Coexistence of colouterine and rectovaginal fistula in an elderly woman: a case report

Introduction: Colouterine and rectovaginal fistulas (RVFs) are rare and are usually associated with inflammatory bowel disease, radiotherapy, neoplasms, or extensive surgery. They affect quality of life, with fecal vaginal discharge being the most characteristic clinical finding. Case presentation: A 65-year-old woman with type 2 diabetes and a history of two cesarean sections presented with 20 days of abundant, cloudy vaginal discharge. On examination, fecal matter was found in the vagina. A computed tomography scan showed hypodense material in the vagina, and fistulography confirmed the passage of contrast from the colon to the genital tract. Exploratory laparotomy identified cervical fistulas and RVFs. Intestinal resection and hysterectomy were performed, but postoperative abdominal sepsis led to the patient’s death. Discussion: The coexistence of colouterine and RVFs without typical risk factors is exceptionally rare. This suggests a severe inflammatory process and highlights the diagnostic limitations of preoperative imaging. Conclusion: Enterogenital fistulas pose major diagnostic and therapeutic challenges. Fecal vaginal discharge associated with intravaginal or intrauterine air and fluid should raise suspicion for complex fistulas, whose definitive diagnosis may require intraoperative evaluation.