Filling of an Internal Pudendal Artery Perforator Flap for Rectovaginal Fistula after Intersphincteric Rectal Resection

A 64-year-old woman underwent endoscopic resection for a neuroendocrine tumor of the lower rectum. Histological examination showed a positive vertical margin and vascular invasion. Additional laparoscopic intersphincteric rectal resection with ileostomy was then performed. Three months after the operation, a gastrografin enema showed that the space on the ventral side of the colorectal anastomosis was filled with contrast agent, and a rectovaginal fistula was diagnosed. At first, simple suture closure of the fistula was performed under lumbar anesthesia, but the fistula recurred. Seven months after the initial surgery, filling of the internal pudendal artery perforator flap was performed. The postoperative course was uneventful and the patient was discharged 9 days after the operation. Currently, there has been no recurrence of the fistula for 16 months after flap filling. There have been reports of various treatments for rectovaginal fistula after rectal resection, but relatively few have focused on internal pudendal artery perforator flap filling. We report this case with a review of the literature.