A Case of Ultra-High Rectovaginal Fistula after Sex Reassignment Surgery

We report a rare case of rectovaginal fistula (RVF) after sex reassignment surgery (SRS) in a 33-year-old male-to-female transsexual. Having undergone SRS 7 years earlier, she had been treated elsewhere 3 years earlier for fecal discharge and bleeding from the neovagina. Contrast enema and endoscopy showed an ultra-high RVF of the rectosigmoid portion, necessitating sigmoid colostomy immediately after admission. Repair of the RVF by a transsacral approach from outside of the rectum was conducted 2 months later. The RVF was successfully closed but with difficulty due to severe intrapelvic adhesion. The colostomy was closed 2 months later. The patient has been problem-free in the 1 year and 3 months since repair. The cause of the RVF was thought to be obturator decubitus due to long-term continuous intravaginal stenting. Vaginal function has not been restored because the patient fears recurrence. We know of no reports of treatment by local repair with a transsacral approach for extremely high RVF of the rectosigmoid portion.