Skip to main content

Advertisement

Log in

Martius flap reconstruction for rectovaginal fistula after stapled hemorrhoidopexy (Longo operation): a case report

  • Case Report
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

A rectovaginal fistula (RVF) is a rare disease. It’s an epithelium-lined abnormal communication between rectum and vagina. It represents approximately 5% of all anorectal fistulas. RVF may have different causes.

Methods

We present a case of a 58-year-old woman with a rectovaginal fistula after stapled hemorrhoidopexy (Longo operation).

Results

A 58-year-old woman presented herself in our department with vaginal fecal discharge and vaginitis almost one month after a stapled hemorrhoidopexy was performed in another hospital. On vaginal examination, a large dorsal defect was palpated at four cm. On rectal examination, the stapler line was palpable at four cm and just distal to this stapler line, a large defect could be palpated. A lower gastrointestinal tract radiography was performed and identified a RVF. The patient was put on antibiotics and two operations were planned. First, a temporary ileostomy was created. After healing of the vaginitis, reconstructive surgery with anatomic fistula repair in combination with the interposition of healthy, vascularised tissue was performed. In this case, we chose the Martius flap. The operation as well as the postoperative course was uneventful.

Conclusions

Cases of postoperative RVF have been increasingly reported since the introduction of stapled hemorrhoidopexy. Patients with RVF can have a varying degree of symptoms. Diagnosis is primarily based on the patient’s medical history together with a clinical examination. There are many surgical approaches for RVF. Anatomic fistula repair alone is associated with lower success rates compared with combined procedures with the adjunctive interposition of healthy, vascularised tissue.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Reichert M et al (2014) Surgical approach for repair of rectovaginal fistula by modified Martius flap. Geburtshilfe Frauenheilkd 74(10):923–927

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Ommer A et al (2012) German S3-guideline: rectovaginal fistula. Ger Med Sci 10:Doc15

    PubMed  PubMed Central  Google Scholar 

  3. Das B, Snyder M (2016) Rectovaginal fistulae. Clin Colon Rectal Surg 29:50–56

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kniery KR, Johnson EK, Steele SR (2015) Operative considerations for rectovaginal fistulas. World J Gastrointest Surg 7(8):133–137

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bhome R, Monga A, Nugent KP (2018) A transvaginal approach to rectovaginal fistulae for the colorectal surgeon: technical notes and case series. Tech Coloproctol 22:305–311

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Gallo G et al (2017) Martius’ flap for recurrent perineal and rectovaginal fistulae in a patient with Crohn’s disease, endometriosis and a mullerian anomaly. BMCSurgery 17:107

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ellen Liekens.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liekens, E., van Sprundel, F., Thiessen, F. et al. Martius flap reconstruction for rectovaginal fistula after stapled hemorrhoidopexy (Longo operation): a case report. Int J Colorectal Dis 34, 1619–1623 (2019). https://doi.org/10.1007/s00384-019-03355-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-019-03355-6

Keywords

Navigation