PMC7530198_01
Rectovaginal fistula. Enema demonstrates anastomotic leakage (white arrowhead) at the anastomotic site (black arrow) (a), with leakage later seen from the vagina (b: black arrowhead). A vaginal examination shows a 3-mm fistula (c).
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Enema using amidotrizoic acid confirmed the formation of RVF (Fig. 1a, b). An examination of the vagina confirmed a 3-mm fistula at the posterior right wall of the upper vagina (Fig. 1c).
Colonoscopy during treatment. Rectovaginal formation at the anterior right wall of the anastomotic ring (a). A polyglycolic acid sheet was inserted to the fistula, and fibrin glue was applied on post-operative date (POD) 18 (b). The fistula remained on POD26 (c). The removal of the old polyglycolic acid sheet, coagulation of the unhealthy granulation tissue (d), insertion of a fresh polyglycolic acid sheet and re-application of fibrin glue were performed on POD35 (e). The fistula shows ulceration on POD42 (f). Colonoscopy shows the collapse of the sutures at the rectal side and reveals small fistula on POD54 (POD7 after re-operation) (g). RVF was cured on POD90 (POD49 after re-operation) (h).
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Colonoscopy revealed RVF formation at the anterior right wall of the anastomotic ring (Fig. 2a). A PGA sheet was inserted into the fistula via colonoscopy, and fibrin glue was applied to close the RVF (Fig. 2b). However, colonoscopy showed that the fistula remained on POD26 (Fig. 2c). Therefore, the old PGA sheet was removed, and a fresh PGA sheet was inserted with the application of fibrin glue after the unhealthy granulation tissue was coagulated on POD35 (Fig. 2d, e). The fistula at the rectal side showed ulceration and still remained on POD42 (Fig. 2f). Although colonoscopy showed the collapse of the sutures at the rectal side and revealed a small fistula on original POD54 (re-operation POD7) (Fig. 2g), an examination from the vagina seemed to show a cured fistula. Colonoscopy on original POD90 (re-operation POD49) showed that the RVF was completely closed (Fig. 2h).
The summary of the clinical course. FXIII: freeze-dried coagulation factor XIII, TPN: total parenteral nutrition, PGA: polyglycolic acid, RVF: rectovaginal fistula, POD: postoperative date.
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The clinical course is summarized in Fig. 3.