Endoscopic Repair of a Recurrent Colovaginal Fistula

Abstract

Introduction:

A colovaginal fistula is an unfortunate complication of abdominal pathology in women, most commonly diverticulitis. ^3,5 Pelvic surgery, such as a hysterectomy, is a well-recognized risk factor. Historically, treatment for a colovaginal fistula involves primary resection of the involved bowel and remains the mainstay of treatment today. More recently, laparoscopic techniques offer a less invasive approach that minimizes risks associated with surgery. ^1,2,4 This video illustrates a novel approach for the definitive closure of colovaginal fistulae utilizing an endoscopic approach and over-the-scope clips to eliminate the need for bowel resection.

Materials and Methods:

Wire access was gained across the fistula site to guide the endoscope into appropriate positioning before clip placement. A vaginal fistulogram was then obtained that did not document communication to the colon after placing the clip. Argon plasma coagulation was then utilized to the epithelium of the fistula tract through the vagina.

Results:

Following the procedure, the patient had a drastic improvement in their symptoms with no indication for a second colonoscopic intervention or surgical resection. At 5 months, the patient remains asymptomatic. The patient refused any further radiological follow-up.

Conclusion:

Endoscopic placement of over-the-scope clips is a feasible method to treat persistent colovaginal fistulae while avoiding the morbidity associated with surgical intervention.

Author Disclosures:

No competing financial interests exist.

Speaking/Teaching Honoraria:

Becton-Dickinson; Boston Scientific Corp.; Cook Biotech, Inc.; C. R. Bard, Inc.; Ovesco Endoscopy.

Research Support:

C. R. Bard, Inc.

Consultant:

Actuated Medical, Inc.; Allergan; Baxter; Boston Scientific Corp.; Cook; Medtronic; Mesh Suture, Inc.

Royalties:

UpToDate (Wolters Kluwer); Springer.

Recognition of Patient Consent:

Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure.

Recognition of Prior Presentations:

This video case presentation was previously presented at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Annual Meeting Aug 31—Sept 03, 2021, Las Vegas, NV, USA.

Runtime of video:

6 mins: 6 secs