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Long-Term Complication: Colovaginal Fistula Nine Years after Laparoscopic Sacrocolpopexy
Su Wang1, Yuna Gao2, Liquan Chen1
1Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China. (Drs. Wang, Chen, Xu, and Zhang).
Background:
Colovaginal fistula (CVF) is a rare, late complication of laparoscopic sacrocolpopexy that significantly impairs quality of life. We report a case occurring 9 years postoperatively to highlight its presentation and management.
Case:
A G3P3 woman in her seventies presented with yellow, foul-smelling vaginal discharge 9 years after laparoscopic total hysterectomy with sacrocolpopexy. Colonoscopy revealed a rectovaginal fistula; histology excluded diverticular disease. A multidisciplinary team performed laparoscopic removal of the eroded mesh and sigmoid resection with primary anastomosis. At 1-year follow-up the vagina was completely healed and the patient reported no further abnormal discharge.
Conclusion:
CVF may arise almost a decade after sacrocolpopexy. A high index of suspicion, prompt multidisciplinary surgery and long-term surveillance are essential for optimal outcomes.
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