Background and study aims A 71-year old female who received low anterior resection for
rectal cancer visited Komatsu Municipal Hospital with complaints of passing feces from the vagina. Endoscopic examination revealed a postsurgical
rectovaginal fistula. Medical approaches, including nonoperative management, initial endoscopic closure, transvaginal and endorectal surgery, and fecal diversion, were unsuccessful. Therefore, the patient underwent endoscopy with a pre-procedural endoscopic creation of mucosal pin holes around the
fistula opening and
clip insertion into the rectal wall in combination with
electrocautery and
clip closure. This novel approach was effective in achieving permanent closure of the
fistula in a single procedure. Most
rectovaginal fistulas are surgically managed, however, surgery may be more difficult, invasive, and unsatisfactory for refractory
fistulas. Although endoscopic treatment with over-the-scope clips has been increasingly used as a less invasive approach for gastrointestinal
fistulas with favorable results, it is not as effective for refractory
rectovaginal fistulas. As a
minimally invasive surgical procedure, this approach might be effective in small
rectovaginal fistulas, particularly refractory ones.