Matsuyama Aika, Kato Kumiko, Sai Hiroki, Ishiyama Akinobu, Kato Takashi, Inoue Satoshi, Hirabayashi Hiroki, Suzuki Shoji
Department of Urology Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital Nagoya Japan.
Department of Female Urology Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital Nagoya Japan.
IJU Case Rep. 2022 Apr 13;5(4):255-258. doi: 10.1002/iju5.12448. eCollection 2022 Jul.
Transvaginal mesh surgery can cause mesh complications including rare rectovaginal fistula. We report a case of a rectovaginal fistula treated transvaginally without colostomy.
A 57-year-old female was referred to us due to post-hysterectomy prolapse and had transvaginal mesh surgery. She underwent transvaginal hysterectomy because of uterine prolapse at age 33 and had taken steroids to treat pemphigus. Two years later, she developed vaginal bleeding and discharge. Transvaginal mesh removal was planned to treat vaginal mesh exposure, but immediately before the operation digital rectal examination revealed rectovaginal fistula. Mesh removal and fistula closure were performed transvaginally without colostomy. Three years of follow-up showed no recurrence of mesh exposure, fistula, or prolapse.
Rectovaginal fistula following mesh surgery may be treated transvaginally without colostomy if infection is minimal. To evaluate mesh exposure on the posterior vaginal wall, rectal examination should be done along with vaginal examination.
经阴道网片手术可导致网片相关并发症，包括罕见的直肠阴道瘘。我们报告一例经阴道治疗直肠阴道瘘且未行结肠造口术的病例。
一名57岁女性因子宫切除术后脱垂转诊至我院，并接受了经阴道网片手术。她33岁时因子宫脱垂接受了经阴道子宫切除术，曾服用类固醇治疗天疱疮。两年后，她出现阴道出血和分泌物。计划行经阴道网片取出术治疗阴道网片外露，但术前直肠指检时发现直肠阴道瘘。经阴道进行了网片取出和瘘管闭合术，未行结肠造口术。三年随访显示，未出现网片外露、瘘管或脱垂复发。
如果感染轻微，网片手术后的直肠阴道瘘可经阴道治疗而无需行结肠造口术。为评估阴道后壁的网片外露情况，应在阴道检查的同时进行直肠检查。
