Rectovaginal fistula is a rare complication of
ulcerative colitis (UC) regardless of surgical history of rectum. Various surgical treatment modalities for the closure of
rectovaginal fistula have been developed, but a radically curative
therapy remains to be developed. Recently,
infliximab, the chimeric anti-human
tumor necrosis factor alpha (TNF-α) antibody, has been largely applied for the treatment of
inflammatory bowel disease (IBD), and a few reports have shown its partial effectiveness in the management of
rectovaginal fistulas associated with UC. In the present report, we describe the successful management of a
rectovaginal fistula, following the stapled ileo-anal canal anastomosis in a UC patient, by administration of
infliximab. The patient was a 40-year-old female, initially diagnosed as UC (total
colitis type) at the age of 15. She received a
restorative proctocolectomy at the age of 22, and developed a
rectovaginal fistula at the eighth postoperative day. The surgical treatment of the
fistula was repeated four times during the 10-year period, but it recurred in intervals ranging between 2 months and 5 years after the operation. The last recurrence occurred at the age of 32, but the surgical repair was considered difficult and a
conservative management was indicated. At the age of 40, infusions of
infliximab were started. Four weeks after the first infusion, drainage from the
fistula was evidently reduced, and 2 weeks later, the
fistula was completely closed. Thereafter, no recurrence of the
fistula is observed, as confirmed by the abdominal magnetic resonance imaging (MRI) and the barium-enema study. From the present case, we concluded that
infliximab may be an effective strategy for the management of
fistulas associated with UC.