Enterocervical Fistula Six Weeks After Laparoscopic Mesh Sacral Colposuspension: A Case Report

Laparoscopic colposuspension with mesh is a common procedure performed to treat apical pelvic organ prolapse refractory to non-surgical interventions. Mesh complications involving a fistula are an uncommon event that typically occurs months or years later. We report a case complicated by enterocervical fistula that occurred six weeks after mesh placement. This was the case of a 67-year-old female with no surgical history who underwent a laparoscopic supracervical hysterectomy, bilateral salpingo-oopherectomy, laparoscopic colposuspension with mesh, and midurethral sling for treatment of stage II anterior and apical pelvic organ prolapse and stress urinary incontinence. She presented to the clinic for her six-week postoperative appointment complaining of vaginal discharge. Physical examination findings were significant for abnormal tissue protruding from the cervix. Examination under anesthesia revealed necrotic tissue within the cervical os. Subsequent laparoscopy revealed an enterocervical fistula resulting from small bowel adhering to the colposuspension mesh. This required cervical debridement, lysis of adhesions, partial mesh excision, and small bowel resection with primary anastomosis. We concluded that although rare, small bowel adhering to mesh can fistulize rapidly, and in this case presented as necrotic cervical tissue. While re-peritonealization has shown no significant difference in small bowel complication rates, the formation of a subacute fistula, in this case, highlights a rare complication. Treatment in the case involved an individualized approach weighing the risk of infection and the need for subsequent operation in leaving the remaining mesh versus the risk of bladder injury, hematoma, and vaginotomy in removing the entirety of the mesh.