Nicorandil-induced rectovaginal fistula

Area of Science:

• Gastroenterology
• Gynecology
• Pharmacology

Background:

• Rectovaginal fistulas are abnormal connections between the rectum and vagina, often resulting from childbirth, inflammatory bowel disease, or malignancy.
• The etiology of rectovaginal fistulas can be complex, and in some cases, no clear cause is identified.
• Nicorandil is a medication used for angina, known to cause gastrointestinal ulcerations.

Observation:

• An 82-year-old female presented with symptoms of feculent vaginal discharge and vaginal bleeding.
• Diagnostic investigations confirmed the presence of a rectovaginal fistula.
• No other apparent cause for the fistula was identified.

Findings:

• The patient's medical history included the use of nicorandil.
• Based on prior experience with nicorandil-induced gastrointestinal ulcerations, the medication was discontinued.
• The rectovaginal fistula demonstrated complete healing over a six-month period following nicorandil cessation.

Implications:

• This case highlights a potential, albeit rare, adverse effect of nicorandil, extending beyond gastrointestinal complications to gynecological fistulas.
• Discontinuation of nicorandil may be a crucial therapeutic step in managing similar fistula cases.
• Further research is warranted to elucidate the mechanism of nicorandil-induced fistula formation and its prevalence.