To demonstrate a laparoscopic approach to managing a colo-ovarian fistula.
Narrated video outlining surgical technique.
Colo-ovarian fistulas are a rare entity with a lack of systematized evidence to guide
surgical treatment.1-3 Available case reports describe open en-bloc resection of the colon and adnexal organs
with colorectal anastomosis.3 We present a case of a colo-ovarian fistula managed laparoscopically with discoid
resection of the fistulous tract, a technique used for rectosigmoid endometriosis.4
A 51-year-old G0 presented with fevers, leukocytosis, and CT imaging showing a peripherally-enhancing
adnexal complex highly suspicious for tubo-ovarian abscess that was refractory to
antibiotics and interventional-radiology guided drainage. The patient elected for
definitive surgery with hysterectomy, bilateral salpingo-oophorectomy, and indicated
Preoperatively, there was no evidence of gastrointestinal tract involvement but intraoperatively,
a colo-ovarian fistula was discovered. General surgery was consulted for en-bloc resection,
but given the small size of the fistula and absence of acute inflammation, a discoid
resection was deemed a possible alternative.
This video highlights:
1. Lysis of adhesions to restore normal anatomy
2. Identification of avascular spaces to secure uterine arteries at the origin
3. Excision of the fistula with an advanced bipolar device enabling surgeon control
of energy dispersed prior to cutting
4. Two-layer closure reapproximating bowel with bubble-test to ensure airtight repair
Postoperatively, there were no complications. The final pathology confirmed tubo-ovarian
abscess, endometriosis, and a fistulous tract.
Colo-ovarian fistulas are rare with little to guide surgical treatment. This video
demonstrates a laparoscopic alternative to open en-bloc resection of the colon and