Hashimoto Yuhei, Koyama Fumikazu, Iwasa Yosuke, Takagi Tadataka, Fujimoto Kosuke, Tamura Takashi, Ejiri Goki, Yoshikawa Chihiro, Sho Masayuki
Department of Surgery, Nara Medical University, Kashihara, Japan.
Division of Endoscopy, Nara Medical University Hospital, Kashihara, Japan.
Inflamm Intest Dis. 2025 May 15;10(1):151-154. doi: 10.1159/000546361. eCollection 2025 Jan-Dec.
Ileal pouch-vaginal fistula (PVF) is a severe complication that can occur following surgery for ulcerative colitis (UC). Most cases of PVF are managed surgically, and reports on successful closure through conservative treatment alone are limited. We report the first documented case of PVF closure without stoma formation, successfully treated with antibiotics and estriol vaginal tablets.
A 65-year-old woman was diagnosed in her 50s with total colitis-type UC. She developed steroid-dependent, refractory disease, prompting the indication of infliximab therapy. However, infliximab failed to maintain remission, necessitating restorative proctocolectomy with ileal pouch-anal anastomosis followed by loop ileostomy. The postoperative course was uneventful, and the ileostomy was closed 6 months later. Two years after surgery, she developed fever, diarrhea, and vaginal discharge containing fecal fluid. The endoscopic evaluation identified a PVF secondary to pouchitis. She was admitted to the hospital, placed on fasting, and treated with antibiotics and estriol vaginal tablets. Endoscopy 18 days after initiating of estriol therapy revealed vaginal wall thickening and PVF closure, and she was subsequently discharged. Estriol vaginal tablet administration continued for 3 months, and no recurrence has been observed 9 years following surgery.
Estriol vaginal tablets may be serve as an effective conservative treatment option for PVF following surgery for UC.
回肠贮袋 - 阴道瘘（PVF）是溃疡性结肠炎（UC）手术后可能发生的一种严重并发症。大多数PVF病例通过手术治疗，仅有少数关于单纯通过保守治疗成功闭合的报道。我们报告首例有记录的未形成造口而成功闭合PVF的病例，通过抗生素和雌三醇阴道片成功治疗。
一名65岁女性在50多岁时被诊断为全结肠炎型UC。她发展为依赖类固醇的难治性疾病，促使使用英夫利昔单抗治疗。然而，英夫利昔单抗未能维持缓解，因此需要进行回肠贮袋肛管吻合术加回肠袢造口术的恢复性直肠结肠切除术。术后过程顺利，6个月后关闭回肠造口。手术后两年，她出现发热、腹泻和含有粪便样液体的阴道分泌物。内镜评估发现继发于贮袋炎的PVF。她入院后禁食，并接受抗生素和雌三醇阴道片治疗。开始雌三醇治疗18天后的内镜检查显示阴道壁增厚且PVF闭合，随后她出院。继续给予雌三醇阴道片3个月，手术后9年未观察到复发。
雌三醇阴道片可能是UC手术后PVF的一种有效的保守治疗选择。
