It refers to a communication between the colon (practically the rectum or sigmoid colon) with the vagina.
At times, specific terms are used dependent on the site of fistulation
It is most commonly associated with
- complicated diverticular disease (may account for 20-40% of diverticular-related fistulas 1-2,4)
- also occurs in those with pelvic or colonic malignancies, inflammatory bowel disease and following pelvic radiotherapy.1
- radiation related fistulas often involve the distal sigmoid colon and/or rectum, and in these situations, recurrent cancer must be ruled out.
It can be uncommonly associated with certain surgical procedures such as:
- polypropylene mesh sacrocolpopexy 5
- tension-free vaginal tape procedure 6
Conventional fluoroscopic methods such as vaginography and barium enema study (in conjunction with physical examination) have been traditionally been used. Vaginography has sensitivity rates ranging between 40-100%.
May show faeculent appearing content within the abdomen. It direct communication may be present if rectal contract is given.
Treatment and prognosis
The usual management is surgical with primary resection and anastomosis 4. A conservative management may be adopted for poor surgical candidates. Malignant fistulas usually carry a poorer prognosis, and when surgical removal is not practical, they are treated palliatively with faecal diversion or an endoluminal stent 7.
- 1. Yu NC, Raman SS, Patel M et-al. Fistulas of the genitourinary tract: a radiologic review. Radiographics. 2004;24 (5): 1331-52. Radiographics (full text) - doi:10.1148/rg.245035219 - Pubmed citation
- 2. Pickhardt PJ, Bhalla S, Balfe DM. Acquired gastrointestinal fistulas: classification, etiologies, and imaging evaluation. Radiology. 2002;224 (1): 9-23. Radiology (full text) - doi:10.1148/radiol.2241011185 - Pubmed citation
- 3. Junqueira BL, Allen LM, Spitzer RF et-al. Müllerian duct anomalies and mimics in children and adolescents: correlative intraoperative assessment with clinical imaging. Radiographics. 2009;29 (4): 1085-103. Radiographics (full text) - doi:10.1148/rg.294085737 - Pubmed citation
- 4. Grissom R, Snyder TE. Colovaginal fistula secondary to diverticular disease. Dis. Colon Rectum. 1991;34 (11): 1043-9. Pubmed citation
- 5. Nicolson A, Adeyemo D. Colovaginal fistula: a rare long-term complication of polypropylene mesh sacrocolpopexy. J Obstet Gynaecol. 2009;29 (5): 444-5. doi:10.1080/01443610902954360 - Pubmed citation
- 6. Patry G, Bolduc S, Martineau G et-al. Colovaginal fistula: an unusual complication of the tension-free vaginal tape procedure. J. Urol. 2004;172 (3): 972-3. doi:10.1097/01.ju.0000134887.21782.8d - Pubmed citation
- 7. Bahadursingh AM, Longo WE. Colovaginal fistulas. Etiology and management. J Reprod Med. 2003;48 (7): 489-95. Pubmed citation
- 8. Cross SB, Copas PR. Colovaginal fistula secondary to diverticular disease. A report of two cases. The Journal of reproductive medicine. 38 (11): 905-6. Pubmed