North Texas GME Research Forum 2024



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North Texas


Medical City Plano


General Surgery

Document Type


Publication Date



fistula, diverticulitis


Medicine and Health Sciences | Surgery | Surgical Procedures, Operative


Introduction: A majority of case reports and review studies exploring the incidence of colovaginal fistulas typically involve patients of older age with a history of both a hysterectomy and at least one episode of symptomatic diverticular disease. Colovaginal fistulas rarely occur in patients who have not had a prior hysterectomy. Case Description: A 52 year old female presented to colorectal surgery clinic with a history of multiple episodes of sigmoid diverticulitis who now had passage of air and stool from her vagina. She was confirmed to have evidence of a colovaginal fistula from her sigmoid colon to her vaginal fornix on CT imaging. She subsequently underwent robotic assisted lower anterior resection of the sigmoid colon with coloanal anastomosis and repair of the vaginal fornix. She was discharged the following day and had an uneventful postoperative course by the time she followed up in clinic 3 weeks later. Learning Points: This was a rare case of a colovaginal fistula that presented in a patient that had not had a hysterectomy. Prior hysterectomy allows for patients with incidences of diverticulitis to be more prone to having these fistulas due to native tissue derangements and proximity of the vaginal cuff to the sigmoid colon. Even though this patient had an intact uterus, they were likely placed at increased risk for fistula formation given they had a history of multiple diverticulitis flares. Clinicians and surgeons should consider the possibility of a colovaginal fistula formation in patients with a history of diverticulitis presenting with unexplained vaginal discharge or stool passage, regardless of gynecological surgery history.

Original Publisher

HCA Healthcare Graduate Medical Education

Colovaginal Fistula in a Patient Without a Hysterectomy



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