The Management of Rectovaginal Fistulas in Patients with Inflammatory Bowel Disease

Rectovaginal fistulas (RVF) pose a significant treatment challenge. Inflammatory bowel disease, particularly Crohn's disease, is the second leading cause of these types of fistulas. Approximately one-third of all the patients with Crohn's disease will have perianal manifestations, including RVFs at some point in their lives. The choice of treatment is dependent on the complexity of the fistula, the severity of the symptoms, the coexisting anorectal disease, and the degree of impairment of the patient's quality of life. As a general principle, Crohn's disease, including its perianal manifestations, preferably should be treated medically with surgical treatment being reserved for patients with refractory disease, debilitating symptoms, and significant impairment of quality of life. In this review we discuss the medical and surgical treatment of RVF in patients with inflammatory bowel disease.