Enterovaginal Fistula Research Articles

PAZEC: a Dutch Gynaecological Oncology Group open-label, multicenter, phase II study of pazopanib in metastatic and locally advanced hormone-resistant endometrial cancer

ObjectiveThere is a continued need for improvement of second-line systemic treatment for metastatic and/or recurrent endometrial cancer.MethodsIn this phase II, open-label study, eligible patients had histologically or cytologically confirmed endometrial...

Complications and Surgical Management of Colovaginal or Enterovaginal Fistula after Simple Hysterectomy

Complications and Surgical Management of Colovaginal or Enterovaginal Fistula after Simple Hysterectomy

S3411 Endoscopic Closure of an Enterovaginal Fistula: Novel Use of a Cardiac Septal Occluder Device

S3411 Endoscopic Closure of an Enterovaginal Fistula: Novel Use of a Cardiac Septal Occluder Device

Imposition of bypass enteroenteroanastomosis with disconnection of the small intestine loop with an enterovaginal fistula. A clinical case description

Тhis article describes a clinical case and applied surgical tactics for entero-vaginal fistula in an older age group patient with comorbid pathology. A compromise surgical intervention with the disconnection of the loop of the small intestine carrying the entero-vaginal fistula without its excision is proposed.

Stereotactic body radiotherapy for pelvic boost in gynecological cancer patients with local recurrence or unsuitable for intracavitary brachytherapy

ObjectiveTo evaluate efficacy of stereotactic body radiotherapy (SBRT) for pelvic boost irradiation in gynecological cancer patients with pelvic recurrence or with intact uterus unsuitable for brachytherapy. Materials and methodsWe retrospectively reviewed the medical records of 25 gynecological cancer patients who received SBRT boost for pelvic recurrence (salvage group, n = 14), or for local dose escalation instead of intracavitary brachytherapy due to unfavorable medical condition (definitive group, n = 11). The pelvis was irradiated with a median dose of 54 Gy in six weeks, and then SBRT was prescribed with a range of 10–25Gy in two to five fractions. The cumulative radiobiological equivalent dose in 2-Gy fractions (EQD2) to the tumors ranged from 62.5 to 89.5 Gy10 (median, 80.7). Overall survival (OS) and in-field relapse-free survival (IFRFS) were calculated using the Kaplan–Meier method. ResultsAt the initial assessment, eighteen (72%) patients achieved complete or partial remission, and seven (28%) had stable or progressive disease. With a median follow duration of 12 months, the 1-year IFRFS for salvage and definitive group were 64.5% and 90.0%, whereas the 1-year OS for the two groups were 80.8% and 49.1%, respectively. One patient developed entero-vaginal fistula and one had sigmoid perforation. No patient experienced ≧ grade 3 genitourinary complications. ConclusionIn gynecological cancer patients with recurrent pelvic tumors or intact uterus unsuitable for brachytherapy, local dose escalation with SBRT resulted in an initial response rate of 72% with acceptable early toxicities. A long-term follow-up is required to assess the impact on local control or survival.

Short bowel syndrome and severe skin toxicity as a complication of FOLFOX chemotherapy with panitumumab in a patient with colorectal cancer — a case report

The combination of monoclonal antibodies targeting epidermal growth factor receptor (EGFR) with chemotherapy is the standard treatment in advanced colorectal cancer without mutations in the RAS and BRAF genes. We present a case of a 55-year-old female patient with unacceptable skin toxicity and short bowel syndrome caused by palliative FOLFOX chemotherapy combined with panitumumab. In 2012, after the emergence of an artificial anus due to gastrointestinal obstruction in the course of rectal cancer, the patient underwent inductive chemotherapy, preoperative chemoradiotherapy, and radical surgery. Tubular adenocarcinoma G2, ypT2N0 was diagnosed. In 2013 and 2015 she underwent two additional surgeries including intestinal resection due to obstruction of the gastrointestinal tract and enterovaginal fistula. In February 2018 she was qualified for palliative chemotherapy because of inoperable relapse. Due to very good performance status (PS0) and absence of mutations of RAS and BRAF genes, regardless of being underweight and suffering from loose stools persisting from the time of surgery, FOLFOX chemotherapy with panitumumab was introduced. After the second administration of drugs an acne-like rash, hand-foot syndrome, and diarrhoea appeared. Intensification of symptoms and manifestations of short bowel syndrome were observed afterwards. Topical treatment of skin lesions, doxycycline, and anti-diarrhoeal therapy were introduced, with a mediocre therapeutic effect. Imaging confirmed disease stabilisation, but due to the deterioration of both performance status and life quality, anti-cancer treatment was discontinued. This case draws attention to the necessity of caution while qualifying for potentially toxic combination chemotherapy.

