title: Tandem vaginoscopy with colonoscopy: a diagnostic technique for the assessment of colovaginal fistula.
abstract: OBJECTIVE
  Colovaginal fistula (CVF) has a negative impact on quality of life. Identifying the fistula track is a critical step in its management. In a subset of patients, localizing the fistula preoperatively can be difficult. The purpose of this report is to describe the technique and results of tandem vaginoscopy with colonoscopy (TVC).
  
  
  METHODS
  A retrospective analysis was conducted of all patients referred to a tertiary centre with symptoms suggestive of CVF but no prior successful localization of a fistula. TVC was performed by one colorectal surgeon in the endoscopy suite under intravenous sedation.
  
  
  RESULTS
  Between 2003 and 2013, 18 patients (median age 58 years) underwent TVC. CVF was ruled out in three patients. In the remaining 15 patients, TVC documented the fistula in 13. In eight cases a wire was passed through the fistulous track from the vagina to the colon, in three the track was large enough to be traversed with the endoscope and in two a fistulous opening was noted on the vaginal side but passage of a wire to localize the opening on the colonic side was not possible due to extensive scarring. No TVC-related complications were recorded. The sensitivity, specificity, positive predictive value and negative predictive value for TVC in detecting CVF were 86.7%, 100%, 100% and 60%, respectively.
  
  
  CONCLUSIONS
  TVC is a useful technique that can localize the fistulous track in most patients with CVF.
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors.forename: A A
authors.initials: AA
authors.lastname: Alkhatib
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors.forename: G A
authors.initials: GA
authors.lastname: Santoro
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Ohio, Cleveland, Ohio, USA.
authors.forename: E
authors.initials: E
authors.lastname: Gorgun
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.|Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Ohio, Cleveland, Ohio, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Abbas
mesh_terms: D003106:Colon / Q000601:surgery; D003108:Colonic Diseases / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods*; D003127:Colposcopy / Q000379:methods*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014621:Vagina / Q000601:surgery; D014624:Vaginal Fistula / Q000175:diagnosis*
keywords: Tandem vaginoscopy with colonoscopy; colon; colovaginal fistula; diagnosis; fistula; vagina