Long-Term Complication: Colovaginal Fistula Nine Years after Laparoscopic Sacrocolpopexy.

BACKGROUND

Colovaginal fistula (CVF) is a rare, late complication of laparoscopic sacrocolpopexy that significantly impairs quality of life. We report a case occurring 9 years postoperatively to highlight its presentation and management.

CASE: A G3P3 woman in her seventies presented with yellow, foul-smelling vaginal discharge 9 years after laparoscopic total hysterectomy with sacrocolpopexy. Colonoscopy revealed a rectovaginal fistula; histology excluded diverticular disease. A multidisciplinary team performed laparoscopic removal of the eroded mesh and sigmoid resection with primary anastomosis. At 1-year follow-up the vagina was completely healed and the patient reported no further abnormal discharge.

CONCLUSION

CVF may arise almost a decade after sacrocolpopexy. A high index of suspicion, prompt multidisciplinary surgery and long-term surveillance are essential for optimal outcomes.