{"paper_id":"aaf54c8a-d2f5-4570-ba50-2d73d786fa66","body_text":"A 36-year-old woman underwent anterior resection of the rectum owing to endometriosis. The procedure was complicated by a rectovaginal fistula, which needed several surgical reinterventions. Despite diversion colostomy and reconstruction of the posterior vaginal wall with a fasciocutaneous flap, the rectovaginal fistula persisted, with a 50-mm abscess interposed between the coloanal anastomosis and the neovagina. The patient was referred for endoscopic evaluation.\nEndoscopy confirmed a 4-mm fistulous tract at the coloanal anastomosis with communication between the abscess and vagina. Two sessions of endoscopic internal drainage were performed (\n Fig. 1 \n a \n); however, because of the lack of significant improvement in terms of the vaginal drainage and abscess dimensions, endoscopic intravaginal evaluation was performed, which revealed a 30-mm wide communication between the fornix and the abscess (\n Fig. 1 \n b \n).\nEndoscopic views showing:\n a \nendoscopic internal drainage of the abscess through the rectum;\n b \nthe abscess cavity with a wide communication with the fornix on intravaginal view.\nA total of seven sessions of intracavitary endoscopic vacuum therapy (EVT) were performed through the vagina (\n Fig. 2 \n a \n), each 3–4 days apart, with progressive reduction of the cavity size (\n Video 1 \n). Foreign bodies (surgical sutures/staples) were retrieved between the sessions to enhance tissue healing. At the end of the intravaginal EVT treatment, successful shrinkage of the cavity had been achieved, with a residual pseudodiverticulum (\n Fig. 2 \n b \n). Because of the persistence of contrast extravasation from the rectum to the pseudodiverticulum on rectal evaluation, a 12/6t over-the-scope (OTS) clip was placed on the rectal side (\n Fig. 2 \n c \n).\nEndoscopic view showing:\n a \nthe intravaginal endoscopic vacuum therapy;\n b \nthe residual pseudodiverticulum after seven sessions of intravaginal endoscopic vacuum therapy had been completed;\n c \nan over-the-scope clip that was placed to close the fistulous tract between the rectum and the pseudodiverticulum.\nIntravaginal endoscopic vacuum therapy is performed to close a rectovaginal fistula.\nVideo 1\nAfter 1 month, a double endoscopic evaluation (rectal and vaginal) was performed simultaneously, which showed OTS clip displacement, with no extravasation of contrast or methylene blue on either side. A computed tomography scan with rectal contrast and magnetic resonance imaging confirmed resolution of the fistula, with there being no recurrence during 12 months of follow-up.\nTreatment of gastrointestinal fistulas frequently requires a multimodality approach, tailored to each phase of the healing process to enhance the possibility of clinical success\n 1 \n 2 \n. To the best of our knowledge, this is the first report of intravaginal EVT, highlighting the expanding applications of EVT in the treatment of surgical complications.\nEndoscopy_UCTN_Code_TTT_1AQ_2AG","source_license":"CC-BY-4.0","license_restricted":false}