Yoshimitsu Masanori, Egi Hiroyuki, Nagamatsu Shogo, Shimomura Manabu, Hakoda Keishi, Miguchi Masashi, Kohashi Toshihiko, Okajima Masazumi, Ohdan Hideki
Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi Naka-Ku, Hiroshima, 730-8518, Japan.
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
Surg Case Rep. 2020 Jul 8;6(1):166. doi: 10.1186/s40792-020-00925-7.
Rectovaginal fistula (RVF) following aluminum potassium sulfate hydrate-tannic acid (ALTA) injection therapy for hemorrhoids is a rare complication. We report the first case of RVF after ALTA injection therapy successfully treated by gluteal-fold flap.
A 49-year-old female suffered from a fever and rectal ulcer after undergoing internal hemorrhoid treatment with a submucosal ALTA injection at a previous clinic. One week after ALTA therapy, she noted obvious passage of flatus and stool through the vagina, and was diagnosed with RVF by anoscope at another clinic. She was referred to our hospital 3 weeks after ALTA therapy. Sigmoid colostomy was performed for fecal diversion as a preliminary step for fistula repair. However, the fistula was scarred and the defect between the rectum and vagina did not improve at all. Ten months after ALTA therapy, we performed fistula repair by gluteal-fold flap. Seven months later, sigmoid-colostomy reversal was performed. The patient has experienced no RVF in the 3 years since sigmoid-colostomy reversal.
The gluteal-fold flap strategy is a useful option for severe RVF management.
水合硫酸铝钾-鞣酸（ALTA）注射疗法治疗痔疮后发生直肠阴道瘘（RVF）是一种罕见的并发症。我们报告首例经臀褶皮瓣成功治疗的ALTA注射疗法后发生的RVF病例。
一名49岁女性在之前的诊所接受内痔黏膜下ALTA注射治疗后出现发热和直肠溃疡。ALTA治疗1周后，她注意到有明显的气体和粪便从阴道排出，在另一家诊所经肛门镜检查诊断为RVF。ALTA治疗3周后她被转诊至我院。作为瘘管修复的初步步骤，行乙状结肠造口术以改道粪便。然而，瘘管形成瘢痕，直肠和阴道之间的缺损完全没有改善。ALTA治疗10个月后，我们采用臀褶皮瓣进行瘘管修复。7个月后，行乙状结肠造口还纳术。自乙状结肠造口还纳术以来的3年里，患者未再发生RVF。
臀褶皮瓣策略是严重RVF治疗的一种有效选择。
