title: Delayed Coloanal Anastomosis for rectovaginal fistula after colorectal resection for deep endometriosis.
abstract: OBJECTIVE
  The deep infiltrating endometriosis, defined as a subperitoneal infiltration of endometrial implants of ≥ 5 mm involving not only the colorectal tract but also rectovaginal septum, vagina and bladder often requires a challenging surgery. Endometriosis nodes of the rectovaginal septum, if symptomatic, need a resection of the involved colorectal tract with colorectal or coloanal anastomosis. Unfortunately in these cases is not uncommon the possibility of a postoperative rectovaginal fistula (RVF), caused by the weakness of the septum that must be skeletonized to completely remove the endometriosis nodes. Here we present a case of anastomotic leakage with high RVF after colorectal resection and low colorectal anastomosis for deep endometriosis in which, for a chronic pelvic sepsis and a high risk of failure of a new immediate coloanal anastomosis, a Turnbull-Cutait pull-through with delayed coloanal anastomosis (DCAA) has been performed.
  
  
  METHODS
  A now 34 years old woman was admitted to our Clinic because of a RVF due to recto-sigmoid resection with colorectal anastomosis for endometriosis. An evaluation in anesthesia confirmed the RVF. In this case we avoided an immediate new colorectal anastomosis for the high risk of a recurrent anastomotic leakage and performed a DCAA.
  
  
  RESULTS
  The outcome of the two-steps operation has been satisfactory both for the healing of the RVF and for the functional results bringing the young patient to a completely restored social, sexual and working life.
  
  
  CONCLUSIONS
  In our opinion Turnbull-Cutait pull-through with delayed coloanal anastomosis is a good choice in patients with RVF in which a new colorectal or coloanal anastomosis can bring to a recurrent leakage.
  
  
  BACKGROUND
  Delayed coloanal anastomosis, Deep endometriosis, Rectovaginal fistula.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Gallo
authors.forename: Alberto Realis
authors.initials: AR
authors.lastname: Luc
authors.forename: Roberta
authors.initials: R
authors.lastname: Tutino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Clerico
authors.forename: Mario
authors.initials: M
authors.lastname: Trompetto
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery; D001803:Blood Transfusion; D003108:Colonic Diseases / Q000601:surgery*; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy; D034161:Pelvic Infection / Q000209:etiology; D010996:Pleural Effusion / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery / Q000628:therapy; D012002:Rectal Diseases / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D012810:Sigmoid Diseases / Q000601:surgery; D013997:Time Factors