Colovaginal fistula

Dr Ian Bickle et al.

Colovaginal fistula is one form of genitourinary fistula. It is also sometimes classed under a type of gastro-intestinal fistula.

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

Associations

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
Fluoroscopy

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%.

CT 

May show faeculent appearing content within the abdomen. It direct communication may be present if rectal contract is given.

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.

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Article information

rID: 21158
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:
  • Colo-vaginal fistula
  • Colovaginal fistulas
  • Colovaginal fistulation

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