Chen Heidi Wen-Chu, Guess Marsha K, Connell Kathleen A, Bercik Richard S
Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
J Reprod Med. 2009 Oct;54(10):645-8.
Synthetic meshes have been used extensively to augment surgical management of pelvic organ prolapses. Posterior intravaginal sling (IVS) is a technique used for correcting vaginal vault/apical prolapse, posterior vaginal prolapse or rectocele. There are limited data on long-term safety of this procedure. In a subanalysis of the IVS tapes from the SUSPEND trial performed secondary to the large number of patients with complications of suburethral sling erosions after IVS, it was noted that the sling erosion tended to have a delayed presentation secondary to poor incorporation of the mesh.
A 48-year-old woman with cystocele, uterine prolapse and rectocele had undergone total vaginal hysterectomy, mesh-augmented anterior repair, posterior colporrhaphy and posterior intravaginal slingplasty (IVS) in July 2005. Thirty months after the surgery, she presented with gradual symptoms of copious vaginal discharge for several weeks followed by constant right buttock pain and swelling. Examination was notable for intact mesh with no signs of erosion and a 3-cm induration deep within the right buttock. Computed tomography suggested a pelvic abscess. Magnetic resonance imaging confirmed a right ischiorectal fossa abscess and a vaginal fistula. The patient underwent sling excision, right ischiorectal fossa exploration and vaginal fistula repair. A fistulous tract was found to extend along the intact sling from the vaginal epithelium toward the right ischiorectal fossa. At 2 months' followup, there were no recurrences or other complications.
This is the first report of a delayed complication of an ischiorectal abscess associated with an ischiorectal-vaginal fistula that presented 30 months after the placement of a posterior IVS.
合成网片已广泛用于加强盆腔器官脱垂的手术治疗。阴道后吊带术（IVS）是一种用于矫正阴道穹窿/顶端脱垂、阴道后壁脱垂或直肠膨出的技术。关于该手术长期安全性的数据有限。在对SUSPEND试验中IVS吊带进行的一项亚分析中，由于大量患者在IVS后出现尿道下吊带侵蚀并发症，发现吊带侵蚀往往因网片整合不良而延迟出现。
一名48岁女性，患有膀胱膨出、子宫脱垂和直肠膨出，于2005年7月接受了全阴道子宫切除术、网片加强前壁修补术、阴道后壁修补术和阴道后吊带成形术（IVS）。手术后30个月，她出现了数周逐渐加重的大量阴道分泌物症状，随后持续出现右臀部疼痛和肿胀。检查发现网片完整，无侵蚀迹象，右臀部深处有3厘米硬结。计算机断层扫描提示盆腔脓肿。磁共振成像证实右坐骨直肠窝脓肿和阴道瘘。患者接受了吊带切除术、右坐骨直肠窝探查术和阴道瘘修补术。发现一条瘘管沿完整的吊带从阴道上皮向右侧坐骨直肠窝延伸。在2个月的随访中，无复发或其他并发症。
这是第一例关于放置后IVS 30个月后出现与坐骨直肠-阴道瘘相关的坐骨直肠脓肿延迟并发症的报告。
