Neovaginal Perforation in Sigmoid Vaginoplasty: An Underrecognized Complication—A Literature Review
Abstract
1. Introduction
2. Material and Methods
3. Result
3.1. Etiology and Pathophysiology
3.2. Clinical Presentation and Case Reports
3.3. Reported Cases
- Liguori et al. (2001) documented a case of acute peritonitis secondary to introital stenosis, leading to perforation of a neovagina constructed from a bowel segment [19].
- Amirian et al. (2011) reported a patient who presented with lower abdominal pain and fever [21]. CT imaging revealed free air in the retroperitoneum, and a leak through the vaginal apex was confirmed via vaginal contrast examination. This patient was successfully managed with conservative antibiotic therapy.
- Shimamura et al. (2015) described a case of neovaginal perforation complicated by an intra-abdominal abscess, where the clinical symptoms and radiologic findings were incongruent [18]. Surgical intraperitoneal drainage was performed due to concerns that the abscess might not resolve with antibiotics alone.
- Meece et al. reported two cases involving diffuse stenosis of unknown etiology, leading to ischemia and subsequent perforation of the sigmoid conduit [1]. One patient underwent midline laparotomy and was found to have multiple interloop abscesses, requiring prolonged intravenous antibiotic therapy. The second patient, who developed vaginal stenosis secondary to a high-riding perineum, required laparoscopic sigmoid conduit resection, followed by a midline incision and internal suturing of the colon flap one month postoperatively.
3.4. Diagnosis
3.5. Management Strategies
4. Discussion
5. Future Directions
6. Limitations
7. Conclusions
Funding
Data Availability Statement
Conflicts of Interest
References
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Category | Risk Factor | Potential Impact |
---|---|---|
Patient-Related Factors | MRKH syndrome or prior pelvic anomalies | Anatomical challenges and altered tissue planes may increase susceptibility |
Poor compliance with dilation protocols | Improper dilation may lead to stenosis or pressure-related trauma | |
Comorbidities (e.g., diabetes, smoking) | Impaired healing and tissue fragility | |
Surgical Factors | Excessive graft length or tension | Increased mechanical stress and risk of ischemia |
Inadequate neovaginal fixation | Higher risk of graft movement or instability | |
Ischemia or poor vascular supply | Tissue necrosis or perforation risk | |
Postoperative Factors | Introital stenosis | Distal obstruction and pressure buildup |
Traumatic intercourse or instrumentation | Direct mechanical trauma to the neovaginal wall | |
Inadequate postoperative follow-up | Delayed detection of complications |
2001 Liguori et al. [19] | 2011 Amirian et al. [21] | 2015 Shimamura et al. [18] | 2023 Meece et al. [1] | 2023 Meece et al. [1] | |
---|---|---|---|---|---|
Early complication after surgery | Total introital stenosis of the neovagina | no | Mild stenosis of the neovagina | Cellulitis and prolonged urinary retention on postoperative days 19 and 20 | Vaginal stenosis secondary to a high riding perineum |
Symptom | Colicky abdominal pain, abdominal distension, and vomiting | Lower abdominal pain and fever | Persistent abdominal pain, nausea, and vomiting | Abdominal pain, vomiting, fever, large volume of mucinous discharge, and an inability to dilate | Abdominal pain, fever, nausea, vomiting |
Onset | 1 year postoperatively | Unknown | Unknown | 1 year postoperatively | 3 years postoperatively |
Image findings | A large amount of fetid mucus in the abdominal cavity via laparoscopy |
| CT: a massive abscess occupying a significant portion of the intra-abdominal cavity |
|
|
Management | Exploratory laparotomy with primary repair | Intravenous antibiotics only | Exploratory laparotomy with primary repair | Midline laparotomy and resection of the necrotic sigmoid conduit | Laparoscopic resection of the sigmoid conduit |
Prognosis | Recurrent total stenosis of the neovaginal introitus | Fair and no complications noted | No complications related to the surgery | Without further complication | Without further complication |
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Huang, Y.-N.; You, J.-F.; Hu, C.-H. Neovaginal Perforation in Sigmoid Vaginoplasty: An Underrecognized Complication—A Literature Review. Medicina 2025, 61, 691. https://doi.org/10.3390/medicina61040691
Huang Y-N, You J-F, Hu C-H. Neovaginal Perforation in Sigmoid Vaginoplasty: An Underrecognized Complication—A Literature Review. Medicina. 2025; 61(4):691. https://doi.org/10.3390/medicina61040691
Chicago/Turabian StyleHuang, Yen-Ning, Jeng-Fu You, and Ching-Hsuan Hu. 2025. "Neovaginal Perforation in Sigmoid Vaginoplasty: An Underrecognized Complication—A Literature Review" Medicina 61, no. 4: 691. https://doi.org/10.3390/medicina61040691
APA StyleHuang, Y.-N., You, J.-F., & Hu, C.-H. (2025). Neovaginal Perforation in Sigmoid Vaginoplasty: An Underrecognized Complication—A Literature Review. Medicina, 61(4), 691. https://doi.org/10.3390/medicina61040691