A Novel Combined Endoscopic and Surgical Approach to Retrieve a Retained Foreign Body Causing a Rectovaginal Fistula

Faris M Murad, MD, Steven R Hunt, MD. Washington University in St. Louis

 

A 45 year old obese female with menorrhagia undergoes robotic hysterectomy.  The patient has a previous history of cellulitis after a C-section.  During the operation, a piece of the bowel grasper was noted to be missing.  The surgeons spent 2 hours searching for the foreign body.  The foreign body could not be located and the patient was closed up.

A few days after the hysterectomy, the patient developed high fevers and was noted to have cellulitis.  The patient then started passing stool through her vagina.  A CT scan revealed a retained foreign body in the rectovaginal cuff.  Initial consultation with colorectal surgery recommended an open operation with diversion.  Patient sought a second opinion.

During sigmoidoscopy to evaluate for placement of a fully covered enteral stent, the foreign body was fluoroscopically visualized behind the rectal wall.  After discussion with the patient, an attempt at endoscopic retrieval was planned.

Endoscopically a small enterotomy was created in the rectum.  The foreign body was surrounded by scar tissue and could not be retrieved.  Colorectal surgery was then consulted at our institution to utilize the TEM scope and attempt foreign body retrieval through the created enterotomy.  The foreign body was retrieved and the fistula subsequently resolved without further intervention.


Session Number: SS25 – Videos: NOTES / Flexible Endoscopy
Program Number: V062

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