EP.WE.117Colovaginal fistula from neglected vaginal pessary; Fallouts from the COVID-19 pandemic

Abstract An 86 year old lady was admitted with a one week history of feeling unwell, polyuria, dysuria, urinary and faecal incontinence. She had previously been treated for recurrent UTIs by her GP. On examination she suprapubic tenderness but no peritonism. Observations revealed tachycardia 122bpm temperature 36.3*C. Inflammatory markers were raised white cell count 22.0x106/L CRP 129 mg/L. Urine cultures grew Pseudomonas aeruginosa. managed urosepsis intravenous antibiotics. Past medical included vaginal pessary uterine prolapse, congestive cardiac failure, hypertension, polymyalgia osteoporosis. lived alone package care. admission improved antibiotics however perineal due to ongoing incontinence noticed be passing faeces per vaginam. A colo-vaginal fistula suspected reviewed the gynaecologist who noted in-situ up routine appointment have it changed cancelled COVID-19 pandemic. MRI Pelvic scan confirmed 3x2cm rectovaginal fistula. general surgery team decision made defunctioned prevent episodes improve quality life. successfully laparoscopic end colostomy an uneventful post-operative period. This case highlights harms caused from cancellation appointments demonstrates rare cause