Surgical treatment of dorsocaudal dislocation of the vagina after excision of the rectum

Abstract

Retained menstrual blood, colpitis, chronic discharge from the vagina, and dyspareunia are not uncommon symptoms after proctectomy. In patients suffering from this syndrome, the vaginal drainage is impaired because of a pouch caused by adhesions formed between the coccyx and the vagina, and an angulation of the upper part of the vagina. Surgical treatment consists of extirpation of the coccyx, separation of the posterior fornix from the lower part of the sacrum, and interposition of muscle flaps from the right and left gluteus maximus muscle, which shifts the vagina to a more vertical position. The authors report the results of this procedure in nine women observed for more than two years. Wound infection occurred in two patients, and one underwent a second operation because of relapsing symptoms. Eight patients were relieved of impaired drainage of the vagina; one patient empties her menstrual blood by straining. Dyspareunia disappeared in all patients. The operation can be recommended in patients with “the horizontal vagina syndrome.”