Abstract
The most feared complication of anterior and low anterior resection is anastomotic dehiscence. Although most leakages remain clinically silent, some may lead to formation of a colovaginal fistula. At the Lahey Clinic Medical Center, the records of nine patients with colovaginal fistula as a complication of colorectal surgery were reviewed to determine clinical characteristics and optimal management. The mean age was 63.7 years (range, 47–72 years). The initial indications for surgery were carcinoma of the rectum (n=4), diverticular disease (n=3), and closure of the colostomy after Hartmann's procedure (n=2). Hysterectomy had been performed earlier in seven patients (78 percent). The end-to-end anastomosis (EEA ®)stapling device was used in five patients, and four patients had a handsewn anastomosis. The fistula developed within 23 days after surgery and usually originated within 8 cm of the anal verge. Two patients underwent immediate diverting transverse colostomy. None of the seven patients who were initially managed medically had spontaneous closure of the fistula. High fistulas were successfully treated by colorectal resection in two patients, whereas low fistulas healed after transanal repair without colostomy in two patients. These results suggest that previous hysterectomy predisposes to development of a colovaginal fistula after colorectal surgery. Not all patients require fecal diversion. Colorectal resection for high fistulas and transanal repair for low fistulas appear to be viable options for treatment.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Mileski WJ, Joehl RJ, Rege RV, Nahrwold DL. Treatment of anastomotic leakage following low anterior colon resection. Arch Surg 1988;123:968–71.
Rothenberger DA, Goldberg SM. The management of rectovaginal fistulae. Surg Clin North Am 1983;63:61–79.
Lescher TC, Pratt JH. Vaginal repair of the simple rectovaginal fistula. Surg Gynecol Obstet 1967;124:1317–21.
Hudson CN, Chir M. Acquired fistulae between the intestine and the vagina. Ann R Coll Surg Engl 1970;46:20–40.
Heald RJ, Chir M, Leicester RJ. The low stapled anastomosis. Dis Colon Rectum 1981;24:437–44.
Smith LE. Anastomosis with EEA stapler after anterior colonic resection. Dis Colon Rectum 1981;24:236–42.
Leff EI, Hoexter B, Labow SB, Eisenstat TE, Rubin RJ, Salvati EP. The EEA stapler in low colorectal anastomoses: initial experience. Dis Colon Rectum 1982;25:704–7.
Antonsen HK, Kronborg O. Early complications after low anterior resection for rectal cancer using the EEA™ stapling device: a prospective trial. Dis Colon Rectum 1987;30:579–83.
Varma JS, Chan AC, Li MK, Li AK. Low anterior resection of the rectum using a double stapling technique. Br J Surg 1990;77:880–90.
Goligher JC, Graham NG, de Dombal FT. Anastomotic dehiscence after anterior resection of rectum and sigmoid. Br J Surg 1970;57:109–18.
Mohiuddin M, Derdel J, Marks G, Kramer S. Results of adjuvant radiation therapy in cancer of the rectum: Thomas Jefferson University Hospital experience. Cancer 1985;55:350–3.
Rider WD, Palmer JA, Mahoney LJ, Robertson CT. Preoperative irradiation in operable cancer of the rectum: report of the Toronto trial. Can J Surg 1977;20:335–8.
MRC Working Party. A trial of preoperative radiotherapy in the management of operable rectal cancer. Br J Surg 1982;69:513–9.
Mattingly RF. Anal incontinence and rectovaginal fistulas. In: Mattingly RF, Thompson JD, eds. Te Linde's operative gynecology. 6th ed. Philadelphia: JB Lippincott, 1985:669–86.
Eden TW. A case of superior recto-vaginal fistula dealt with by the abdominal route after preliminary colostomy. J Obstet Gynaecol Br Commonw 1914;26:175–85.
Bentley RJ. Abdominal repair of high rectovaginal fistula. J Obstet Gynaecol Br Commonw 1973;80:364–7.
Goligher JC. Irradiation, proctitis, and enteritis. In: Surgery of the anus, rectum and colon. 5th ed. London: Ballière Tindall, 1984:1047–57.
Parks AG, Allen CL, Frank JD, McPartlin JF. A method of treating post-irradiation rectovaginal fistulas. Br J Surg 1978;65:417–21.
Drake DB, Pemberton JH, Beart RW Jr, Dozois RR, Wolff BG. Coloanal anastomosis in the management of benign and malignant rectal disease. Ann Surg 1987;206:600–5.
Bauer JJ, Sher ME, Jaffin H, Present D, Gelerent I. Transvaginal approach for repair of rectovaginal fistulae complicating Crohn's disease. Ann Surg 1991;213:151–8.
Hoexter B, Labow SB, Moseson MD. Transanal rectovaginal fistula repair. Dis Colon Rectum 1985;28:572–5.
Russell TR, Gallagher DM. Low rectovaginal fistulas: approach and treatment. Am J Surg 1977;134:13–8.
Author information
Authors and Affiliations
Additional information
Read at the meeting of the New England Society of Colon and Rectal Surgeons, Newport, Rhode Island, April 5 to 7, 1991.
About this article
Cite this article
Fleshner, P.R., Schoetz, D.J., Roberts, P.L. et al. Anastomotic-vaginal fistula after colorectal surgery. Dis Colon Rectum 35, 938–943 (1992). https://doi.org/10.1007/BF02253495
Issue Date:
DOI: https://doi.org/10.1007/BF02253495