Araki Toshimitsu, Okita Yoshiki, Kawamura Mikio, Kondo Satoru, Toiyama Yuji, Hiro Junichiro, Yoshiyama Shigeyuki, Uchida Keiichi, Kusunoki Masato
Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Int J Colorectal Dis. 2017 May;32(5):757-759. doi: 10.1007/s00384-016-2746-8. Epub 2016 Dec 29.
Pouch-vaginal or vestibular fistula is an uncommon, but devastating complication that occurs in women after ileal J pouch-anal anastomosis. The management of these fistulae is challenging, and it is associated with high recurrence and pouch loss rates. This report describes the use of the modified Martius flap procedure for three patients with ulcerative colitis who developed refractory pouch-vestibular fistulae.
Three patients with ulcerative colitis, who underwent total colectomy, mucosal proctectomy, and ileal pouch-anal anastomosis, developed pouch-vestibular fistulae. The fistulae originated in the pouch-anal anastomosis site in all three cases. We performed fistulectomy and transvaginal closure with sphincteroplasty followed by the modified Martius flap procedure under diversion ileostomy. No complications occurred after ileostomy closure, and the postoperative anal function was good.
The modified Martius flap procedure is among the best options for patients with ulcerative colitis who develop refractory pouch-vestibular fistula as a complication of mucosal proctectomy.
