Delayed Coloanal Anastomosis for rectovaginal fistula after colorectal resection for deep endometriosis

AIM: The deep infiltrating endometriosis, defined as a subperitoneal infiltration of endometrial implants of ≥ 5 mm involving not only the colorectal tract but also rectovaginal septum, vagina and bladder often requires a challenging surgery. Endometriosis nodes of the rectovaginal septum, if symptomatic, need a resection of the involved colorectal tract with colorectal or coloanal anastomosis. Unfortunately in these cases is not uncommon the possibility of a postoperative rectovaginal fistula (RVF), caused by the weakness of the septum that must be skeletonized to completely remove the endometriosis nodes. Here we present a case of anastomotic leakage with high RVF after colorectal resection and low colorectal anastomosis for deep endometriosis in which, for a chronic pelvic sepsis and a high risk of failure of a new immediate coloanal anastomosis, a Turnbull-Cutait pull-through with delayed coloanal anastomosis (DCAA) has been performed. CASE REPORT: A now 34 years old woman was admitted to our Clinic because of a RVF due to recto-sigmoid resection with colorectal anastomosis for endometriosis. An evaluation in anesthesia confirmed the RVF. In this case we avoided an immediate new colorectal anastomosis for the high risk of a recurrent anastomotic leakage and performed a DCAA. RESULTS: The outcome of the two-steps operation has been satisfactory both for the healing of the RVF and for the functional results bringing the young patient to a completely restored social, sexual and working life. CONCLUSIONS: In our opinion Turnbull-Cutait pull-through with delayed coloanal anastomosis is a good choice in patients with RVF in which a new colorectal or coloanal anastomosis can bring to a recurrent leakage. KEY WORDS: Delayed coloanal anastomosis, Deep endometriosis, Rectovaginal fistula.