{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:47:30Z","timestamp":1782283650329,"version":"3.54.5"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rectovaginal fistula (RVF) secondary to migrated intrauterine device (IUD) is an extremely rare complication, and high-level RVF with multiple prior failed IUD removal attempts remains a formidable clinical challenge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a 43-year-old female who presented with vaginal fecal discharge for 3\u202fweeks. She underwent insertion of an oval metallic IUD in 2014, which was confirmed to have migrated during induced abortion, and had a failed laparoscopic-hysteroscopic IUD removal attempt in 2022. During that attempt, intraoperative findings revealed the IUD had migrated to the left pelvic floor; however, the procedure was terminated due to concerns regarding the complex surrounding tissue structure and the surgeon\u2019s technical limitations at a smaller-scale hospital, as the patient was not experiencing significant physical discomfort at that time. Preoperative examinations revealed a 1-cm fistula at the posterior vaginal fornix and an annular metallic IUD embedded in the anterior rectal wall 8\u202fcm from the anal verge. After multidisciplinary consultation, the patient underwent laparoscopic proctectomy, combined transabdominal-transvaginal rectovaginal fistula repair, and temporary ileostomy. The operation was uneventful, and no postoperative complications occurred. Ileostomy closure was performed at 3\u202fmonths postoperatively, and no fistula recurrence, fecal incontinence, or other adverse events were observed during the 6-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The combined laparoscopic transabdominal-transvaginal approach is a safe and effective surgical option for high-level RVF secondary to migrated IUD, offering the advantages of precise exposure, minimal trauma, and low recurrence risk. This case highlights the importance of long-term follow-up after IUD insertion and the value of multidisciplinary collaboration in managing complex pelvic fistulas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1863833","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:56:18Z","timestamp":1782280578000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Minimally invasive surgical management of a complex high rectovaginal fistula caused by long-term retained and migrated intrauterine device"],"prefix":"10.3389","volume":"13","author":[{"given":"Ziwen","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Coloproctology, The Affiliated Guangzhou Hospital of TCM of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyin","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Coloproctology, The Affiliated Guangzhou Hospital of TCM of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haixia","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanqing","family":"Lu","sequence":"additional","affiliation":[{"name":"Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"goae068","DOI":"10.1093\/gastro\/goae068","article-title":"Laparoscopic fistula repair for high-level rectovaginal fistula by combined transabdominal-transvaginal approach: a case report","volume":"12","author":"Luo","year":"2024","journal-title":"Gastroenterol Rep (Oxf)"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1007\/s00384-011-1259-8","article-title":"Laparoscopic fistula excision and omentoplasty for high rectovaginal fistulas: a prospective study of 40 patients","volume":"26","author":"van der Hagen","year":"2011","journal-title":"Int J Color Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"6421","DOI":"10.3390\/jcm12196421","article-title":"Perioperative factors affecting the healing of rectovaginal fistula","volume":"12","author":"Satora","year":"2023","journal-title":"J Clin Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1186\/s12884-022-04681-4","article-title":"Intrapartum versus postpartum insertion of intrauterine device in women delivering by cesarean section","volume":"22","author":"Abdel-Ghany","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/j.bpobgyn.2014.05.004","article-title":"The intrauterine device and the intrauterine system","volume":"28","author":"Stephen Searle","year":"2014","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s10397-017-1032-2","article-title":"Clinical characteristic and intraoperative findings of uterine perforation patients in using of intrauterine devices (IUDs)","volume":"15","author":"Sun","year":"2018","journal-title":"Gynecol Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"109515","DOI":"10.1016\/j.ijscr.2024.109515","article-title":"Intrauterine device migration resulting in acute appendicitis: a case report","volume":"117","author":"Sebai","year":"2024","journal-title":"Int J Surg Case Rep"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1148\/rg.322115068","article-title":"Migration of intrauterine devices: radiologic findings and implications for patient care","volume":"32","author":"Boortz","year":"2012","journal-title":"Radiographics"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"41","DOI":"10.2147\/OAJC.S458156","article-title":"Migration of intra-uterine devices","volume":"15","author":"Verstraeten","year":"2024","journal-title":"Open Access J Contracept"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1186\/1752-1947-8-81","article-title":"Sigmoid colocolic fistula caused by intrauterine device migration: a case report","volume":"8","author":"Weerasekera","year":"2014","journal-title":"J Med Case Rep"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"107610","DOI":"10.1016\/j.ijscr.2022.107610","article-title":"Rare case of rectal perforation by an intrauterine device: case report and review of the literature","volume":"99","author":"Boushehry","year":"2022","journal-title":"Int J Surg Case Rep"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e231410","DOI":"10.1136\/bcr-2019-231410","article-title":"Endoscopic removal of an incidentally discovered intrauterine contraceptive device eroding into the rectum","volume":"12","author":"Al Sahaf","year":"2019","journal-title":"BMJ Case Rep"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e11512","DOI":"10.1097\/MD.0000000000011512","article-title":"Migration of a foreign body to the rectum: a case report and literature review","volume":"97","author":"Ye","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1097\/DCR.0000000000002473","article-title":"The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula","volume":"65","author":"Gaertner","year":"2022","journal-title":"Dis Colon Rectum"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1007\/s10151-021-02417-8","article-title":"Single incision modified Martius flap for rectovaginal fistula","volume":"25","author":"Kajohnwongsatit","year":"2021","journal-title":"Tech Coloproctol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1007\/s00384-017-2784-x","article-title":"Treatment of rectovaginal fistula with gracilis muscle flap transposition: long-term follow-up","volume":"32","author":"Park","year":"2017","journal-title":"Int J Color Dis"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e83036","DOI":"10.7759\/cureus.83036","article-title":"Intrauterine device migration into the rectum: a case report","volume":"17","author":"Alrowili","year":"2025","journal-title":"Cureus"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e101538","DOI":"10.7759\/cureus.101538","article-title":"Laparoscopic Management of a Migrated Intrauterine Device Causing a partial-thickness rectal injury diagnosed following contraceptive failure: a case report","volume":"18","author":"Kassa","year":"2026","journal-title":"Cureus"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"9362962","DOI":"10.1155\/2018\/9362962","article-title":"Retained intrauterine device (IUD): triple case report and review of the literature","volume":"2018","author":"Cheung","year":"2018","journal-title":"Case Rep Obstet Gynecol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1863833\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:56:20Z","timestamp":1782280580000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1863833\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":19,"alternative-id":["10.3389\/fmed.2026.1863833"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1863833","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]},"article-number":"1863833"}}