title: Perforation of the neovagina in a male-to-female transsexual: a case report.
abstract: BACKGROUND
  There are several techniques for creation of a neovagina in male-to-female reassignment surgery. Although vaginoplasty with the sigmoid colon is not a common procedure, it is becoming more common. Perforation of the recto-sigmoid neovagina after sex reassignment surgery is very rare. We hereby report a case of perforation of the neovagina that presented as acute peritonitis, with a massive abscess in the intra-abdominal cavity.
  
  
  METHODS
  This case report describes a 33-year-old Asian woman presenting with mild persistent abdominal pain, nausea, and vomiting who had undergone male-to-female sex reassignment surgery four years prior. Physical examination revealed mild abdominal pain without rebound tenderness. An abdominal computed tomography scan showed a massive abscess that occupied a significant portion of the intra-abdominal cavity. Perforation of the neovagina was confirmed by exploratory laparotomy and surgical drainage with primary closure was performed without any complications.
  
  
  CONCLUSIONS
  This is a rare case involving perforation of the neovagina that was successfully treated with surgical intervention. This case emphasizes the importance of taking a detailed medical history and to make physicians and patients aware that bowel vaginoplasty can result in a weak vagina.
authors.affiliation: Division of Gastroenterology, St, Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan. yutshi@luke.ac.jp.
authors.forename: Yuto
authors.initials: Y
authors.lastname: Shimamura
authors.forename: Aoi
authors.initials: A
authors.lastname: Fujikawa
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishii
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujita
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Ohta
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D004322:Drainage; D005260:Female; D006801:Humans; D007813:Laparotomy; D010538:Peritonitis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D019651:Plastic Surgery Procedures; D057830:Gender-Affirming Surgery / Q000009:adverse effects; D013997:Time Factors; D063106:Transgender Persons; D016896:Treatment Outcome; D014621:Vagina / Q000473:pathology; D014623:Vaginal Diseases / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D014839:Vomiting / Q000209:etiology*; D008297:Male