Concomitant repair of a complex rectovesicovaginal fistula following extensive pelvic surgery: A case report

Introduction: Complex pelvic fistulae involving the genitourinary and the gastrointestinal tracts represent a rare but serious complication following extensive pelvic surgery. Management of such conditions could be challenging due to the disrupted anatomy and multidisciplinary involvement. Case Report: We are reporting a case of a 41-year-old female with a long-standing history of endometriosis, recurrent ovarian endometriomas, and multiple pelvic surgeries who developed a combined vesicovaginal and rectovaginal fistula manifesting as continuous urinary and fecal leakage. Two fistulous tracts were identified in imaging and endoscopic evaluation connecting the posterior bladder wall, vaginal vault, and rectal stump. Both fistulae were repaired simultaneously via the transabdominal approach where multidisciplinary teams including urology and colorectal surgery were involved. The patient remained continent and asymptomatic in her subsequent follow-up appointments. Conclusion: Concomitant repair of rectovesicovaginal fistulae is feasible and safe in selected patients via thorough multidisciplinary approach, adequate imaging, and individualized surgical intervention.