Clinical Outcome of a Rectovaginal Fistula in Crohn's Disease.
10.3393/jksc.2007.23.1.10
- Author:
Choon Sik CHUNG
1
;
Dong Keun LEE
;
Bruce D GEORGE
;
Neil J MORTENSEN
Author Information
1. Department of Surgery, Hansol Hospital, Seoul, Korea. drcschung@hanmail.net
- Publication Type:Original Article
- Keywords:
Crohn's disease;
Rectovaginal fistula;
Transanal advancement flap;
Endovaginal advancement flap;
Proctectomy
- MeSH:
Colitis;
Colitis, Ulcerative;
Crohn Disease*;
Diagnosis;
Fibrin Tissue Adhesive;
Fistula;
Follow-Up Studies;
Humans;
Infliximab;
Rectovaginal Fistula*;
Recurrence;
Sepsis
- From:Journal of the Korean Society of Coloproctology
2007;23(1):10-15
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The aim of this study is to analyze the outcome of a variety of treatments, including local surgical treatments, diverting stoma, and combined medical therapy, for patients with a rectovaginal fistula complicating Crohn's disease. METHODS: Between 1994 and 2003, twenty-one patients with a rectovaginal fistula complicating Crohn's disease from a prospectively compiled 422-patient Crohn's disease database were reviewed. RESULTS: All three patients treated by seton and fibrin glue recurred despite having relatively long tracts. Of six patients with infliximab treatment combined with a seton procedure, five patients had an improvement of their symptoms, but were not cured. Of eight patients with a transanal or endovaginal advancement flap techniques, three had successful closure, three eventually required a proctectomy, and two had a recurrent fistula without symptoms. Four (2 without any local treatments, and 2 with seton placement) of 16 patients who had a diverting stoma during treatment had successful closure. All proctectomy patients (n=8) had rectal involvement of Crohn's disease. Two patients who underwent a proctectomy with a presumptive diagnosis of ulcerative colitis and indeterminate colitis turned out to have Crohn's disease. Overall, except for the proctectomy patients, seven patients (54%) had successful closure, but six (four without symptoms, and two with symptoms) following a wide spectrum of treatments had recurrence after a mean follow-up of 44 months. CONCLUSIONS: Combining different treatments for a rectovaginal fistula in Crohn's disease can be successful in a reasonable number of cases. The presence of uncontrolled perianal sepsis and/or complicated anorectal problems is likely to lead to a proctectomy.
