A 35-year-old gender-reassigned female presented to the emergency department after several days of worsening central and right-sided abdominal pain with associated fevers and vomiting. There was no described change in bowel habit. Past surgical history consisted of open appendicectomy as a child and gender reassignment surgery 5 years prior. This colovaginoplasty had involved mobilization of the right colon and anastomosis of transverse colon to inverted penile skin to form the neovagina. Bowel continuity was maintained through a separate ileocolic anastomosis.
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