Omental Pedicle Flap Was Useful for Rectovaginal Fistula Secondary to Uterine Prolapse Pessary in an Elderly Patient

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  • Kimura Kazutaka
    Department of General and Gastroenterological Surgery, Toho University Omori Medical Center
  • Funahashi Kimihiko
    Department of General and Gastroenterological Surgery, Toho University Omori Medical Center
  • Koda Takamaru
    Department of General and Gastroenterological Surgery, Toho University Omori Medical Center
  • Kagami Satoru
    Department of General and Gastroenterological Surgery, Toho University Omori Medical Center
  • Usigome Mitsunori
    Department of General and Gastroenterological Surgery, Toho University Omori Medical Center
  • Kaneko Tomoaki
    Department of General and Gastroenterological Surgery, Toho University Omori Medical Center
  • Siokawa Hiroyuki
    Department of General and Gastroenterological Surgery, Toho University Omori Medical Center
  • Kurihara Akiharu
    Department of General and Gastroenterological Surgery, Toho University Omori Medical Center
  • Koike Junichi
    Department of General and Gastroenterological Surgery, Toho University Omori Medical Center

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Other Title
  • 子宮脱用リングペッサリー留置による高齢者の直腸膣瘻に対し有茎大網充填が有用であった1例

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<p>A pessary is a relatively simple and noninvasive choice for treating uterine prolapse, but rectovaginal fistula resulting from mechanical pressure has a high recurrence rate even after repair, and is a problematic complication of therapy. The patient was a 75-year-old woman who had been fitted with a pessary for uterine prolapse 5 years previously. The rectovaginal fistula was diagnosed by vaginal and rectal examinations during her regular 3-month visit. The vaginal tear was 4 cm, the fistula was a large 3 cm in diameter, and because of the patient’s age and thinning of the rectovaginal septum, we decided that a single procedure would be too taxing. Subsequent to colostomy, the second stage of treatment involved hysterectomy, proctectomy, and omentoplasty of the rectovaginal septum. There were no postoperative complications, and the patient was released on day 13 after surgery. We found that a pedicled omental flap was useful as repair tissue for a patient with a large, 3 cm rectovaginal fistula who was considered difficult to treat because of age-related thinning of the rectovaginal septum.</p>

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