Clinical characteristics and outcome of fistulizing Crohn's disease: One single‐center experience in Taiwan

Crohn's disease (CD) is characterized by chronic and/or relapsing immune activation and inflammation within the gastrointestinal tract. Approximately 35% of patients with CD are complicated by fistulae. However, little is known about the incidence and natural history of fistulizing CD in Asia, especially enterocutaneous fistulae (ECF). In this study, we aimed to investigate the clinical course and outcomes of patients with fistulizing CD. We performed a retrospective analysis using the database of Chang Gung Memorial Hospital to analysis the clinical characteristics, clinical course of CD, gender, age, medical and surgical treatment, complications, and long‐term outcomes. From January 1989 to November 2016, 97 patients were enrolled (73 males and 24 females) with a median age at diagnosis of CD of 32 years (average 36.28 ± 15.84 years). All of the patients were classified by Montreal classification. Montreal classifications A2 (age 16‐40 years; n = 56, 57.7%), L3 (ileocolonic type; n = 47, 48.5%), and B1 (nonstricturing and nonpenetrating type; n = 43, 44.3%) were the most common phenotypes. ECF occurred in five patients (5.1%), enterovaginal fistula in three patients (3.1%), and enterovesical fistula in two patients (2.0%). The duration of CD before the onset of ECF was 3.9 years, enterovaginal fistula was 2.5 years, and enterovesical fistula was 5 years, and most of the patients complicated with a fistula required surgical treatment.

858PD - A DGOG open-label multicenter phase II study of pazopanib in metastatic and locally advanced hormone-resistant endometrial cancer

There is a pressing need for second-line systemic treatment for metastatic, recurrent and/or locally advanced endometrial cancer (AEC) after hormonal therapy or chemotherapy. We studied the effect of the selective multi-targeted receptor tyrosine kinase inhibitor pazopanib on progression free survival (PFS) at three months for patients with AEC. In this prospective phase II open label study, patients were recruited from six oncology departments in the Netherlands. Eligible patients had histologically or cytologically confirmed AEC, documented progressive disease and a WHO performance status of ≤ 2. All participants received treatment with pazopanib 800 mg once daily until progression, unacceptable toxicity or patient refusal. Dose reductions for toxicity were allowed. Patients were evaluable for the primary endpoint of PFS at three months if they had received pazopanib for at least four weeks. All participants were analysed for toxicity and overall survival (OS). The study was powered to demonstrate 50% PFS at 3 months (vs <30% based on previously reported studies) with &agr; = 0.05 and &bgr; = 80%. Between January 2011 and February 2016, 60 eligible patients were included. Median age was 68 years (range 53-85). Previous treatment included pelvic radiotherapy (58%), chemotherapy (90%) and hormonal therapy (43%). Forty-five out of sixty patients were treated for at least four weeks, and were thus evaluable for the primary endpoint. Twenty-six of the evaluable patients (58%) had no progression at three months, with median PFS and OS of 5.3 and 9.5 months, respectively. The most common severe adverse events were gastrointestinal toxicity in 21% of 60 participants, including 2 patients with a gut perforation, one fatal gastrointestinal hemorrhage, one enterocutaneous fistula and one fatal enterovaginal fistula. Peritoneal disease existed in 80% of patients with severe gastrointestinal toxicity. A definite correlation with previous radiotherapy could not be established. Pazopanib showed encouraging 3 months PFS in AEC. There may be a correlation between previous treatments and/or disease site with rare but severe gastrointestinal toxicity that has yet to be elucidated.

