Martius’ flap for recurrent perineal and rectovaginal fistulae in a patient with Crohn’s disease, endometriosis and a mullerian anomaly

Abstract

BackgroundRectovaginal fistulas represent 5% of all anorectal fistulae and are a disastrous manifestation of Crohn’s disease that negatively affects patients’ social and sexual quality of life. Treatment remains challenging for colorectal surgeons, and the recurrence rate remains high despite the numerous available options.Case presentationWe describe a 31-year-old female patient with a Crohn’s disease-related recurrent perineo-vaginal and recto-vaginal fistulae and a concomitant mullerian anomaly. She complained of severe dyspareunia associated with penetration difficulties. The patient’s medical history was also significant for a previous abdominal laparoscopic surgery for endometriosis for the removal of macroscopic nodules and a septate uterus with cervical duplication and a longitudinal vaginal septum. The patient was successfully treated using a Martius’ flap. The postoperative outcome was uneventful, and no recurrence of the fistula occurred at the last follow-up, eight months from the closure of the ileostomy.ConclusionMartius’ flap was first described in 1928, and it is considered a good option in cases of rectovaginal fistulas in patients with Crohn’s disease.The patient should be referred to a colorectal centre with expertise in this disease to increase the surgical success rate.

Rectovaginal fistula after low anterior tumour resection: modified Martius graft technique: A video vignette

“…A modified Martius technique was performed. This technique was described in 1928 by Dr Henrich Martius as a treatment for rectourethral/rectovesical fistulas [5,6]. Modification of a Martius flap to treat rectovaginal fistulas consists of the transposition of a bulbocavernosus muscle flap between the vagina and rectal wall [7].…”

Rectovaginal Fistula in Crohn's Disease: When and How to Operate?

“…It consists of the transposition of the bulbocavernosus muscle, or later modified to the labial fat pad (modified Martius flap) graft into the rectovaginal septum. The Martius flap has been used successfully in patients with RVF and CD 76 77 and a success rate of up to 50% has been reported. 78 Persistent or recurrent fecal incontinence and dyspareunia may result in view of the underlying perineal graft harvest and repair.…”

Martius flap for repair of complex rectovaginal fistulas – a video vignette

“…The patient had previously undergone four attempts at repair and already had a loop ileostomy in place. After an examination under anaesthesia to confirm the RVF and assess the local condition, we decided to perform a Martius procedure (using the bulbocavernosus muscle as an interposition graft). In the Video S1 we show and describe the details (Data S1) of Martius' flap for repair of complex rectovaginal fistulas.…”