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Session: ePoster Monitor 4-Benign Anorectal Disease 2

eP552 - Redo Turnbull-Cutait Delayed Coloanal Anastomosis for Management of Recurrent Rectovaginal Fistula

Monday, June 3, 2024
8:39 AM – 8:44 AM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • KF

    Kristina Fioretti, MD

    General Surgery Resident
    Wake Forest University School of Medicine
    Wake Forest University School of Medicine
    Winston-Salem, NC, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Bigyan Mainali, MD MPH

    General Surgery Resident
    Atrium Health Wake Forest Baptist
    Wake Forest Baptist
    Winston-Salem, NC, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • Jean H. Ashburn, MD

    Associate Professor of Surgery
    Wake Forest University School of Medicine
    Wake Forest Baptist Health
    Winston-Salem, North Carolina, United States

    All relevant financial disclosures have been managed and will be listed below.
    This individual has no relevant relationships with ineligible companies.

    • Author(s)

  • AS

    Alton G. Sutter, MD, PhD

    Assistant Professor of Surgery
    Wake Forest University School of Medicine
    Winston-Salem, North Carolina, United States

    Disclosure information not submitted.

Purpose/Background: Rectovaginal fistula (RVF) has been reported as a complication of colorectal resection for deep infiltrating endometriosis in 2.5-10% of patients. It can be very difficult to treat in this cohort as the rectovaginal septum is often thinned to surgically treat the endometriosis, increasing the risk for fistula development and subsequent recurrence. Surgical techniques for both initial and recurrent RVF repair are highly individualized based upon fistula and patient characteristics. This case aims to highlight the unique difficulty in managing this pathology.Methods/Interventions: We present a case of a 26-year-old female with recurrent RVF following initial complicated low anterior resection with concurrent local excision of endometriosis for deep pelvic endometrial disease. Her initial RVF developed due to early anastomotic dehiscence and required diversion and drainage. The RVF defect was quite large and initially managed with debridement, primary closure of vagina, and two stage Turnbull-Cutait abdominoperineal pull through. She unfortunately recurred several months after her first repair, albeit with a markedly smaller defect.Results/Outcomes: We successfully performed a second two stage abdominoperineal pull through to manage the patient’s recurrent RVF. The vaginal defect was repaired primarily, and an omental pedicle flap was used to buttress the repair.Conclusion/

Discussion: This case demonstrates that in rare circumstances, a repeat attempt at Turbull-Cutait abdominoperineal pull through may be considered to bring about a successful outcome.