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Gluteal-sacrospinous-vaginal fistula as a complication of sacrospinous ligament fixation after a vault prolapse: A case report

Background: Vault prolapse has a negative impact on women’s quality life as a result of associated ano-rectal, urinary and coital dysfunctions. One of the most common surgical procedures for the treatment of vault prolapse is sacrospinous ligament fixation. In this report we present an uncommon case of a gluteal-sacrospinous-vaginal fistula complication after this procedure. Case presentation: A 63-year-old woman with a history of multiple procedures to repair vault prolapse and cystocele was referred to our institution with a nodule 5 X 4 cm in the left buttock. Magnetic Resonance Imaging and endoanal ultrasound confirmed an extrasphincteric gluteal-sacrospinous-vaginal fistula with purulent drainage in her vagina. A multidisciplinary approach was performed with Urogynecology, traumatology and colorectal surgeon. A fistulectomy was executed successfully. Posterior controls revealed an asymptomatic patient. Conclusions: This case report revealed an uncommon complication of sacrospinous fixation and the importance of a multidisciplinary approach and treatment with notable results. Keywords: complication; sacrospinous fixation; fistula; pelvic organ prolapsed; abscess; gynaecology; mesh. Abbreviations: POP: Pelvic Organ Prolapse; MRI: Magnetic Resonance Imaging; cm: centimetre.