PMC3016021_01
PMC3016021_02
Barium enema demonstrates colovaginal fistula.
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F1
The preprocedural barium enema was reviewed to assess the location of the fistula, the length and diameter of the stricture, and the anatomic course of the colon including angulation and redundancy (Figure 1).
Transvaginal view of fistula.
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F2
Once intravenous sedation was adequate, the vagina was intubated and the endoscope was advanced to its apex, the usual location of the fistula (Figure 2).
A: Fluoroscopic view of vaginal wire. The endoscope has been reinserted transanally. B: Endoscopic view of colorectal stricture. C: Transanal placement of second guidewire. Intersection point delineates exact fistula location.
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F3
Once the vaginal wire crossed the fistula, it was advanced into the colonic lumen proximal to the area of the stricture and fistula (Figure 3A). The endoscope was withdrawn out of the vagina keeping the vaginal wire in place, and it was reinserted transanally and advanced to the area of the stricture (Figure 3B). The intersection ("kissing") of both colonic and vaginal wires pinpointed the exact location of the colovaginal fistula (Figure 3C).
Endoscopic and fluoroscopic guidance of stent delivery device over colonic guidewire.
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F4
The delivery device of a 16 French covered Ultraflex stent (12 cm long, 18 mm x 23 mm diameter) (Boston Scientific Corporation, Natick, Maryland) was advanced over the colonic wire under fluoroscopic and endoscopic guidance after reintroducing the endoscope transanally (Figure 4).
Immediate endoscopic view of stented lumen.
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F5
The delivery device and colonic wire were then retrieved, and the stented lumen was visualized endoscopically (Figure 5).