Introduction. Enterovaginal fistula (EVF), a rare but severe complication that can arise following gynecological surgeries, presents significant diagnostic and therapeutic challenges. The complex nature of these fistulas and their profound impact on the patients’ quality of life emphasize the need for a prompt and accurate diagnosis followed by appropriate treatment to prevent severe morbidity.
Case presentation. We report the case of a 54-year-old female who developed an EVF following a total hysterectomy performed for benign uterine fibroids. The patient presented with symptoms of persistent vaginal discharge and recurrent urinary tract infections. Initial investigations, including pelvic examination and imaging studies, suggested an abnormal communication between the bowel and vagina. The presence of non-specific symptoms and the delay in presentation complicated the diagnosis of EVF. Advanced imaging techniques, such as contrast-enhanced CT scans and MRI, were utilized to confirm the diagnosis and delineate the anatomical pathway of the fistula. However, only an essential examination, such as a vaginogram, found the presence of EVF. The fistula management required a comprehensive multidisciplinary approach involving gynecologists, surgeons, and radiologists. The surgical intervention involved the resection of the fistulous tract and primary repair of the bowel and vaginal walls. The patient underwent a successful repair surgery with no postoperative complications.
Conclusions. This case highlights the importance of high clinical suspicion, advanced diagnostic imaging, and a multidisciplinary approach in managing EVF post-hysterectomy. Early identification and appropriate surgical intervention are crucial to achieving favorable outcomes in complex cases.
Keywords: enterovaginal fistula, total hysterectomy, diagnostic challenges.
Full text sources https://doi.org/10.31688/ABMU.2024.59.3.08
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Agron S. DOGJANI
Department of Surgery, Faculty of Medicine, University of Medicine, Tirana, Albania
University Hospital of Trauma, Tirana, Albania
E-mail: agrondogjani@yahoo.com
