<b>A Case of Enterovaginal Fistula After Ileoanal Canal Anastomosis for Ulcerative Colitis Successfully Treated with Kampo Medicine </b> / 日本東洋医学雑誌

Enterovaginal fistula, which causes uncontrollable symptoms such as gas release, vaginal defecation, perineal erosion, and vaginitis, markedly reduces patients' quality of life. In this report, we present a case of successful treatment for enterovaginal fistula with Kampo medicine.<br>A 62 year-old female who had ileoanal canal anastomosis for ulcerative colitis developed symptoms of gas release and defecation from the vagina. Although these symptoms had disappeared with conventional medicine previously, they recurred 7 years later. There was no medical indication for surgery because the fistula could not be located by barium enema or endoscopic examination. She, therefore, visited our outpatient clinic 1 and a half years after all conventional management had ended in vain.<br>Her symptoms were slightly improved by the administration of ifutokaogi, a Kampo formula, although they persisted. Three months after switching her prescription to another Kampo formula, goreisan, her symptoms completely disappeared.<br>In recent years, there has been no report on goreisan for the successful treatment of enterovaginal fistulae. Our case suggests that Kampo medicine can be an option for the treatment of enterovaginal fistula refractory to conventional treatments.

Enfermedad de Crohn fistulizante: manejo actual y su aplicabilidad en la realidad nacional / Fistulizing Crohn’s disease, current management and its applicability in the national reality

The development of fistulas during the evolution of Crohn’s Disease represents a severe situation that affects quality of life and requires a multidisciplinary care approach that involving gastroenterologists, surgeons and radiologists. Fistulizing Crohn’s disease can be divided in perianal and not perianal disease. Perianal disease can also be divided in simple or complicated disease depending on the fistula’s characteristics that will guide the clinical and therapeutic approach. Fistulizing not perianal disease can be internal when it communicates the bowel with other organs (colovesical, rectovaginal or enteroenteric fistulas), and external when it communicates the bowel with the abdominal wall (enterocutaneous fistula), either as a spontaneous or post-surgical phenomenon. Given the variety of fistula presentation, it is necessary to give an individualized approach, taking into account the fistula’s route, the inflammatory bowel activity, the presence of abscesses, and the nutritional status of the patient. This review is focused on the current management of fistulizing Crohn’s disease in our country.

El desarrollo de fistulas durante la evolución de la enfermedad de Crohn es una situación grave que condiciona una peor calidad de vida, así como mayor complejidad en el enfrentamiento, debiendo involucrar la colaboración multidisciplinar entre gastroenterólogos, cirujanos y radiólogos. La enfermedad fistulizante se divide en aquella que afecta la zona perianal (enfermedad perianal) y en aquella que no afecta la zona perianal. La enfermedad perianal a la vez se dividirá en simple o compleja dependiendo de las características de las fistulas, lo cual condiciona variaciones en el enfrentamiento y tratamiento. La enfermedad fistulizante no perianal se divide en interna cuando comunica al intestino con otros órganos (fistulas entero-vesicales, entero-vaginales, entero-entérico) y externas cuando se comunica al intestino con la pared abdominal (fistulas entero-cutáneas) tanto de forma espontánea como postquirúrgica. Debido a la gran diversidad de presentación de las fistulas es necesario individualizar cada grupo de trayectos fistulosos, valorar la asociación a actividad inflamatoria luminal, descartar la presencia de abscesos y valorar el estado nutricional de los pacientes para definir el manejo integral adecuado. Este artículo se centra en el manejo actual de la enfermedad de Crohn fistulizante en nuestro país.