Case Report: Minimally invasive surgical management of a complex high rectovaginal fistula caused by long-term retained and migrated intrauterine device

The article describes a case of a 43-year-old woman with vaginal fecal discharge lasting 3 weeks. The patient had a metallic intrauterine device (IUD) inserted in 2014, which migrated during induced abortion. An attempted laparoscopic-hysteroscopic IUD removal in 2022 failed due to complex tissue structures. Preoperative examinations revealed a 1 cm fistula at the posterior vaginal fornix and a metallic IUD embedded in the anterior rectal wall 8 cm from the anal verge. Following multidisciplinary consultation, the patient underwent laparoscopic proctectomy, combined transabdominal-transvaginal rectovaginal fistula repair, and temporary ileostomy. The operation was uneventful without complications. Ileostomy closure was performed 3 months postoperatively, and no fistula recurrence, fecal incontinence, or other adverse events were observed during 6-month follow-up.