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Table 1 Categorisation, causes and mechanisms of entero-vaginal fistulas

From: Elucidating vaginal fistulas on CT and MRI





Complicated colonic diverticulitis

Patients with prior hysterectomy

Either (a) inflamed sigmoid colon directly adheres to the vaginal vault or (b) via formation of interposed abscess that opens in the vagina


Past irradiation such as for uterine cervix carcinoma

Delayed onset (years after treatment) Increasingly uncommon

Primary or recurrent pelvic tumours

Either (a) rectal carcinoma invading the vagina or (b) gynaecologic malignancies invading the rectum

Surgical injury


  - Low anterior resection for rectal cancer

Risk up to 5–10% of patients, part of anastomotic leakage spectrum

Inadvertent clipping of vagina in staples

  - Pelvic floor surgery

With positioning of prosthetic mesh

  - Haemorrhoid surgery


Crohn’s disease (CD)

CD = 25% of all vaginal fistulas (VF) VF < 4–9% of all CD-related perianal inflammatory disease

Often complex forms

Ulcerative colitis

Perianal inflammatory disease (rare)

Ileal pouch-anal anastomosis leakage

Cryptoglandular or other inflammation

E.g. Bartholin’s gland abscess

Perineal laceration

From either (a) direct trauma (often sexual violence) or (b) obstetric injury (spontaneous or instrumental delivery)