Modified Martius flap procedure for refractory ileal pouch-vestibular fistula: a report of three cases.

Abstract

PURPOSE:

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.

RESULTS:

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.

CONCLUSION:

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.

• Authors: Toshimitsu Araki, Yoshiki Okita, Mikio Kawamura, Satoru Kondo, Yuji Toiyama, Junichiro Hiro, Shigeyuki Yoshiyama, Keiichi Uchida, Masato Kusunoki
• Journal: International journal of colorectal disease (Int J Colorectal Dis) Vol. 32 Issue 5 Pg. 757-759 (May 2017) ISSN: 1432-1262 [Electronic] Germany
• PMID: 28035458 (Publication Type: Case Reports, Letter)

Topics

• Adolescent
• Adult
• Child
• Colonic Pouches
• Female
• Humans
• Intestinal Fistula (surgery)
• Surgical Flaps
• Young Adult