Colovaginal Fistulas: Presentation, Evaluation, and Management

Area of Science:

• Gastroenterology
• Gynecology
• Colorectal Surgery

Background:

• Colovaginal fistulas are rare but complex conditions.
• Diagnosis and management can be challenging, often requiring a multidisciplinary approach.

Purpose of the Study:

• To review a single institution's experience with colovaginal fistulas.
• To provide guidance for the identification and management of these fistulas.

Main Methods:

• Retrospective chart review of 19 patients treated between 1990 and 2011.
• Analysis of presenting characteristics, evaluation methods, and treatment outcomes.

Main Results:

• The most common etiology was diverticulitis (79%).
• Key symptoms included stool per vagina (89%) and flatus per vagina (37%).
• Sigmoid resection with primary anastomosis achieved symptom resolution in 84% of patients.

Conclusions:

• A triad of symptoms (vaginal discharge/odor, previous hysterectomy, diverticulitis history) should raise suspicion.
• Diagnosis can be aided by speculum examination and contrast enema.
• Rectosigmoid resection and primary reanastomosis are effective, recommending multidisciplinary management.