P307. The clinical course of rectovaginal fistulas in Crohn's disease since the introduction of anti TNF drugs
P. Tozer1, B. Kayani1, D. Balmforth1, R. Phillips1, A. Hart2
1St Mark's Hospital, London, United Kingdom; 2St Mark's Hospital, Gastroenterology, London, United Kingdom
Background: Rectovaginal fistulas (RVF) in patients with Crohn's disease are common and unpleasant. They frequently recur after both medical and surgical treatment. There are limited data describing the natural history of Crohn's RVF since the introduction of anti‑TNF drugs.
Methods: A retrospective review of patients with Crohn's disease and rectovaginal fistulas, seen at St Mark's hospital between 2000 and 2008 was carried out. Demographic, clinical, surgical and outcome data were obtained.
Results: Thirty seven women with Crohn's disease with a median age of 44 years (range 19–75 years) were treated for RVFs. The majority of the RVFs were small (less than 1cm) although 3 women had large (greater than 1cm diameter) openings. Crohn's rectovaginal fistulas were healed in 35% (13/37) of women, following multiple surgical and medical interventions. Surgery healed half (6/13) of these fistulas with others palliated by seton insertion or a defunctioning stoma. Only half (6/13) the stomas created were reversed. Medical interventions induced improvement in patients' symptoms but healing occurred in only 7 women and side effects, although mostly minor, were common.
Conclusions: Rectovaginal fistulas still represent a difficult problem for clinicians and are unpleasant for patients. Current medical and surgical approaches are inadequate with two thirds of patients experiencing ongoing unhealed fistulas.