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

From: Elucidating vaginal fistulas on CT and MRI

Type Cause Notes
Colovaginal 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
Rectovaginal 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
Anovaginal 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)