Frontiers in medicine · 2026
Case Report: Minimally invasive surgical management of a complex high rectovaginal fistula caused by long-term retained and migrated intrauterine device.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Wang Ziwen, Deng Zhiyin, Zhu Min, Zhang Li, Xu Haixia, Zhou Zhen, Lu Yanqing, Wang Hao
Аннотация
BACKGROUND: Rectovaginal fistula (RVF) secondary to migrated intrauterine device (IUD) is an extremely rare complication, and high-level RVF with multiple prior failed IUD removal attempts remains a formidable clinical challenge.
CASE PRESENTATION: We report a 43-year-old female who presented with vaginal fecal discharge for 3 weeks. She underwent insertion of an oval metallic IUD in 2014, which was confirmed to have migrated during induced abortion, and had a failed laparoscopic-hysteroscopic IUD removal attempt in 2022. During that attempt, intraoperative findings revealed the IUD had migrated to the left pelvic floor; however, the procedure was terminated due to concerns regarding the complex surrounding tissue structure and the surgeon's technical limitations at a smaller-scale hospital, as the patient was not experiencing significant physical discomfort at that time. Preoperative examinations revealed a 1-cm fistula at the posterior vaginal fornix and an annular metallic IUD embedded in the anterior rectal wall 8 cm from the anal verge. After multidisciplinary consultation, the patient underwent laparoscopic proctectomy, combined transabdominal-transvaginal rectovaginal fistula repair, and temporary ileostomy. The operation was uneventful, and no postoperative complications occurred. Ileostomy closure was performed at 3 months postoperatively, and no fistula recurrence, fecal incontinence, or other adverse events were observed during the 6-month follow-up.
CONCLUSION: The combined laparoscopic transabdominal-transvaginal approach is a safe and effective surgical option for high-level RVF secondary to migrated IUD, offering the advantages of precise exposure, minimal trauma, and low recurrence risk. This case highlights the importance of long-term follow-up after IUD insertion and the value of multidisciplinary collaboration in managing complex pelvic fistulas.
CASE PRESENTATION: We report a 43-year-old female who presented with vaginal fecal discharge for 3 weeks. She underwent insertion of an oval metallic IUD in 2014, which was confirmed to have migrated during induced abortion, and had a failed laparoscopic-hysteroscopic IUD removal attempt in 2022. During that attempt, intraoperative findings revealed the IUD had migrated to the left pelvic floor; however, the procedure was terminated due to concerns regarding the complex surrounding tissue structure and the surgeon's technical limitations at a smaller-scale hospital, as the patient was not experiencing significant physical discomfort at that time. Preoperative examinations revealed a 1-cm fistula at the posterior vaginal fornix and an annular metallic IUD embedded in the anterior rectal wall 8 cm from the anal verge. After multidisciplinary consultation, the patient underwent laparoscopic proctectomy, combined transabdominal-transvaginal rectovaginal fistula repair, and temporary ileostomy. The operation was uneventful, and no postoperative complications occurred. Ileostomy closure was performed at 3 months postoperatively, and no fistula recurrence, fecal incontinence, or other adverse events were observed during the 6-month follow-up.
CONCLUSION: The combined laparoscopic transabdominal-transvaginal approach is a safe and effective surgical option for high-level RVF secondary to migrated IUD, offering the advantages of precise exposure, minimal trauma, and low recurrence risk. This case highlights the importance of long-term follow-up after IUD insertion and the value of multidisciplinary collaboration in managing complex pelvic fistulas.