Clinical Outcome of a Rectovaginal Fistula in Crohn's Disease

Chung, Choon Sik; Lee, Dong Keun; George, Bruce D; Mortensen, Neil J

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.