title: Simultaneously Diagnosed and Successfully Treated Rectovaginal and Vesicovaginal Fistulae after Low Anterior Resection with Concomitant Resection of Female Genitalia.
abstract: Rectovaginal fistula (RVF) and vesicovaginal fistula (VVF) are infrequent but distressing complications after pelvic surgery. However, their adequate treatment is not well described. Here, we simultaneously encountered and successfully treated RVF and VVF after radical surgery for rectal cancer. A 70-year-old woman underwent low anterior resection (LAR) combined with resection of the uterus, the bilateral adnexa, and the upper side of the vagina, as well as diverted ileostomy for rectal cancer. A month after the surgery, she developed urinary incontinence and underwent medical treatment, but her symptoms did not improve. Evaluation with contrast enema before stoma closure revealed the presence of RVF and VVF. We repaired the VVF and RVF via transabdominal and transperineal approaches. After 6 months, ileostomy was closed and the patient had no recurrence of cancer and fistula. In LAR with hysterectomy and resection of the vaginal wall, there is a risk of RVF and VVF. The excision and closure of the fistula tract and omental flap can be effective to treat both fistulae.
authors.affiliation: Department of Surgery, Saitama City Hospital, Saitama City, Japan.
authors.forename: Chisato
authors.initials: C
authors.lastname: Takagi
authors.affiliation: Department of Surgery, Saitama City Hospital, Saitama City, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.affiliation: Department of Surgery, Saitama City Hospital, Saitama City, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamafuji
authors.affiliation: Department of Surgery, Saitama City Hospital, Saitama City, Japan.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Asami
authors.affiliation: Department of Surgery, Saitama City Hospital, Saitama City, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Takeshima
authors.affiliation: Department of Surgery, Saitama City Hospital, Saitama City, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Okamoto
authors.affiliation: Department of Surgery, Saitama City Hospital, Saitama City, Japan.
authors.forename: Hidena
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Surgery, Saitama City Hospital, Saitama City, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kubochi
keywords: Omental flap; Rectal cancer; Rectovaginal fistula; Vesicovaginal fistula