Complicated rectovaginal fistula secondary to Bartholin’s cyst infection Haydar A. Nasser 1 , Vanessa Marron Mendes 1 , Farah Zein 2 , Bassem Y. Tanios 2 and Tarek Berjaoui 2 1 Free University of Brussels, Faculty of Medicine, Brussels, Belgium; and 2 American University of Beirut, Faculty of Medicine, Beirut, Lebanon Abstract Rectovaginal fistula formation secondary to Bartholin’s cyst is a very rare complication, and to date only three cases were reported in the literature. We report a case of a 32-year-old woman who suffered recurrent episodes of Bartholin’s cyst infection with subsequent abscess formation that resulted in rectovaginal fistula formation. We treated her initially with transperineal repair; however, the fistulous tract recurred a month later. A laparoscopic colostomy and transperineal repair using biological graft was then performed, with excellent results. The patient underwent reversal of colostomy after 2 months, and remained asymptomatic upon follow-up 12 months later. Key words: Bartholin’s cyst, Bartholin’s cyst abscess, benign disease of vulva and vagina, biological mesh, rectovaginal fistula, transperineal repair. Introduction Described by Casper Bartholin in 1677, 1 Bartholin’s glands are prone to obstruction and subsequent cyst formation in 2% of women. 2 Infection or abscess for- mation may complicate 2–5% of cases. 3,4 Most rectovaginal fistulas (RVF) arise from obstetric and vaginal trauma; other causes may be related to inflammatory bowel disease, such as Crohn’s disease and ulcerative colitis. 5 Other possible causes are radia- tion proctitis, 6,7 cancer, 5 and pelvic infections. 8–11 Only a few cases of RVF secondary to Bartholin’s cyst infec- tion were reported in the literature. 12–14 Case Report A 32-year-old woman was referred to general surgery outpatient clinics because of 1-month history of passing flatus per vagina, malodorous vaginal discharge and continuous pelvic pain. The patient is G2P2A0L2 and both children were delivered vaginally; her last delivery was 2 years ago, and the post-delivery course was uneventful. However, the patient underwent multiple incision- drainage procedures for a Bartholin’s cyst infection by her gynecologist 6 months prior to her presentation to our clinic. The patient was offered a pelvic exam under general anesthesia, which revealed an RVF at 7 o’clock, with purulent discharge from the vaginal pit and induration at the level of the rectovaginal septum. Pus culture grew coliform bacteria; appropriate antibiotherapy was prescribed for the patient and she was discharged home for a scheduled follow-up in 3 weeks. Three weeks later, another pelvic exam under general anesthesia revealed persistence of the fistulous tract with resolution of the inflammatory process. The decision was to proceed with a transperineal repair. This treatment option was discussed with the patient, and she had signed the informed consent the night Received: April 24 2013. Accepted: September 8 2013. Reprint request to: Dr BassemY. Tanios,AUBMC, Department of Internal Medicine, P.O. Box: 11-0236, Riad-El-Solh Beirut 1107 2020, Beirut, Lebanon. Email: bassemtanios@gmail.com doi:10.1111/jog.12294 J. Obstet. Gynaecol. Res. Vol. 40, No. 4: 1141–1144, April 2014 © 2014 The Authors 1141 Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology