(79) Neovaginectomy and Secondary Vaginoplasty with AlloDerm Graft in a Cloaca Patient with Tubular Adenoma of the Colonic Neovagina: A Case Report

Background: Intestinal graft vaginal replacement is an alternative for vaginal reconstruction in patients born with cloacal anomalies requiring partial or total vaginal replacement. There are no consensus guidelines on cancer surveillance for patients with a colonic neovagina. Although rare, premalignant and malignant neoplasms of colonic neovagina can arise decades after reconstruction, requiring neovaginectomy and another vaginal replacement.

Case: We present a case of a 45-year-old female with a history of long common channel cloaca and partial vaginal replacement with colon at one year of age. She was diagnosed with tubular adenoma of the distal one-third of her colonic neovagina on routine screening. For management of this precancerous lesion, she underwent a partial neovaginectomy and secondary vaginoplasty with AlloDerm graft via perineal approach. Approximately 7 cm of distal colonic neovagina was removed and pathology confirmed negative margins. The patient’s post operative course was complicated by a polymicrobial pelvic and graft site infection that occurred one month post operatively. This was managed with hospital admission, serial vaginoscopies with irrigation, IV antibiotics, and debridement of the graft at the introitus.

Comments: Although rare, premalignant and malignant lesions of the intestinal neovagina can occur and routine screening should be performed on these patients. The use of AlloDerm graft is a viable option for secondary vaginoplasty if neovaginectomy is performed for neovaginal premalignant and malignant lesions.