Reconstruction of a completely obstructed rectosigmoid vaginal introitus in a transgender woman

Abstract

Rectosigmoid vaginoplasty is a frequently used surgical method in male-to-female sex reassignment surgery. However, severe side effects, such as sepsis, may occur owing to stricture, mucorrhea, and rectovaginal fistula. Herein, we present the case of a 29-year-old patient who underwent complete reconstruction of an obstructed rectosigmoid vaginal orifice. The patient had undergone male-to-female sex reassignment surgery with rectosigmoid vaginoplasty 8 years previously. The vaginal introitus was completely obstructed, and mucous secretions of the rectum remained in the blind pouch. Therefore, she developed several complications, including panperitonitis, sepsis, and repeated obstruction. We performed complete resection of the scar and reconstructed the orifice of the neovagina using a pudendal thigh island flap. The patient's life-threatening condition subsided with the successful release of the vaginal orifice. Vaginal orifice stricture is a frequent complication of rectosigmoid vaginoplasty. A pudendal thigh flap can be used to effectively and safely release this stricture and reconstruct the neo-orifice of the rectosigmoid vagina without recurrence.