Delayed presentation of an enterocutaneous fistula after tension-free vaginal tape sling.

BACKGROUND

: Bowel injury is a rare but serious complication associated with tension-free vaginal tape (TVT) sling procedures.

CASE: : A 50-year-old woman with a previous history of pelvic surgery underwent TVT for stress urinary incontinence. Surgery and the immediate postoperative period were unremarkable; however, she returned 5 months later with bloody, purulent discharge from a suprapubic exit site. This was unresponsive to antibiotic therapy, and when the patient returned with abdominal pain and fever, a computed tomographic scan showed an enterocutaneous fistula. At the time of exploratory laparotomy, the mesh was noted to have perforated the small bowel and led to a sinus tract that communicated with the skin.

CONCLUSIONS

: Bowel perforation is a recognized, but rare, complication of TVT. This case highlights the need for a high index of suspicion for bowel injury after TVT maintained beyond the more commonly described peritonitis or obstructive symptoms presenting in the immediate perioperative period.