Rectovaginal fistula in Crohn's disease |
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Authors: | Jeffrey L Cohen MD James W Stricker MD Dr David J Schoetz Jr MD John A Coller MD Malcolm C Veidenheimer MD |
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Institution: | (1) Department of Colon and Rectal Surgery, Lahey Clinic Medical Center, 41 Mall Road, 01805 Burlington, Massachusetts;(2) Present address: 85 Seymour Street, Suite 425, 06106 Hartford, Connecticut;(3) Present address: San Francisco-Kaiser, 2200 O'Farrell Street, 94115 San Francisco, California |
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Abstract: | Rectovaginal fistulas in the setting of Crohn's disease present a difficult management dilemma. Some patients with this problem
require proctocolectomy, yet other patients with minimal symptoms never require an operation for treatment of the rectovaginal
fistula. For a small percentage of patients, local surgical repair of the fistula may be warranted. Since 1980, this study
has attempted local repair in seven patients with symptomatic rectovaginal fistulas from Crohn's disease. Five patients underwent
staged repair of the fistula. Closure of the colostomy was eventually possible in three of these patients. Two of the three
patients have had no evidence of recurrence at followup in excess of two years. The third patient required an ileostomy for
intestinal disease and had no recurrence of the fistula. Two patients underwent primary repair of the rectovaginal fistula
without fecal diversion; in one of these patients, the fistula recurred ten days after operation, necessitating a diverting
ileostomy. The other patient remains cured 26 months after repair. The results of this review indicate that in the setting
of quiescent rectal disease, an attempt to repair the fistula can be expected to have a reasonable chance of success. The
presence of a rectovaginal fistula in a patient with Crohn's disease does not mandate removal of the rectum.
Poster presentation at the meeting of the American Society of Colon and Rectal Surgeons, Anaheim. California, June 12 to 17,
1988. |
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Keywords: | Rectovaginal fistula Crohn's disease |
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