Embolization - An optional treatment for intractable hemorrhage from a malignant rectovaginal fistula - Report of a case

PURPOSE: Patients rarely have intractable hemorrhage from rectovaginal fist ulas, which usually require surgical intervention. This report presents our experience with nonsurgical treatment of a high-risk patient with uncontro lled hemorrhage originating from a malignant rectovaginal fistula. METHODS: A 74-year-old female developed uncontrolled hemorrhage from a malignant re ctovaginal fistula. Because of her poor physical condition, an embolization with metal clips of the right and left hypogastric arteries was performed, distal to the superior gluteal artery. RESULTS: Embolization was successfu l in controlling the rectovaginal bleeding, allowing the patient to live 12 months. She refused adjuvant radiotherapy or chemotherapy. CONCLUSIONS: Se lective angiography and embolization is a worthwhile alternative in patient s with uncontrolled bleeding from a malignant rectovaginal fistula who are poor candidates for surgical intervention.