Delayed presentation of an enterocutaneous fistula after tension-free vaginal tape sling.
BACKGROUND: : Bowel injury is a rare but serious complication associated with tension-free vaginal tape (TVT) sling procedures.
CASE: : A 50-year-old woman with a previous history of pelvic surgery underwent TVT for stress urinary incontinence. Surgery and the immediate postoperative period were unremarkable; however, she returned 5 months later with bloody, purulent discharge from a suprapubic exit site. This was unresponsive to antibiotic therapy, and when the patient returned with abdominal pain and fever, a computed tomographic scan showed an enterocutaneous fistula. At the time of exploratory laparotomy, the mesh was noted to have perforated the small bowel and led to a sinus tract that communicated with the skin.
CONCLUSIONS: : Bowel perforation is a recognized, but rare, complication of TVT. This case highlights the need for a high index of suspicion for bowel injury after TVT maintained beyond the more commonly described peritonitis or obstructive symptoms presenting in the immediate perioperative period.
Female Pelvic Med Reconstr Surg
Westermann, L. B., Brown, A., & Long, J. B. (2011). Delayed presentation of an enterocutaneous fistula after tension-free vaginal tape sling.. Female Pelvic Med Reconstr Surg, 17 (5), 258-259. https://doi.org/10.1097/SPV.0b013e31823065c1