Post written by Omar Sadiq, MD, from the Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan.

We present a case of a 70-year-old woman who developed a colovaginal fistula following debulking surgery for stage 3 ovarian carcinoma. She refused further surgical intervention, and endoscopic interventions such as over-the-scope clips and endoscopic suturing were not successful. She was highly symptomatic from her fistula, and we attempted off-label use of a cardiac septal occluder (CSDO) to close her fistula.

While other cases have reported the use of CSDO for treatment of other fistulas in the GI tract, this is the first case report to our knowledge of a successful closure of a colovaginal fistula. We also emphasized the deployment of the CSDO and attempted to make the process easily replicable by readers/viewers.

This video demonstrates the application of an emerging technique for fistula closure in a unique scenario. Beyond that, however, this case illustrates how informed consent and shared decision making must always accompany such novel applications of medical techniques. Our patient had failed prior endoscopic closure methods and was adamant about avoiding further surgery. Only after extensive discussion with the patient regarding risks and benefits did we proceed with this endoscopic intervention. This process is paramount for balancing the advancement of medical therapies while maintaining focus on patient safety and autonomy.

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