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Anovaginal and rectovaginal fistula in patients with Crohn's disease
N A Scott1, A Nair, L E Hughes
1University Department of Surgery, University of Wales College of Medicine, Heath Park, Cardiff, UK.
Insights
Anorectal-vaginal fistulas significantly worsen outcomes for women with perianal Crohn's disease, necessitating more aggressive surgical interventions like proctectomy.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Inflammatory Bowel Disease
Background:
- Perianal Crohn's disease affects a significant number of patients.
- Anorectal involvement, including fistulas, presents complex management challenges.
- Vaginal fistulas represent a specific and potentially severe complication.
Purpose of the Study:
- To investigate the impact of anorectal-vaginal fistulas on the clinical course and management of perianal Crohn's disease in women.
- To compare outcomes between patients with and without vaginal fistulas.
Main Methods:
- Prospective data collection of 67 women with perianal Crohn's disease from 1971-1991.
- Classification using the Cardiff system.
- Comparison of patient demographics, lesion characteristics, and treatment outcomes between groups with and without vaginal fistulas.
Main Results:
- No significant difference in age, disease duration, or other perianal lesions between groups.
- Anorectal-vaginal fistulas were associated with a higher incidence of distal intestinal Crohn's disease.
- Patients with vaginal fistulas required significantly more defunctioning stomas or proctectomies (18/29 vs. 13/38).
Conclusions:
- Anorectal-vaginal fistulas are linked to more extensive intestinal disease.
- The presence of a vaginal fistula adversely impacts the management and outcomes of perianal Crohn's disease.
- Aggressive surgical management is frequently required for perianal Crohn's disease with vaginal involvement.
Abstract:
Between 1971 and 1991, details of 67 women with perianal Crohn's disease were recorded prospectively using the Cardiff classification. Two groups were identified according to the presence (n = 29) or absence (n = 38) of anorectal Crohn's fistula involving the vagina. Patients in both groups were of a similar age and had had Crohn's disease for a similar period before diagnosis of perianal involvement. The incidence of associated perianal lesions, superficial ulcers, cavitating ulcers, other fistulas and strictures was not significantly different between the two groups. A greater proportion of patients with anorectal-vaginal fistulation (n = 15) had distal intestinal Crohn's disease (rectal or contiguous colorectal) compared with women with no vaginal fistulation (n = 14). A range of therapies was used to manage women with perianal Crohn's disease, from local surgery to a defunctioning stoma and/or proctectomy. Only 13 of 38 women with perianal Crohn's disease but no vaginal fistula required a defunctioning stoma or proctectomy, whereas 18 of 29 with anorectal-vaginal fistulation underwent these procedures (P < 0.05). A vaginal fistula has a considerable adverse effect on the outcome of perianal Crohn's disease.