Background: Spontaneous development of colovaginal fistula is a rare cause of abnormal vaginal discharge in older women and most commonly arises from diverticular disease. Laparotomy for segmental colonic resection is the accepted treatment. The author found no previous reports of attempted transvaginal closure of these fistulae, although such closure of similar fistulae can sometimes be accomplished in patients with Crohn's disease when quiescence is achieved.
Case: An otherwise healthy 69-year-old female developed a colovaginal fistula as a result of diverticular disease. Resolution of all associated inflammatory changes was achieved over four months. A three-layer transvaginal closure of the fistula using the Futh technique was then performed; it was technically successful but broke down one week later.
Conclusion: Transvaginal closure of a colovaginal fistula, even with intensive preparatory efforts, cannot be recommended on the basis of this attempt.