van der Sluis W B, Bouman M, Meijerink Wjhj, Neefjes-Borst E A, van Bodegraven A A
Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands.
Frontline Gastroenterol. 2016 Jul;7(3):227-230. doi: 10.1136/flgastro-2015-100602. Epub 2015 Jun 4.
Colonic segments are being used as pedicled grafts in neovaginoplasty, a surgical procedure to (re)construct a (neo)vagina. A disadvantage of using colonic grafts is the potential occurrence of neovaginal complications due to diversion from the faecal stream. Here, we report a case of severe, refractory diversion colitis of the sigmoid neovagina, so-called 'diversion neovaginitis', in a 42-year-old woman with complete androgen insensitivity syndrome. Neovaginal biopsy specimens showed colonic-type mucosa with strong increase of lymphoplasmacellular infiltrate in the lamina propria, ulceration with fibrinoid deposition and some crypt irregularity. Endoscopy showed erythematous mucosa, superficial ulceration, mucus discharge and multiple pseudopolyp-like lesions. Local application of mesalazine foam enemas and sodium butyrate enemas initially gave symptom relief. However, this was a temporary effect, ultimately necessitating removal of the neovaginal construct. It is important that all patients are informed about neovaginal bowel complications, for example, diversion neovaginitis. Regular medical and endoscopic follow-up appears recommendable.
结肠段正被用作带蒂移植物用于新阴道成形术，这是一种（重新）构建（新）阴道的外科手术。使用结肠移植物的一个缺点是，由于粪便流改道，新阴道可能会出现并发症。在此，我们报告一例42岁完全雄激素不敏感综合征女性患者，其乙状结肠新阴道发生了严重的难治性改道性结肠炎，即所谓的“改道性新阴道炎”。新阴道活检标本显示为结肠型黏膜，固有层淋巴浆细胞浸润显著增加，伴有纤维蛋白样沉积的溃疡形成以及一些隐窝不规则。内镜检查显示黏膜红斑、浅表溃疡、黏液分泌物以及多个假息肉样病变。局部应用美沙拉嗪泡沫灌肠剂和丁酸钠灌肠剂最初缓解了症状。然而，这只是暂时的效果，最终不得不切除新阴道结构。重要的是要告知所有患者有关新阴道肠道并发症的情况，例如改道性新阴道炎。定期进行医学和内镜随访似乎是可取的。
