An unexpected link: A unique presentation of colovaginal fistula secondary to post-hysterectomy adhesions in an elderly patient

Abstract

Colovaginal fistulas (CVFs) are rare pathological communications between the colon and vagina, often arising from diverticulitis, malignancy, or pelvic trauma. They may initially present with nonspecific symptoms, often leading patients to seek care for a presumed urinary or gynecological issue. Clinicians should maintain a high index of suspicion for CVFs in patients with a history of pelvic surgeries, even in the absence of acute inflammatory conditions such as diverticulitis. We report the case of an 84-year-old woman with a colovaginal fistula attributed to post-hysterectomy adhesions, without evidence of diverticulitis or active inflammation. This case underscores the importance of advanced imaging in diagnosing complex fistulas and highlights the successful management with laparoscopic sigmoid colectomy and fistula repair.