A novel dynamic field-matching technique for treatment of patients with para-aortic node-positive cervical cancer: Clinical experience

AimTo report outcomes for patients with para-aortic lymph node positive cervical cancer treated with a dynamic field-matching technique. BackgroundPET staging of cervical cancer has increased identification of patients with para-aortic lymph node metastasis. IMRT enables dose escalation in this area, but matching IMRT fields with traditional whole pelvis fields presents a challenge. Materials and methodsFrom 2003 to 2012, 20 patients with cervical cancer and para-aortic lymph node metastasis were treated utilizing the dynamic field-matching technique. As opposed to single-isocenter half-beam junction techniques, this technique employs wedge-shaped dose junctions for the abutment of fields. We reviewed the records of all patients who completed treatment with the technique and abstracted treatment, toxicity, and disease-related outcome data for analysis. ResultsMedian prescribed dose to the whole pelvis field was 45Gy and para-aortic IMRT field 50.4Gy. All but 3 patients underwent HDR (13 pts) or LDR (4 pts) brachytherapy. All patients developed lower GI toxicity; 10 grade 1, 9 grade 2, and 1 grade 4 (enterovaginal fistula). Median DFS was 12.4 months with 1 and 2-year DFS 60.0% and 38.1%. One-year OS was 83.7% and 2-year OS, 64.4%. A total of 10 patients developed recurrence; none occurred at the matched junction. ConclusionsThe dynamic field-matching technique provides a means for joining conventional whole pelvis fields and para-aortic IMRT fields that substantially reduces dose deviations at the junction due to field mismatch. Treatment with the dynamic matching technique is simple, effective, and tolerated with no apparent increase in toxicity.

&lt;b&gt;潰瘍性大腸炎に対する大腸亜全摘術後の腸膣瘻に漢方治療が奏効した1例 &lt;/b&gt;

腸膣瘻は膣からの排ガス，排便，会陰部のびらんや膣炎などをきたす病態である。腸膣瘻に漢方治療が有効であった症例を経験したので報告する。症例は62歳女性。潰瘍性大腸炎（UC）に対して大腸亜全摘術，回腸嚢肛門管吻合術を施行された。その後腸膣瘻によると考えられる膣からのガス・便排出を生じ，残存直腸におけるUC 再燃を考慮した内科的治療で軽快した。この7年後に同様の症状を生じたが，同様の内科的治療は効果なく回腸嚢炎はあるものの瘻孔が同定されないなどの理由のため手術による閉鎖の適応もなかった。内科的治療の継続による症状の軽快はなく漢方治療を行うこととなった。胃風湯加黄耆の投与で若干の改善がみられたが，五苓散料に転方したところ症状の消失を得た。五苓散による腸膣瘻の治験例は近年見られないため貴重な症例と考えた。また，今回のように西洋医学的な治療が難しい腸膣瘻に対し，漢方治療は試みる価値があると考えた。

Outcomes of FIGO Stage Ib-IVa Cervical Cancer With or Without Nodal Metastases After Radical Radiotherapy or Chemoirradiation

Objectives: Radical radiotherapy or chemoirradiation is the standard of care for International Federation of Gynecology and Obstetrics (FIGO) stage Ib-IVa cervical cancer. However, patients with pelvic or para-aortic nodal metastases have increased chance of recurrence and poor survival compared with those patients with no lymph node involvement. Their optimal management remains unclear. This study aimed at retrospectively evaluating the treatment outcomes of these patients in our unit to identify potential ways of improvement. Methods: From May 2007 to December 2012, 137 consecutive patients with FIGO stage Ib-IVa cervical cancers were treated with radical radiotherapy or chemoirradiation. Radical radiotherapy consisted of whole-pelvic external radiotherapy (ERT) with a median dose of 50 Gy in 2 Gy per fraction (median shield after 40 Gy), highdose-rate intracavitary brachytherapy (6.5 Gy/application for four or 7.7 Gy/application for three at Manchester point A, 2 applications/week) followed by additional external beam parametrial boost of 6 to 8 Gy, if indicated. Involved pelvic lymph nodes were boosted with a total dose of 60 to 64 Gy. Para-aortic nodal metastases were treated upfront by extended anteroposterior-posteroanterior field ERT covering both the para-aortic regions and the whole pelvis with a dose of 30 Gy in 2 Gy per fraction, followed by split-field 3-dimensional conformal boost of 20 Gy. Routine intracavitary brachytherapy, parametrial boost, and pelvic nodal boost were then given, when appropriate. Concurrent chemotherapy, when given, consisted of weekly cisplatin (40 mg/m 2 ). Treatment outcome parameters including overall survival (OS), cancer-specific survival (CSS), relapse-free survival (RFS), and patterns of failure were evaluated in all patients. Survival data were compared with the log-rank test and prognostic factors were analysed with the Cox proportional hazards regression model. Results: Of the 137 patients, 99 (72%) received chemoirradiation; 37 (27%) had either pelvic and / or paraaortic nodal metastases on radiological or pathological examination. After a median follow-up of 31 (range, 2-72) months, a significantly higher proportion of patients in group A (those with lymph node metastasis, 35%) had disease recurrence than in group B (those without lymph node metastasis, 19%; p = 0.047). Patients in group A had poorer 3-year OS (60%) and CSS (64%) compared with those in group B (OS, 75%, p = 0.08; CSS, 81%, p = 0.051) but the difference did not reach statistical significance. Patients in group A had significantly poorer 3-year RFS (50%) compared with those in group B (RFS, 73%; p = 0.009). FIGO stage III-IVa, presence of nodal metastases, and overall treatment time of more than 56 days were significant poor prognostic factors for both OS and RFS in multivariate analysis. Among patients with relapse, the majority (77% in group A and 84% in group B) developed first recurrence at distant sites with or without local relapse at a median time of 9.6 (range, 1.339.6) months. Only four (11%) patients in group A and five (5%) patients in group B developed first recurrence within the pelvis (pelvic control, 89% and 95%, respectively). Both radical radiotherapy and chemoirradiation were well-tolerated with no grade 3-4 acute toxicities. Only 4% (6/137) of patients developed grade 3-4 chronic toxicities (enterovaginal fistula, n=3; proctitis requiring surgery, n=2; cystitis with frequent haematuria, n=1). All four patients with para-aortic nodal metastases received extended-field chemoirradiation. Half died from distant metastases and the other half remained alive without recurrence. None of them developed grade 3 or 4 acute or chronic toxicities.

