title: Transvaginal repair and graft interposition for rectovaginal fistula due to a neglected pessary: case report and review of the literature.
abstract: BACKGROUND
  : There are few reported cases of rectovaginal fistula due to a neglected pessary, with few data to guide management.
  
  
  METHODS
  : An 83-year-old lady presented with an impacted Gellhorn pessary 5 years after insertion. Upon removal of the pessary in the operating room, a 4-cm high rectovaginal fistula was discovered. An immediate transvaginal layered repair was performed with porcine dermal graft interposition and partial obliteration of the posterior vagina. At 8 months' follow-up, the patient remained asymptomatic with normal bowel function.
  
  
  CONCLUSIONS
  : A large, high rectovaginal fistula due to a neglected pessary can be repaired vaginally with the use of a graft and partial obliteration of the posterior vagina to provide additional layers of closure, without the need for colostomy. The literature is reviewed, focusing on the management of pessary-related rectovaginal fistula and the role of graft augmentation.
authors.affiliation: From the Department of Obstetrics and Gynecology, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Yong
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Garrey
authors.forename: Roxana
authors.initials: R
authors.lastname: Geoffrion