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

Meyer, Jérémy; Ris, Frédéric; Parkes, Miles; Davies, Justin

doi:10.1055/s-0041-1740029

Cited by 6 publications

(6 citation statements)

References 105 publications

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“…10 The reason is that fecal diversion is thought to reduce the bacterial load around the anus and help improve healing conditions. 29 On the other hand, the presence of a large fistula and pelvic sepsis are two important predictors of failure of fecal diversion alone. 30 Therefore, after colostomy, concomitant or subsequent repair of the RVF is recommended for patients with these two risk factors.…”

Section: Discussionmentioning

confidence: 99%

Successful Fistula Closure After Treatment with Colostomy and Infliximab in a Patient with Ulcerative Colitis Complicated by Rectovaginal Fistula

Katsube,

Matsumoto,

Misawa

et al. 2024

BTT

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The patient was a 50-year-old Japanese woman who was diagnosed with total-colitis-type ulcerative colitis (UC) at the age of 26 years. She was treated with mesalazine and azathioprine, and her disease activity was well controlled. At the age of 50 years, the patient was experiencing fever, abdominal pain, diarrhea, bloody stool, and anal pain, which led to a diagnosis of a relapse of UC. Although steroid therapy was administered and tended to improve her symptoms, fecaloid vaginal discharge occurred, and rectovaginal fistula (RVF) was confirmed. Colostomy was performed, and infliximab was initiated as maintenance therapy for UC. All symptoms improved, and RVF closure was confirmed 6 months after the initiation of infliximab. To date, she has been free from relapse of UC. There have been only a few reports of UC complicated by RVF, and this condition is often difficult to treat. To the best of our knowledge, no other case of UC complicated by RVF in which the fistula was closed after treatment with colostomy and infliximab has been previously reported; thus, our report of the present case is valuable to the literature.

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Section: Discussionmentioning

confidence: 99%

Successful Fistula Closure After Treatment with Colostomy and Infliximab in a Patient with Ulcerative Colitis Complicated by Rectovaginal Fistula

Katsube,

Matsumoto,

Misawa

et al. 2024

BTT

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“…Given the fact that a couple of the mentioned algorithms for the treatment of RVF suggest fecal diversion in surgical re-do attempts, and our patient had no diverting stoma formation, we suggest the further evaluation of local MFAT-MSC application in cases of repeated surgeries in order to lower stoma formation rates, as well as to lower postoperative inflammation and pain and improve chances of any RVF surgical procedure [ 4 , 8 , 58 ].…”

Section: Discussionmentioning

confidence: 99%

“…The conservative therapeutic options for treating CD-related RVF include antibiotics and various immunomodulators such as tacrolimus, azathioprine, 6-mercaptopurine, and biologic agents. However, these treatments need a long time to reach the desired healing outcome, have severe side effects, and can lead to relapse as soon as the treatment is ceased [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. Infliximab is genetically engineered immunoglobulin 1 (IgG1), a monoclonal antibody that binds to TNFα (both to its soluble and transmembrane form) with high affinity.…”

Section: Introductionmentioning

confidence: 99%

Novel Approach in Rectovaginal Fistula Treatment: Combination of Modified Martius Flap and Autologous Micro-Fragmented Adipose Tissue

Dimova,

Erceg Ivkošić,

Brlek

et al. 2023

Biomedicines

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In this paper, we introduce an innovative therapeutic approach for managing rectovaginal fistulas (RVF), by combining the modified Martius flap and micro-fragmented adipose tissue (MFAT) enriched with mesenchymal stem cells (MSC). This novel approach aims to deal with the difficulties associated with RVF, a medically complex condition with a lack of effective treatment options. We present the case of a 45-year-old female patient with a 15-year history of Crohn’s disease (CD). During the preceding eight years, she had encountered substantial difficulties resulting from a rectovaginal fistula (RVF) that was active and considerable in size (measuring 3.5 cm in length and 1 cm in width). Her condition was accompanied by tissue alterations at both the vaginal and rectal openings. Following her admission to our hospital, the patient’s case was discussed during both surgical and multidisciplinary hospital team (IRB) meetings. The team decided to combine a modified Martius flap with autologous MFAT containing MSCs. The results were remarkable, leading to comprehensive anatomical and clinical resolution of the RVF. Equally significant was the improvement in the patient’s overall quality of life and sexual satisfaction during the one-year follow-up period. The integration of the modified Martius flap with MFAT emerges as a highly promising approach for addressing CD-related RVFs that had historically been, and still are, difficult to treat, given their often refractory nature and low healing success rates.

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“…It is well recognized that RVF constitutes one of the most debilitating and refractory manifestations of perianal CD to treat, presenting high rates of recurrence and frequent need for multiple consecutive therapies. Indeed, the decreased vascularization and the thin rectovaginal septum do not provide ideal conditions to promote healing, probably justifying the greater difficulty in obtaining complete RVF healing in patients with Crohn's disease [ 26 ]. Of note, in our series no adverse event of vaginal laser therapy was noticed.…”

Section: Discussionmentioning

confidence: 99%

Combined clinical and radiological remission of rectovaginal fistulas using fractional CO2 vaginal laser: a case series and medium-term follow-up

Drumond,

Condé,

Chebli

et al. 2023

BMC Res Notes

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Introduction Despite the advances in surgical and clinical approaches, there is no consensus regarding the best line of treatment from rectovaginal fistula (RVF). Faced with a challenging scenario in the approach of RVF, the fractional CO2 laser receives attention as a possible form of treatment. Objectives A single-center, prospective, open-label study evaluating the effectiveness and safety of laser therapy for RVF treatment. Subjects and methods The total of 15 patients was recruited at the Juiz de Fora University Hospital between August 2018 and July 2022. Inclusion criteria were presence of clinically suspects RVF of any etiology confirmed by pelvic magnetic resonance image (MRI) and gynecological examination. Five fractional CO2 laser sessions with monthly interval followed by complete evaluation through clinical examination and pelvic MRI were performed for all patients after the completion of treatment. Analysis of sexual function before and after the treatment was performed using Female Sexual Quotient (FSQ). Results The evaluation through physical examination showed no persistent inflammatory signs in the vagina for all patients. Additionally, 10 of out 15 (67.7%) patients achieved clinical remission of RVF symptoms, while 33.3% patients reported significant improvement. Of note, five patients who did not have previous sexual activity returned to regular sexual activity while seven patients who have baseline sexual activity had improvement in their sexual function as assessed by the FSQ. Three out of four ostomized patients had their ostomy reversed and remained without complains. All six patients with RVF secondary to Crohn’s disease reported a marked improvement in symptoms and sexual function. In seven (47%) patients radiological remission was confirmed by pelvic MRI. Conclusion CO2 fractional laser can be considered a promising and safe therapeutic alternative for the management of RVF.

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

Cited by 6 publications

References 105 publications

Successful Fistula Closure After Treatment with Colostomy and Infliximab in a Patient with Ulcerative Colitis Complicated by Rectovaginal Fistula

Successful Fistula Closure After Treatment with Colostomy and Infliximab in a Patient with Ulcerative Colitis Complicated by Rectovaginal Fistula

Novel Approach in Rectovaginal Fistula Treatment: Combination of Modified Martius Flap and Autologous Micro-Fragmented Adipose Tissue

Combined clinical and radiological remission of rectovaginal fistulas using fractional CO2 vaginal laser: a case series and medium-term follow-up

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