Retreatment with bevacizumab in patients with gynecologic malignancy is associated with clinical response and does not increase morbidity

PurposeBevacizumab (Bev) is associated with improved progression-free survival in advanced epithelial ovarian cancer. The use of Bev in patients with gynecologic malignancy is increasing; however, little is known about cumulative toxicity and response in patients retreated with Bev. Our goal was to determine cumulative side effects and response in patients retreated with Bev.Patients and methodsWomen with recurrent gynecologic malignancy treated with Bev between January 2007 and March 2012 at a single institution were identified, including a subset who received Bev in a subsequent regimen. The primary outcome was Bev-associated toxicity, and the secondary outcome was response.ResultsOf 83 patients that received Bev for recurrent disease, 23 were retreated with Bev and four received Bev maintenance. Three patients (13%) developed grade 3 or 4 hypertension; all had a history of chronic hypertension. One (4.3%) patient developed grade 3 proteinuria, and one (4.3%) developed an enterovaginal fistula. Four patients discontinued Bev secondary to toxicity. Toxicity was not related to the cumulative number of cycles. Twenty-six percent of patients responded to Bev retreatment. On univariate analysis, there was a significant (P=0.003) overall survival advantage when the Bev-free interval was >9 months (95% confidence interval [CI] 4.9–43.7) compared to ≤9 months (95% CI 2.1–11.5), 24.3 months, and 6.8 months.ConclusionRetreatment of patients with recurrent gynecologic malignancy with Bev did not increase morbidity and was associated with treatment response. Physicians treating women with recurrent disease may consider a Bev-containing regimen even if prior regimen(s) included Bev. Future studies should prospectively evaluate the efficacy of this treatment strategy.

Persistent vaginal discharge following proctocolectomy—if there is no fistula, what is it?

Dear Editor: Distressing vaginal discharge following conventional proctocolectomy has been reported in up to 50 % of patients. The primary evaluation of such patients includes assessing for the presence of an enterovaginal fistula. We report a case of a patient who presented with distressing vaginal discharge lasting for 2 years after a conventional proctocolectomy. The discharge was found to be a result of the pelvic floor muscle shift and compression of the vagina, with a formation of a fluid reservoir in the upper third of the vagina. A 39-year-old woman with ulcerative colitis (UC) underwent an urgent total colectomy, rectal preservation, and end ileostomy for toxic colitis. The postoperative period was uneventful. Histopathological examination confirmed the diagnosis. Due to persistent rectal mucous discharge and her reluctance to have a completion proctectomy with ileal pouch and anal anastomosis, a perineal proctectomy was performed. The operation and the postoperative period were uneventful. Following the second operation, the patient complained of new onset vaginal discharge. She described recurrent episodes of sudden drainage of copious amount of fluid from the vagina, which was often brown or bloody and had an unpleasant odor. The patient underwent a gynecologic assessment which included repeated vaginal examinations and cultures, without findings. The comprehensive evaluation included transvaginal ultrasonography, computed tomography (CT), gastrografin enema, and magnetic resonance imaging (MRI) for the assessment of an enterovaginal fistula. All of the studies failed to identify a fistula, but the ultrasound, CT, and MRI demonstrated an accumulation of fluid in the upper vagina. An examination under anesthesia was performed, which also failed to diagnose a fistula. Two years after the second procedure, the patient was referred to a vulvovaginal clinic. Detailed history revealed that since analresection, the patient also had dyspareunia and a “phantom” anal pressure sensation. Upon palpation of the levator ani muscle, a ventral migration was noted. Insertion of a speculum was disrupted by a circular narrowing of the upper vagina. Passing the narrowing resulted in the drainage of large amount of fluid. The vagina appeared normal without inflammation, and microscopic evaluation of the discharge was negative. Review of the MRI films confirmed a pelvic floor muscle shift and the compression of the vagina, with the formation of a reservoir offluidintheupper third of the vagina. The patient was referred to pelvic floor physiotherapy, and following pelvic floor muscle relaxation and voluntary emptying of her vaginal contents, she became symptom free.

