# Rectovaginal fistula as a complication of rectal injury during vaginal reconstructive surgery: A case report

## TL;DR

This case report describes a rare complication of rectovaginal fistula following rectal injury during vaginal reconstructive surgery and highlights the importance of early recognition and collaborative treatment.

## Contribution

The report emphasizes the complexity of high-type rectovaginal fistulas and the need for collaboration between gynecologists and gastroenterologists in such cases.

## Key findings

- A 33-year-old woman developed a rectovaginal fistula after rectal injury during synechia release surgery.
- Collaborative surgery between a gynecologist and a gastroenterologist was performed to correct the fistula.
- Early recognition and management are critical to reduce complications and improve patient outcomes.

## Abstract

Rectovaginal fistula is a complication that may occur due to rectal injury during vaginal reconstructive surgery. To prevent these complications, the recognition of the injury is an important factor so that primary repair can be done. The primary repair can reduce the risk of complications such as fistula formation, and also reduce the physical and psychological impact on the patient.

A 33-year-old woman, came with a chief complaint of fecal leakage from the vagina and abdominal pain three months before admission with a history of vaginal reconstructive surgery due to vaginal agenesis. Eleven years after the reconstruction, the patient was diagnosed with recurrent obstruction caused by vaginal synechia. During the surgery of synechia release, rectum injury occurred. Even though primary closure repair was done at that time, several months later there was a complication of rectovaginal fistule formation in the form of fecal leakage from the vagina. The corrective surgery is performed in collaboration with a surgical gastroenterologist.

Iatrogenic rectal injury may occur during gynecological surgery. A fistula that occurs after the reconstruction of vaginal agenesis is a high-type rectovaginal fistula, making the repairs more complex. Collaboration surgery between surgical gastroenterologist and gynecologist may be an option in such cases.

Rectovaginal fistula is a rare but serious complication of vaginal reconstructive surgery. Early recognition, immediate management, and postoperative follow-up are essential in cases of rectal injury during vaginal reconstructive surgery.

•Rectovaginal fistula is a complication that may occur due to rectal injury during vaginal reconstructive surgery.•The primary repair can reduce the risk of complication such as fistula formation, and reduce the physical and psychological impact on the patient.•Early recognition and management with postoperative follow-up are essential in cases of rectal injury during vaginal reconstructive surgery.

Rectovaginal fistula is a complication that may occur due to rectal injury during vaginal reconstructive surgery.

The primary repair can reduce the risk of complication such as fistula formation, and reduce the physical and psychological impact on the patient.

Early recognition and management with postoperative follow-up are essential in cases of rectal injury during vaginal reconstructive surgery.