An Unusual Complication of Gluteal Fistula after Sacrospinous Ligament Suspension: A Case Report

Background: Sacrospinous ligament suspension (SSLS), also referred to as sacrospinous ligament fixation, is a well-established transvaginal procedure performed to treat apical prolapse. Serious complications are uncommon following SSLS, and mild infectious complications, such as cystitis, are most common. In this report, we present an uncommon case of gluteal fistula as a complication of this procedure. Case: A multiparous 48-year-old with a history of vaginal hysterectomy with bilateral salpingectomy, anterior and posterior colporrhaphy, and sacrospinous ligament suspension presented one year later with multiple emergency department visits for gluteal abscesses and continuous right gluteal drainage. MRI confirmed a gluteal fistula extending from the sacrum to the right gluteal fold and right piriformis muscle, thought to be caused by retained suture. The patient subsequently underwent an exam under anesthesia in which the reproduction of the vaginal dissection performed to place the SSLS sutures and probing of the fistula failed to expose any suture. The fistula was copiously irrigated with antibiotic solution, and on a 2-week post- operative visit, the fistula was noted to be completely healed. Conclusion: This is a rare case of gluteal fistula as a complication of SSLS procedure. In this case, the suspected retained suture causing the fistula was not identified; however, the fistula was still able to heal.