W361 ENTEROVAGINAL FISTULA: RARE COMPLICATION OF CAESAREAN SECTION, DEMONSTRATED BY HIGH CLINICAL DIAGNOSIS

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S821-S822 Poster presentations W361 ENTEROVAGINAL FISTULA: RARE COMPLICATION OF CAESAREAN SECTION, DEMONSTRATED BY HIGH CLINICAL DIAGNOSIS T.I. Gusau, T.I. GusauSearch for more papers by this authorK. Waaldijik, K. WaaldijikSearch for more papers by this authorA. Tilli, A. TilliSearch for more papers by this author T.I. Gusau, T.I. GusauSearch for more papers by this authorK. Waaldijik, K. WaaldijikSearch for more papers by this authorA. Tilli, A. TilliSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)62084-0AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S821-S822 RelatedInformation

Novel Approach to Surgical Repair of Enterovaginal Fistula in the Irradiated Pelvis

Novel Approach to Surgical Repair of Enterovaginal Fistula in the Irradiated Pelvis

Transperineal omentum flap for the anatomic reconstruction of the rectovaginal space in the therapy of rectovaginal fistulas

Deep rectovaginal fistulas are a rare entity and pose a delicate challenge for the surgeon. The present study introduces different operative interventions involved in transperineal omental flap surgery. A retrospective analysis of all patients treated with a low or mid rectovaginal or enterovaginal fistula at the Department of Surgery of the University Hospital of Schleswig-Holstein, Campus Luebeck, was performed. Treatment results were discussed with respect to aetiology, localization, morbidity and outcome. Between the years 2000 and 2010, a total of nine patients with a low or mid rectovaginal fistula were treated at our clinic. After local fistulectomy, all patients were additionally treated by a laparoscopically assisted omental flap reconstruction of the rectovaginal and perineal space. Eight of the nine patients received a protective ileostomy or colostomy. Only the patient with a history of Crohn's disease had no ileostomy raised. At a median follow-up of 22 months, no patient experienced recurrence of a rectovaginal fistula. Perioperative mortality was zero and minor complications were observed in 22%. Major complications were an anastomotic insufficiency after low anterior resection that was treated without further interventions. Another complication was a persistent fistula within the sphincter that needed re-operation and bovine plug repair combined with a mucosa flap. Complete omental reconstruction of the rectovaginal space appears decisive in the operative therapy of deep rectovaginal or enterovaginal fistulas. Comparative studies on standard therapies are necessary although direct comparison of case series is difficult.

Percutaneous Treatment of a Jejunovaginal Fistula Using a Combination of the Amplatzer Vascular Plug II and N-Butyl-2-Cyanoacrylate: A Case Report

Treatment for an enterovaginal fistula should consider the location of an intestinal fistula. Most rectovaginal fistulas develop in the lower third of the vagina and can be treated surgically. Jejunovaginal fistulas can spontaneously close during conservative management. We report the first use of the Amplatzer vascular plug II (AVP II; AGA Medical Corp, Golden Valley, MN, USA) and the use of an N-butyl-2-cyanoacrylate (NBCA; Histoacryl, Braun, Melsungen, Germany)- iodized oil (Lipiodol Ultra-Fluid, Guerbet, Aulnay-sous-Bois, France) mixture for treatment of a patient with a jejunovaginal fistula which failed to close after conservative management. The patient did not have any vaginal discharge one day later after deployment of the AVP II.

