ABSTRACT
Crohn’s disease (CD) is a chronic inflammatory disease that may occur anywhere in the alimentary tract with a variable clinical course and that is characterised by a tendency to form stenosis and/or fistulas with adjacent strictures. Rectovaginal fistulas (RVFs) occur in up to 10% of women with CD and are more common in the presence of perianal and colorectal disease. RVF is a devastating condition that negatively impacts the woman’s quality of life and continues to be the most difficult perianal manifestation of CD to treat. The introduction of anti-TNF therapy has been a major advance in the treatment of fistulising CD and has completely altered treatment strategies for perianal disease. W. B. Gaertner et al showed that pre-operative anti-TNF therapy significantly reduced the prevalence of proctitis at the time of surgery. Early faecal diversion may be proposed only in patients with active proctitis refractory to anti-TNF.
