COMPLEX PERIANAL FISTULA COMPLICATED BY RECTOVAGINAL FISTULA TREATED WITH MESENCHYMAL CELLS

Case Presentation A 44-year-old female patient with a history of complex perianal and rectovaginal fistula was initially diagnosed in December 2021 with a perianal abscess, which required drainage under anesthesia. In May 2022, an MRI revealed a complex perianal fistula complicated by a rectovaginal fistula, though no external opening was observed at the time. In December 2023, the patient presented with an external fistula opening, confirmed by a new MRI performed in September 2023, which aligned with physical examination findings of the fistulous tract. Treatment was initiated in January 2024 using autologous mesenchymal cells, which were collected, processed, and applied during the same procedure. At the 10-day follow-up, the patient exhibited a small amount of secretion, which was considered a normal postoperative finding. At the 120-day follow-up, anoscopy findings were normal. After 150 days, a follow-up MRI showed fibrotic scar tissue with no evidence of fistulas.

Discussion Rectovaginal fistulas are rare conditions that occur primarily after gynecological or obstetric trauma and in the context of Crohn's disease. Other potential causes include neoplasms, pelvic radiotherapy, infections, and unintentional consequences of anorectal surgery. Treatment options for rectovaginal fistulas vary based on symptoms, fistula anatomy, adjacent tissue quality, and prior repair attempts. Mesenchymal cells, a subtype of adult stem cells, exhibit properties such as immunomodulatory, anti-inflammatory, analgesic, anti-apoptotic, and particularly neoangiogenic effects. These properties make them a promising option for treating complex perineal fistulas.

Conclusion The use of mesenchymal cells in the treatment of complex perineal fistulas has shown promising results, as demonstrated in reported studies and in this case report.

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Publikationsverlauf

Artikel online veröffentlicht:
25. April 2025