdivided into epidemiology, etiology, presentation, diagnosis and management.
  
  
  RESULTS
  English-language papers were selected based on their relevance to all aspects of colovaginal fistulas.
  
  
  CONCLUSIONS
  Optimizing nutrition is paramount prior to surgery. Medical management rarely corrects the problem. Diverticular colovaginal fistulas arise in patients who have previously undergone a hysterectomy. Radiation-related fistulas often involve the distal sigmoid colon and rectum, and recurrent cancer must be ruled out. Often symptoms are associated with radiation cystitis and terminal ileitis. When indicated, restoration of intestinal continuity is preferred. Malignant fistulas carry a poor prognosis, and when surgical removal is not practical, they are treated palliatively with fecal diversion or an endoluminal stent. Those arising from inflammatory bowel disease most frequently arise due to Crohn's disease, and extirpation of diseased bowel and associated abscess will successfully treat the condition. Fistulas arising from ulcerative colitis can be malignant. There remains a small role for colostomy as a nondefinitive procedure to alleviate symptoms. Colovaginal fistulas require a multidisciplinary approach and focused diagnostics, successful treatment can dramatically improve the patient's quality of life.
authors.affiliation: Section of Colon and Rectal Surgery, Department of Surgery, Saint Louis University Health Sciences Center, St. Louis, Missouri, USA.
authors.forename: Anil M
authors.initials: AM
authors.lastname: Bahadursingh
authors.forename: Walter E
authors.initials: WE
authors.lastname: Longo
mesh_terms: D003108:Colonic Diseases / Q000209:etiology* / Q000628:therapy*; D003424:Crohn Disease / Q000150:complications; D004239:Diverticulitis, Colonic / Q000150:complications; D004241:Diverticulum, Colon / Q000150:complications; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007412:Intestinal Fistula / Q000209:etiology* / Q000628:therapy*; D011788:Quality of Life; D012006:Rectovaginal Fistula / Q000209:etiology / Q000628:therapy; D012810:Sigmoid Diseases / Q000209:etiology / Q000628:therapy; D001747:Urinary Bladder Fistula / Q000209:etiology / Q000628:therapy; D014624:Vaginal Fistula / Q000209:etiology* / Q000628:therapy*