P26.10: The role of 2D and 3D transvaginal sonography on the diagnosis of enterovaginal fistula

P26.10: The role of 2D and 3D transvaginal sonography on the diagnosis of enterovaginal fistula

The use of porcine small intestinal submucosa mesh (SURGISIS) as a pelvic sling in a man and a woman with previous pelvic surgery: two case reports

IntroductionClosing the pelvic peritoneum to prevent the small bowel dropping into the pelvis after surgery for locally recurrent rectal cancer is important to prevent adhesions deep in the pelvis or complications of adjuvant radiotherapy. Achieving this could be difficult because sufficient native tissue is unavailable; we report on the use of small intestine submucosa extra-cellular matrix mesh in the obliteration of the pelvic brim.Case presentationWe describe two cases in which submucosa extra-cellular matrix mesh was used to obliterate the pelvic brim following resection of a recurrent rectal tumour; the first patient, a 78-year-old Caucasian man, presented with small bowel obstruction caused by adhesions to a recurrent rectal tumour. The second patient, an 84-year-old Caucasian woman, presented with vaginal discharge caused by an entero-vaginal fistula due to a recurrent rectal tumour.ConclusionWe report on the use of submucosa extra-cellular matrix mesh as a pelvic sling in cases where primary closure of the pelvic peritoneum is unfeasible. Its use had no infective complications and added minimal morbidity to the postoperative period. This is an original case report that would be of interest to general and colorectal surgeons.

Entero-tubulo-uterine fistula in a patient with ulcerative colitis

Ulcerative colitis (UC) is a type of inflammatory bowel disease that affects approximately 500,000 Americans. Although medical treatment is available for UC patients, surgery is often necessary and curative. Surgical treatment of fistulas is uncommon in UC compared to Crohn’s disease. In this paper, we report a case of a fistula complicating a total proctocolectomy with ileo-anal anastomosis in a patient with UC 5 years after the surgery. A 22-year-old woman with a history of UC and total colectomy with ileostomy in 2001 and ileostomy reversal in 2002 presented to the emergency department with a 1-day history of liquid, brown, foul-smelling feculent material discharging from her vagina. She denied any blood in the discharge and reported no history of prior episodes. She denied nausea, vomiting, fever, chills, or change in appetite or change in stooling habits. She reported moderate suprapubic fullness and bloating but denied rectal or vaginal pain. She has a history of irregular menses. The patient has a history of pelvic abscess formation as noted on prior admissions and computed tomographies. All of the abscesses responded quickly to antibiotics as an inpatient and outpatient. Her surgical history also includes a C-section in 2004. On review of symptoms, she reported weight loss and lower back pain radiating down bilateral legs for the last 8 months for which she has been taking methadone 5 mg twice daily to alleviate. Physical exam revealed a soft abdomen with mild suprapubic tenderness. There were no masses or distention, and bowel sounds were present. Rectal exam revealed perianal skin tags, normal rectal tone, normal healing of the anal anastomosis, and no masses. The patient deferred a pelvic exam at that time. A computed tomography was performed, which showed a pelvic abscess. The patient was admitted to the hospital for treatment of an enteropelvic fistula with pelvic abscess. A flexible sigmoidoscopy of the pouch was unremarkable and without any inflammation. Intravenous antibiotics were given with improvement of her symptoms. She was discharged. She was readmitted approximately 1 month later with recurrence of symptoms after failure of medical management with mesalmine and steroids. She was taken for endoscopy at which time a possible fistula opening was found. Next, she was taken for exam under anesthesia. This revealed feculent discharge from the cervix. The external opening seemed to end blindly near the anal anastomosis at the time of examination. The patients was worked up with small bowel follow through, which was normal. Because of recurrence of symptoms, another computed tomography was obtained, which showed worsening inflammatory change in the presacral tissue and a fistulous connection into the adjacent soft tissues of the adjacent bowel within the right hemipelvis. An abscess could not be ruled out by the radiologist. Pelvic magnetic resonance imaging was obtained without contrast. The uterus was found to be normal in appearance. Neither ovary was visualized. A 3.6×3-cm cystic lesion was visualized in the pelvis posterior to the uterus. A colonic barium enema was performed revealing an enterovaginal fistula tract projecting posterior from the J-pouch. Int J Colorectal Dis (2008) 23:449–450 DOI 10.1007/s00384-007-0381-0