Restorative proctocolectomy in patients with ulcerative colitis having a recto‐vaginal fistula

Zinicola, R.; Nicholls, R. J.

doi:10.1111/j.1463-1318.2004.00606.x

Cited by 13 publications

(12 citation statements)

References 17 publications

(23 reference statements)

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“…Various complications are reported for UC, but it is deferent from CD, according to the previous reports, the frequency of rectovaginal fistula associated with UC was lower than that with CD [1-3]. Various techniques for the treatment of rectovaginal fistulas, including the loose draining seton, direct surgical repair, fistulotomy, fibrin glue instillation, endorectal or vaginal advancement flap, abdominal procedures with colorectal or coloanal anastomosis, and epiplooplasty, have been applied, according to the hole size of the fistula, their position, the sphincteric function, and their etiology [4, 5].…”

Section: Discussionmentioning

confidence: 99%

“…In IBD patients, it is more frequently observed in patients with Crohn’s disease (CD) than ulcerative colitis (UC). The incident rate of rectovaginal fistula complicating UC has been reported to be 0.5-2.2% [1, 2]. The treatment of rectovaginal fistula associated with IBD has been reported to be difficult.…”

Section: Introductionmentioning

confidence: 99%

“…The treatment of rectovaginal fistula associated with IBD has been reported to be difficult. Therefore, it often requires repeated surgical procedures to achieve complete cure, or most of the cases will finally receive an ileostomy or proctocolectomy [1]. …”

Section: Introductionmentioning

confidence: 99%

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Successful Treatment of Rectovaginal Fistula Complicating Ulcerative Colitis With Infliximab: A Case Report and Review of the Literature

et al. 2015

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Rectovaginal fistula is a rare complication of ulcerative colitis (UC) regardless of surgical history of rectum. Various surgical treatment modalities for the closure of rectovaginal fistula have been developed, but a radically curative therapy remains to be developed. Recently, infliximab, the chimeric anti-human tumor necrosis factor alpha (TNF-α) antibody, has been largely applied for the treatment of inflammatory bowel disease (IBD), and a few reports have shown its partial effectiveness in the management of rectovaginal fistulas associated with UC. In the present report, we describe the successful management of a rectovaginal fistula, following the stapled ileo-anal canal anastomosis in a UC patient, by administration of infliximab. The patient was a 40-year-old female, initially diagnosed as UC (total colitis type) at the age of 15. She received a restorative proctocolectomy at the age of 22, and developed a rectovaginal fistula at the eighth postoperative day. The surgical treatment of the fistula was repeated four times during the 10-year period, but it recurred in intervals ranging between 2 months and 5 years after the operation. The last recurrence occurred at the age of 32, but the surgical repair was considered difficult and a conservative management was indicated. At the age of 40, infusions of infliximab were started. Four weeks after the first infusion, drainage from the fistula was evidently reduced, and 2 weeks later, the fistula was completely closed. Thereafter, no recurrence of the fistula is observed, as confirmed by the abdominal magnetic resonance imaging (MRI) and the barium-enema study. From the present case, we concluded that infliximab may be an effective strategy for the management of fistulas associated with UC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Successful Treatment of Rectovaginal Fistula Complicating Ulcerative Colitis With Infliximab: A Case Report and Review of the Literature

et al. 2015

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“…Although it is difficult to determine if perianal sepsis after IPAA arises from anastomotic dehiscence or the anal gland, except for patients who are clearly diagnosed with cuff abscess, these complications may cause pouch failures regardless of their origins [27]. For these fistulae after IPAA, some treatment options, such as reestablishment of diverting ileostomy, simple closure of the fistula or fistula opening, sliding flap advancement techniques, curettage, a gracilis muscle interposition flap and fistulotomy, have been proposed [28,29]. In the worst case, these options include a permanent defunctioning ileostomy or excision of the pouch [6,20,30].…”

Section: Discussionmentioning

confidence: 99%

Full Mucosal Proctectomy Initiated below the Dentate Line May Prevent the Development of a Perianal Fistula after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Araki

Okita²,

Fujikawa³

et al. 2013

Dig Surg

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Background: Long-term functional results of ileal pouch-anal anastomosis (IPAA) with mucosal proctectomy (MP) for ulcerative colitis (UC) are satisfactory but may be compromised by perianal fistulae. Methods: We analyzed the effect of the level of MP (above or below the dentate line) on the risk of perianal fistulae in 151 patients undergoing IPAA for UC. Results: A postoperative perianal fistula occurred in 12 patients (10 with MP from the level above the dentate line and 2 below). Patients developing perianal fistulae after IPAA were significantly younger at IPAA (23 vs. 32 years, p = 0.015). Age <25 years at UC onset (hazard ratio, HR, 3.5, p = 0.041), age <30 years at IPAA (HR 4.3, p = 0.015) and MP above the dentate line (HR 4.7, p = 0.010) were significant risk factors for perianal fistulae after IPAA. Multivariate analysis showed that age <30 years at IPAA (HR 4.4, p = 0.018) and MP above the dentate line (HR 6.0, p = 0.012) were significant risk factors. Conclusion: IPAA with MP below the dentate line for UC might reduce the risk of postoperative perianal fistulae.

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“…Elles sont associées à une maladie plus sévère avec sténose rectale et ulcération profonde. Le risque de récidive après coloproctectomie est de 50 % [24].…”

Section: Frv Et Maladies Inflammatoires Chroniques Intestinales : MC unclassified

Fistules rectovaginales : classifications, clinique et examens complémentaires

Soudan¹

2007

Pelv Perineol

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Les fistules rectovaginales (FRV) sont d'étio-logies variées, dominées par les fistules postobstétricales. Leur pronostic est lié à leur anatomie et à leur étiologie. Les fistules simples intéressant la partie inférieure du vagin et en règle postobstétricales ou cryptiques sont de pronostic meilleur que les fistules plus hautes ou dues à la maladie de Crohn (MC), séquellaires de la chirurgie ou de la radiothérapie. Le diagnostic est aisé, basé sur la clinique. Les examens complémentaires sont utiles pour le bilan de la maladie causale et le bilan sphinctérien.Mots clés : Fistule rectovaginale -Déchirure obstétricale -Maladie de Crohn -Fistule postopératoire Rectovaginal fistulas: classification, clinical examination and additional assessment Abstract: Rectovaginal fistulas have various aetiologies and mainly occur as post-delivery complications. Prognosis depends on the underlying disease and the anatomy of the fistulous tract. Simple fistulas involving the lower vagina, as well as post-delivery and cryptoglandular fistulas, have better prognoses than more complex fistulas or those related to Crohn's disease, postoperative sequelae or radiation therapy. Diagnosis is straightforward and based on clinical examination. Additional imaging is only useful in assessing the anal sphincter and the underlying disease.

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Restorative proctocolectomy in patients with ulcerative colitis having a recto‐vaginal fistula

Abstract: Patients with ulcerative colitis and a recto-vaginal fistula can be successfully treated by restorative proctocolectomy, nevertheless they are at risk of late recurrence of the fistula.

Cited by 13 publications

References 17 publications

Successful Treatment of Rectovaginal Fistula Complicating Ulcerative Colitis With Infliximab: A Case Report and Review of the Literature

Successful Treatment of Rectovaginal Fistula Complicating Ulcerative Colitis With Infliximab: A Case Report and Review of the Literature

Full Mucosal Proctectomy Initiated below the Dentate Line May Prevent the Development of a Perianal Fistula after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Fistules rectovaginales : classifications, clinique et examens complémentaires

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