Recurrent Fistula between Ileal Pouch and Vagina—Successful Treatment with a Gracilis Muscle Flap

Figure 4

Suggested algorithm for treatment of recurrent PVF: in the case of PVF, the first priority is sepsis control (that is if necessary an ileostomy). Next the type of fistula, high or low should be determined. In the case of a high fistula, an abdominal procedure should be performed. In the case of low fistula the course of therapy depends on the presence or absence of pelvic sepsis. In the case of pelvic sepsis an abdominal procedure should be performed. If there is no severe pelvic sepsis, local procedures should be carried out. These procedures can be repeated. In the case of recurrence, gracilis interposition flap should be performed. Pouch excision should be considered only as the ultimate treatment.