Case Report: Minimally invasive surgical management of a complex high rectovaginal fistula caused by long-term retained and migrated intrauterine device.

Authors

Ziwen Wang, Zhiyin Deng, Min Zhu, Li Zhang, Haixia Xu, Zhen Zhou, Yanqing Lu, Hao Wang

Published in

Frontiers in medicine. Volume 13. Pages 1863833. Epub Jun 24, 2026.

Abstract

Rectovaginal fistula (RVF) secondary to migrated intrauterine device (IUD) is an extremely rare complication, and high-level RVF with multiple prior failed IUD removal attempts remains a formidable clinical challenge.
We report a 43-year-old female who presented with vaginal fecal discharge for 3 weeks. She underwent insertion of an oval metallic IUD in 2014, which was confirmed to have migrated during induced abortion, and had a failed laparoscopic-hysteroscopic IUD removal attempt in 2022. During that attempt, intraoperative findings revealed the IUD had migrated to the left pelvic floor; however, the procedure was terminated due to concerns regarding the complex surrounding tissue structure and the surgeon's technical limitations at a smaller-scale hospital, as the patient was not experiencing significant physical discomfort at that time. Preoperative examinations revealed a 1-cm fistula at the posterior vaginal fornix and an annular metallic IUD embedded in the anterior rectal wall 8 cm from the anal verge. After multidisciplinary consultation, the patient underwent laparoscopic proctectomy, combined transabdominal-transvaginal rectovaginal fistula repair, and temporary ileostomy. The operation was uneventful, and no postoperative complications occurred. Ileostomy closure was performed at 3 months postoperatively, and no fistula recurrence, fecal incontinence, or other adverse events were observed during the 6-month follow-up.
The combined laparoscopic transabdominal-transvaginal approach is a safe and effective surgical option for high-level RVF secondary to migrated IUD, offering the advantages of precise exposure, minimal trauma, and low recurrence risk. This case highlights the importance of long-term follow-up after IUD insertion and the value of multidisciplinary collaboration in managing complex pelvic fistulas.

PMID:
42422852
Bibliographic data and abstract were imported from PubMed on 09 Jul 2026.

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