Welcome to the ehealthforum and I am really glad to help you out. Barium enema is the primary diagnostic test for the confirmation of colovaginal fistula although its accuracy is around only 35%â50%. CT scan is another important test which has the added benefit of demonstrating associated features such as diverticulitis, abscess, or malignancy.
Other diagnostic modalities are fistulogram, vaginography, colposcopy, water-soluble contrast enema with tampon, or methylene blue enema with tampon.
Contrast enema with radiologic exam can provide greater anatomic detail than a methylene blue enema or other tests.
A colovaginal fistula rarely responds to nonoperative therapy, so defining the anatomy is very important.
The treatment is done by resection and primary anastomosis of the involved colon. The vaginal opening may be left open for drainage or sutured closed.
A malignant colovaginal fistula requires a wider resection that other types.
Transvaginal repair with loop ileostomy is the right option if you have had irradiation in the past or you have a densely scarred pelvis.
Endorectal advance flap is the preferred repair in low colovaginal fistulae or rectovaginal fistulae.
It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care.
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