Therapy of pessary-induced rectovaginal fistula and pelvic organ prolapse in elderly patients by vaginal approach and modified LeFort colpocleisis: a case series



Pelvic organ prolapse (POP) presents a common benign condition in women associated with reduced quality of life (QoL). The use of pessaries is considered a first-line treatment of POP. However, pessaries can cause perforations into adjacent organs resulting in fistulas. We present a series of three cases of rectovaginal fistulas (RVF) due to pessary perforation.


Three consecutive cases of pessary-induced RVF in patients with POP stage IV were assessed between September 2016 and September 2019. Consensus for therapeutic strategy was reached by an interdisciplinary board.


The RVF were located in the posterior vaginal wall and had a diameter of up to 60 mm. In one of three patients, a two-step approach was chosen with the ostomy being performed at the same time as fistula closure and modified LeFort colpocleisis. It was followed by ostomy closure 3 months later. In two patients, a three-step approach was chosen with the ostomy performed separately due to a local tissue inflammation around RVF. Neither fistula nor POP recurrences have occurred so far.


Combined temporary gastrointestinal diversion, RVF closure and POP therapy can be performed as a two- or three-stage approach. Lack of evidence and standardized algorithms in RVF therapy make further clinical studies essential. We encourage the preoperative assessment of any case of complex rectovaginal fistula by an interdisciplinary board for determining an individualized treatment.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. 1.

    Barber MD (2016) Pelvic organ prolapse. BMJ 354:i3853.

    Article  Google Scholar 

  2. 2.

    Swift SE (2000) The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol 183(2):277–285.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Trowbridge ER, Fultz NH, Patel DA, DeLancey JO, Fenner DE (2008) Distribution of pelvic organ support measures in a population-based sample of middle-aged, community-dwelling African American and white women in southeastern Michigan. Am J Obstet Gynecol 198(5):548e541–546.

    Article  Google Scholar 

  4. 4.

    Hill AM, Pauls RN, Crisp CC (2019) Practice patterns regarding apical support procedures at time of hysterectomy for pelvic organ prolapse. Female Pelvic Med Reconstr Surg.

    Article  PubMed  Google Scholar 

  5. 5.

    Tulikangas P (2019) Pelvic organ prolapse: ACOG practice bulletin summary, number 214. Obstet Gynecol 134(5):1124–1127.

    Article  Google Scholar 

  6. 6.

    Torbey MJ (2014) Large rectovaginal fistula due to a cube pessary despite routine follow-up; but what is 'routine'? J Obstet Gynaecol Res 40(11):2162–2165.

    Article  PubMed  Google Scholar 

  7. 7.

    Yimphong T, Temtanakitpaisan T, Buppasiri P, Chongsomchai C, Kanchaiyaphum S (2018) Discontinuation rate and adverse events after 1 year of vaginal pessary use in women with pelvic organ prolapse. Int Urogynecol J 29(8):1123–1128.

    Article  PubMed  Google Scholar 

  8. 8.

    Arias BE, Ridgeway B, Barber MD (2008) Complications of neglected vaginal pessaries: case presentation and literature review. Int Urogynecol J Pelvic Floor Dysfunct 19(8):1173–1178.

    Article  PubMed  Google Scholar 

  9. 9.

    Cichowski S, Rogers RG (2013) Nonsurgical management of a rectovaginal fistula caused by a Gellhorn pessary. Obstet Gynecol 122(2 Pt 2):446–449.

    Article  PubMed  Google Scholar 

  10. 10.

    Powers K, Grigorescu B, Lazarou G, Greston WM, Weber T (2008) Neglected pessary causing a rectovaginal fistula: a case report. J Reprod Med 53(3):235–237

    PubMed  Google Scholar 

  11. 11.

    Reisenauer C, Huebner M (2017) Recto-vaginal fistula after pessary therapy. Arch Gynecol Obstet 295(5):1289–1290.

    Article  PubMed  Google Scholar 

  12. 12.

    Rubin R, Jones KA, Harmanli OH (2010) Vaginal evisceration during pessary fitting and treatment with immediate colpocleisis. Obstet Gynecol 116(Suppl 2):496–498.

    Article  PubMed  Google Scholar 

  13. 13.

    Reisenauer C, Oberlechner E, Schoenfisch B, Wallwiener D, Huebner M (2013) Modified LeFort colpocleisis: clinical outcome and patient satisfaction. Arch Gynecol Obstet 288(6):1349–1353.

    Article  PubMed  Google Scholar 

  14. 14.

    Reisenauer C, Wallwiener D (2011) Treatment of recurrent vaginal eversion after previous Le Fort colpocleisis. Int J Gynaecol Obstet 114(2):161–162.

    Article  PubMed  Google Scholar 

  15. 15.

    DeLeon MF, Sapci I, Akeel NY, Holubar SD, Stocchi L, Hull TL (2019) Diverticular colovaginal fistulas: what factors contribute to successful surgical management? Dis Colon Rectum 62(9):1079–1084

    Article  Google Scholar 

  16. 16.

    Fu J, Liang Z, Zhu Y, Cui L, Chen W (2019) Surgical repair of rectovaginal fistulas: predictors of fistula closure. Int Urogynecol J 30(10):1659–1665.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Ryoo SB, Oh HK, Ha HK, Han EC, Kwon YH, Song I, Moon SH, Choe EK, Park KJ (2019) Outcomes of surgical treatments for rectovaginal fistula and prognostic factors for successful closure: a single-center tertiary hospital experiences. Ann Surg Treat Res 97(3):149–156.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Ambe PC, Kurz NR, Nitschke C, Odeh SF, Moslein G, Zirngibl H (2018) Intestinal Ostomy. Dtsch Arztebl Int 115(11):182–187.

    Article  PubMed  Google Scholar 

  19. 19.

    Caricato M, Ausania F, Ripetti V, Bartolozzi F, Campoli G, Coppola R (2007) Retrospective analysis of long-term defunctioning stoma complications after colorectal surgery. Colorectal Dis 9(6):559–561.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Robertson I, Leung E, Hughes D, Spiers M, Donnelly L, Mackenzie I, Macdonald A (2005) Prospective analysis of stoma-related complications. Colorectal Dis 7(3):279–285.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Guenaga KF, Lustosa SA, Saad SS, Saconato H, Matos D (2007) Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Cochrane Database Syst Rev 1:CD004647.

    Article  Google Scholar 

  22. 22.

    Gynecologists TACoOa, Society TAU (2019) Pelvic organ prolapse. Female Pelvic Med Reconstr Surg 25(6):397–408.

    Article  Google Scholar 

  23. 23.

    Carberry CL, Tulikangas PK, Ridgeway BM, Collins SA, Adam RA (2017) American urogynecologic society best practice statement: evaluation and counseling of patients with pelvic organ prolapse. Female Pelvic Med Reconstr Surg 23(5):281–287.

    Article  Google Scholar 

Download references


The authors state that no funding was involved.

Author information




PW: data collection or management, data analysis, manuscript writing/editing. JR: manuscript writing/editing. CF and AK: manuscript writing/editing, data collection or management. CR: protocol/project development, data collection or management, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Christl Reisenauer.

Ethics declarations

Conflict of interest

The authors state no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wilhelm, P., Rolinger, J., Falch, C. et al. Therapy of pessary-induced rectovaginal fistula and pelvic organ prolapse in elderly patients by vaginal approach and modified LeFort colpocleisis: a case series. Arch Gynecol Obstet 302, 283–287 (2020).

Download citation


  • Pelvic organ prolapse
  • Pessary therapy
  • Rectovaginal fistula
  • Colpocleisis
  • Prolapse therapy