Case Report: Treatment for Rectovaginal Fistula in Crohn's Disease Using Fractionate CO 2 Vaginal Laser with Anti-TNF Therapy

Abstract

Background:

Rectovaginal fistulas (RVFs) are defined as any connection between the anorectum and the vagina. They can have several causes, being Crohn's disease, the second leading cause of RVFs, responsible for ∼10% of the RVFs. Despite the advances in surgical and clinical treatment, there is no consensus regarding the best line of treatment.

Objective:

To report another therapeutic option, we describe the case of a patient with Crohn's disease and RVF refractory to anti-tumor necrosis factor (TNF) therapy, submitted to intravaginal CO₂ fractional laser treatment.

Materials and methods:

Three laser sessions with monthly interval and analysis by clinical examination, sexual evaluation questionnaire, and magnetic resonance of the pelvis were performed.

Results:

We obtained an important improvement of the symptoms and of the dimension of the fistulous path.

Conclusions:

We believe this method to be a complementary, promising, and safe therapeutic alternative for the management of vaginal fistula. Future studies using this therapeutic strategy are needed to confirm the efficacy of this method in this clinical setting.