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Case Reports
. 2024 May 6:18:107-113.
doi: 10.2147/BTT.S457300. eCollection 2024.

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

Sota Katsube  1 , Satohiro Matsumoto  1 , Masahiro Misawa  2 , Nao Kakizawa  3 , Ryo Hashimoto  1 , Taku Mizutani  1 , Keita Matsumoto  1 , Shuhei Yoshikawa  1 , Hirosato Mashima  1
Affiliations
Case Reports

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

Sota Katsube et al. Biologics. .

Abstract

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.

Keywords: colostomy; infliximab; rectovaginal fistula; ulcerative colitis.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Abdominal CT showed continuous edematous wall thickening from the sigmoid colon to the rectum.
Figure 2
Figure 2
Abdominal MRI showed a continuous hyperintense area from the inside of the anal canal to the dorsal aspect of the vaginal wall on T2-weighted images.
Figure 3
Figure 3
Sigmoidoscopy revealed deep ulceration (arrowheads) near the dentate line (Mayo endoscopic subscore 3) but did not identify the opening of the fistula.
Figure 4
Figure 4
Gynecological examination showed rectovaginal fistula (arrowhead) on the dorsal aspect of the vagina at 1.0–1.5 cm from the vulva, with a size of 1.0 cm.
Figure 5
Figure 5
Gynecological examination confirmed the closure of rectovaginal fistula (arrowhead).
Figure 6
Figure 6
Colonoscopy showed improvement of colonic mucosal inflammation (Mayo endoscopic subscore 1). An ulcer near the dentate line was scarred (arrowheads).
See this image and copyright information in PMC

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