939 Enterovaginal Fistula; Could It Be Gallstones?

This is a rare presentation of an impacted gallstone leading to a ileovaginal fistula. A 76-year old female presented with a 4 week history of faecal vaginal discharge and weight loss on a background of endometrial cancer treated with chemotherapy and radiotherapy 9 years ago. She was initially investigated with a pelvc MRI which showed a collection in the vaginal stump. A further abdominal and pelvic CT scan revealed a cholecystoduodenal fistula complicated by an ileovaginal fistula at the point of impaction. The patient underwent a laparotomy with small bowel resection and anastomosis. She was admitted to the intensive care unit post operatively and recovered well. There are no previous reports of a vaginal fistula caused by gallstone ileus. This case highlights a rare complication of gallstones in a patient who has undergone pelvic radiotherapy.

Gallstone ileus with an enterovaginal fistula: a rare complication of pelvic radiotherapy

Gallstone ileus is a rare cause of small bowel obstruction. Chronic gallstone irritation can lead to the formation of a cholecystoduodenal fistula, with gallstone impaction typically in the terminal ileum. Rarely gallstones can become impacted in other structures such as the colon or can even erode through the bowel. We present an unusual case of a gallstone ileus which resulted in the formation of an enterovaginal fistula, secondary to previous pelvic radiotherapy. Our case highlights the importance of considering fistula formation as a late complication of radiotherapy and how this can alter expected features of other pathologies, such as a gallstone ileus.