Transvaginal repair and graft interposition for rectovaginal fistula due to a neglected pessary: case report and review of the literature.

BACKGROUND: : There are few reported cases of rectovaginal fistula due to a neglected pessary, with few data to guide management. CASE: : An 83-year-old lady presented with an impacted Gellhorn pessary 5 years after insertion. Upon removal of the pessary in the operating room, a 4-cm high rectovaginal fistula was discovered. An immediate transvaginal layered repair was performed with porcine dermal graft interposition and partial obliteration of the posterior vagina. At 8 months' follow-up, the patient remained asymptomatic with normal bowel function.
CONCLUSION: : A large, high rectovaginal fistula due to a neglected pessary can be repaired vaginally with the use of a graft and partial obliteration of the posterior vagina to provide additional layers of closure, without the need for colostomy. The literature is reviewed, focusing on the management of pessary-related rectovaginal fistula and the role of graft augmentation.