An unusual complication of the use of stapler after Hartmann's procedure

Circular anastomotic staplers have been used in colorectal surgery for several years with low complication rates. We report here an extremely rare case of direct colovaginal anastomosis and rectovaginal fistula occurred by using a 31 end-to-end anastomosis stapler after reversal of Hartmann's Procedure.

A 33-year-old woman with complaint of rectal bleeding had undergone low anterior resection and end colostomy for rectal adenocarcinoma in 1995. In spite of making recommendation for colostomy closure, she had postponed the operation until 2003 due to afraid of incontinence. After reversal of Hartmann's procedure achieved by using circular stapler and diverting ileostomy, she developed complaints of vaginal gas and minimal vaginal fecal discharge.

Endoscopic examination and imaging methods revealed a rectovaginal fistula with a blind Hartmann's pouch. After a certain verification of complexity of the case, a reoperation which comprises true intestinal anastomosis and repair of fistula was performed. Postoperative period was uneventful except an incisional infection, and ileostomy was closed subsequently.

A rectovaginal fistula, though encountered rarely, must be taken into account in cases with suspicious complaints after using circular stapler for pelvic intestinal anastomosis. Careful placement of stapler in accurate direction has a great importance to avoid stapling related complications.