Conservative treatment of rectovaginal fistula after laparoscopic treatment of rectovaginal adenomyotic nodule

Abstract

Objective To report a case of successful conservative treatment of a single rectovaginal fistula occurring after laparoscopic treatment for rectovaginal adenomyosis. Setting Gynaecology department at a university hospital. Subject A young healthy patient who presented with a high rectovaginal fistula (RVF) 3 weeks after laparoscopic resection of a rectovaginal adenomyotic nodule. Intervention The patient was treated medically under parenteral nutrition over a period of 18 days, along with a fluid diet and oral intake of loperamide hydrochloride 2 mg three times daily for the first week, and a fibre-rich regimen during the rest of the hospital stay. Results Gastrograffin enema controls showed the closure of the fistula track after 18 days of treatment, when the patient had already been asymptomatic for 4 days. Conclusion High RVF are considered to rarely heal under medical therapy. Nevertheless in non-septic healthy patients with an RVF of small diameter and few symptoms, medical treatment may be attempted under close clinical and biological monitoring. RVF must be considered as a rare but possible complication of rectovaginal adenomyosis surgery. Great care must be taken when dissecting, manipulating or coagulating on the anterior rectal wall which is most usually involved in adenomyosis. Other adapted surgical alternatives must be considered in the case of failure of this conservative medical treatment.