Rectovaginal fistula after STARR procedure complicated by haematoma of the posterior vaginal wall: report of a case.
We report the case of a patient treated with the stapled transanal rectal resection (STARR) procedure for obstructed defecation, who developed an early postoperative haematoma of the posterior vaginal wall and, after 30 days, a rectovaginal fistula (RVF), even though the intervention had been performed according to the standardized technique. After clinical examination and three-dimensional anal endosonography, we carried out a successful surgical correction with double vaginal and rectal flaps with repair of the rectovaginal septum and without faecal diversion. The STARR procedure, even if performed according to a rigorous application of the methodological standards, may be followed by a RVF possibly due to a blood collection leading to ischaemia of the vaginal wall.
Bassi
R
R
Coloproctology Unit, Division of General Surgery Ospedale Maggiore, Crema (CR), Italy. roberto.bassi@libero.it
Rademacher
J
J
Savoia
A
A
D005260:Female; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013524:Surgical Flaps; D017792:Surgical Stapling / Q000009:adverse effects*; D014623:Vaginal Diseases / Q000209:etiology*