A Case of Postoperative Pouch-Vaginal Fistula of Ulcerative Colitis Successfully Treated with Estriol Vaginal Tablet.

Abstract

Introduction: 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.

Case presentation: 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.

Conclusion: Estriol vaginal tablets may be serve as an effective conservative treatment option for PVF following surgery for UC.