Rectovaginal fistula developed after sex reassignment surgery - A case report

Abstract

A 22-year-old male-to-female transsexual was admitted to our clinic with a complaint of gas and fecal discharge from the neo-vagina. Sex reassignment surgery, including construction of the neo-vagina, had been performed 22 months previously. Contrast radiography and endoscopy revealed a high fistula located near the vault and partial loss of the epithelial lining of the vagina. Transsacral route excision of the fistula was performed with layer closure plus interposition of the mesorectum. The patient has been recurrence-free for more than 3 years since the repair. Vaginal function was not restored in the present case because he refused to allow his body to be injured. Repair of rectovaginal fistula as a complication of sex reassignment surgery seems difficult due to the obturator decubitus caused by protracted use of a stent to prevent vaginal shrinkage and wide dissection of the perineum. The incidence of this complication may be underestimated because of shortness of the observation period.