PMC5301109_01
Contrast enema fistula findings. The contrast enema demonstrated a rectovaginal fistula (yellow arrowhead) and a vesicovaginal fistula (red arrowhead). The remnant vagina was also shown (black arrowhead).
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F1
Contrast media reached the residual vagina and bladder from the colorectal anastomosis site, which suggested that RVF and VVF were simultaneously present (Fig. 1).
Preoperative urological evaluation. a The black arrowhead shows a vesicovaginal fistula. b Retrograde cystography revealed that the vesicovaginal fistula (yellow arrowhead) was near the internal urethral orifice. A urethral catheter (black arrowhead) and a forceps point to the internal urethral orifice and the remnant vagina, respectively.
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F2
Cystoscopy and retrograde cystography revealed that the VVF was located at the trigone of the bladder (Fig. 2).
Operative findings. a The bladder was incised sagittally from the dome, and a vesicovaginal fistula was detected (yellow arrowhead). b A rectovaginal fistula was detected in the vagina (yellow arrowhead). c An omental flap (yellow arrowhead) covered the bladder, vagina, and anastomosis of the rectum.
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F3
Laparotomy was performed, and a sagittal incision was made from the dome of the bladder down to the fistulous tract, which was near the trigone of the bladder (Fig. 3a). Subsequently, the fistulous tract of the RVF was completely excised via a vaginal approach (Fig. 3b). Finally, the omental flap was made by cutting the omentum from the right, interposing it between the vagina and bladder, and placing it over the repaired RVF to prevent leakage and recurrence of the fistula (Fig. 3c).