Rectovaginal fistula in Crohn's disease

Abstract

Low rectovaginal fistulas occur in Crohn''s disease but are not common. As with other manifestations of anorectal Crohn''s disease, their incidence is directly proportional to the closeness of the diseased segment of bowel to the anus. Rectovaginal fistula in Crohn''s disease signifies a bad prognosis. The fistula will not heal when treatment is limited to either medical treatment or proximal diversion of the fecal stream. Direct surgical treatment is reserved for those patients whose symptoms are unacceptable despite medical treatment. In nearly all of these cases, ileostomy and abdominoperineal excision are necessary. A few cases may be repaired when the rectal segment is normal and other conditions are favorable.