Transvaginal flexible endoscopy for bleeding arteriovenous malformation hemostasis near a vesico-rectovaginal fistula

Background and Aims

Flexible GI endoscopy has been applied in the field of gynecology. GI endoscopy is useful in diagnosing uterine cervical cancers, because high-resolution imaging using magnification enables targeted biopsies. Moreover, hemostasis for uterine cancer using GI endoscopy and hemostatic forceps, as well as the local treatment of vaginal intraepithelial neoplasia, have been achieved.

Methods

In the present case, hemostasis for arteriovenous malformation using argon plasma coagulation was attained with transvaginal endoscopy.

Results

An 85-year-old female patient presented to our hospital for admission with intermittent rectal and genital bleeding. She had previously undergone concurrent chemoradiotherapy for cancer of the uterine body, at 45 years of age. Furthermore, she had undergone a colostomy and urostomy for a vesico-rectovaginal fistula, in her 70s. The source of the bleeding could not be identified by contrast-enhanced abdominal computed tomography, cystoscopy, vaginal examination, or rectal endoscopy. Spontaneous hemostasis was achieved; nevertheless, she was readmitted to our hospital because of a recurrence of symptoms and progressively worsening anemia. Vaginoscopy revealed blood in the vagina; however, the source of bleeding was not detected, particularly by subsequent rectal endoscopy. An oozing from arteriovenous malformation near the vesico-rectovaginal fistula was identified by transvaginal endoscopy. Hemostasis was achieved, using argon plasma coagulation. No recurrence of bleeding was observed after endoscopic hemostasis. The absence of symptomatic recurrence was confirmed at the 1-month follow-up, after discharge.

Conclusions

In this case, transvaginal endoscopy revealed the source of bleeding that was in the blind spot, during rectal endoscopy. This case highlighted that further applications using flexible GI endoscopy in the field of gynecology should be investigated.