Enterovaginal and colovesical fistulas as late complications of pelvic radiotherapy

Abstract

A 72‐year‐old Japanese woman presented with a fever, diarrhea, intermittent spotting, and constant fluid discharge from the vagina. Imaging studies revealed an enterovaginal fistula. She underwent radical hysterectomy and radiotherapy 35 years previously. She also had a surgical history of nephrostomy, nephrectomy, ileoascending anastomosis, and colostomy. As bleeding from the enterovaginal fistula was uncontrollable, ileocecal resection was performed. However, a colovesical fistula with urinary tract infection occurred 3 months later. The present case indicates that fistula formation occurs and causes various symptoms in patients who underwent postpelvic radiotherapy, particularly in those with prior surgeries in the irradiated field.

Endoscopic closure of a radiation induced colovesical fistula using the novel over-the-scope Padlock Clip system—a case report

“…Recognition of radiation enteritis as a potential side effect of radiotherapy is pertinent as this would help in making an early diagnosis through clinical presentation and subsequently assist in organizing relevant radiological and endoscopic evaluation. These group of patients should then be closely monitored and followed up for signs of radiation enteritis sequelae, namely fistula formation, strictures, perforation and abscesses (6)(7)(8).…”

Enterocutaneous Fistula: A Simplified Clinical Approach

“…Radiation causes long-term chronic inflammation with poor healing and repair processes. Therefore, an intestinal fistula caused by radiation manifests after a long lag period that could extend several months or years and is particularly difficult to manage and heal [19].…”

Commentary

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Colovesical fistula is a well-known complication of pelvic radiation, especially when the latter is combined with surgery [1]. Interventional management is usually necessary but difficult, with surgery preferably avoided as these patients are poor surgical candidates and the irradiated field is an unfriendly surgical environment [1,2].

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Colovesical fistula is a well-known complication of pelvic radiation, especially when the latter is combined with surgery [1]. Interventional management is usually necessary but difficult, with surgery preferably avoided as these patients are poor surgical candidates and the irradiated field is an unfriendly surgical environment [1,2]. In this e-Video, the authors elegantly demonstrate how a patient with sepsis due to a fistula between a neobladder and the rectum was successfully treated with placement of an atrial septal defect closure device.

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