PMC5655408_01
Rectovaginal fistula was diagnosed by computed tomography (A) and contrast enema (B). The triangles show the vagina, and the arrow shows rectovaginal fistula.
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Computed tomography showed air and coagulate in the vagina and no air in the peritoneal cavity (Fig. 1A). Enema using amidotrizoate sodium meglumine confirmed RVF formation (Fig. 1B).
Colonoscopy images, showing rectovaginal fistula on the 12th (A) and 20th (B) postoperative days. It was closed on the 50th postoperative day (C). The arrows show the fistula (A, B) or its scar (C).
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The diameter of the fistula was over 1 cm, and a thin scope (10.2 mm in diameter) could pass through it (Fig. 2A). Oral intake was restarted on the 20th postoperative day after we confirmed by colonoscopy that the RVF decreased in size (Fig. 2B). Colonoscopy on the 50th postoperative day showed that the RVF was closed (Fig. 2C).
Operative video still frames, suggesting the linear stapler might have included the vaginal wall. The red line is the border between the rectum and vagina, while the yellow line is the suspected line that the blade of the circular stapler might have punched.
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Retrospective inspection of our operative video revealed that the linear stapler might have slightly included the vaginal wall (Fig. 3).