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Case report
Refractory diversion neovaginitis in a sigmoid-colon-derived neovagina: clinical and histopathological considerations
  1. WB van der Sluis1,
  2. M Bouman1,2,
  3. WJHJ Meijerink2,3,
  4. EA Neefjes-Borst4,
  5. AA van Bodegraven5,6
  1. 1Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
  2. 2Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
  3. 3Department of Gastro-Intestinal Surgery and Advanced Laparoscopy, VU University Medical Center, Amsterdam, The Netherlands
  4. 4Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
  5. 5Department of Gastroenterology, VU University Medical Center, Amsterdam, The Netherlands
  6. 6Department of Gastroenterology, ORBIS Medical Center, Sittard-Geleen, The Netherlands
  1. Correspondence to Dr Adriaan A van Bodegraven, Department of Gastroenterology, VU University Medical Center, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands; v.bodegraven{at}vumc.nl

Abstract

Colonic segments are being used as pedicled grafts in neovaginoplasty, a surgical procedure to (re)construct a (neo)vagina. A disadvantage of using colonic grafts is the potential occurrence of neovaginal complications due to diversion from the faecal stream. Here, we report a case of severe, refractory diversion colitis of the sigmoid neovagina, so-called ‘diversion neovaginitis’, in a 42-year-old woman with complete androgen insensitivity syndrome. Neovaginal biopsy specimens showed colonic-type mucosa with strong increase of lymphoplasmacellular infiltrate in the lamina propria, ulceration with fibrinoid deposition and some crypt irregularity. Endoscopy showed erythematous mucosa, superficial ulceration, mucus discharge and multiple pseudopolyp-like lesions. Local application of mesalazine foam enemas and sodium butyrate enemas initially gave symptom relief. However, this was a temporary effect, ultimately necessitating removal of the neovaginal construct. It is important that all patients are informed about neovaginal bowel complications, for example, diversion neovaginitis. Regular medical and endoscopic follow-up appears recommendable.

  • ABDOMINAL SURGERY
  • SURGICAL COMPLICATIONS
  • LAPAROSCOPIC SURGERY
  • COLORECTAL PATHOLOGY
  • COLORECTAL DISEASES

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