Ileal interposition reconstruction for ileo-rectal fistula following sex reassignment surgery: A case report

INTRODUCTION: Ileorectal fistulas following sigmoid colon vaginoplasty are rare. Reports on the management of the surgical complications of sex reassignment operations among transgender patients are few. PRESENTATION OF CASE: A 40-year-old patient with a male-to-female sex identity disorder underwent sigmoid vaginoplasty for sex reassignment 4 months prior to presentation. The patient was referred for persistent diarrhea and postoperative lower abdominal pain. Proctoscopy, gastrografin enema, and small bowel enterography revealed rectal anastomotic stenosis and an ileorectal fistula. The prior anastomotic site and ileal rectal fistula were resected, and ileal interposition reconstruction was performed to avoid damaging the blood supply to the artificial vagina. Routine follow-up after the closure of the diverting ileostomy showed no new pathologies. DISCUSSION: This case highlighted the management of surgical complications after sex reassignment surgery. CONCLUSION: Ileal interposition was a useful reconstruction method after resecting the colonic anastomotic site to preserve the artificial vagina.