Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2021; 27(5): 442-448
Published online Feb 7, 2021. doi: 10.3748/wjg.v27.i5.442
Vedolizumab in Crohn’s disease with rectal fistulas and presacral abscess: A case report
Heng Yeh, Chia-Jung Kuo, Ren-Chin Wu, Chien-Ming Chen, Wen-Sy Tsai, Ming-Yao Su, Cheng-Tang Chiu, Puo-Hsien Le
Heng Yeh, School of Medicine, Chang Gung University, Taoyuan City 333323, Taiwan
Chia-Jung Kuo, Cheng-Tang Chiu, Puo-Hsien Le, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
Chia-Jung Kuo, Ming-Yao Su, Cheng-Tang Chiu, Puo-Hsien Le, Taiwan Association of the Study of Small Intestine Disease, Taoyuan 333, Taiwan
Ren-Chin Wu, Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
Chien-Ming Chen, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
Wen-Sy Tsai, Department of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
Ming-Yao Su, Department of Gastroenterology and Hepatology, New Taipei City Municipal Tucheng Hospital, New Taipei City 236017, Taiwan
Puo-Hsien Le, Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
Author contributions: Yeh H wrote and revised the manuscript; Kuo CJ acquired the data; Wu RC interpreted the pathological result; Chen CM analyzed the radiological images; Tsai WS, Su MY and Chiu CT analyzed the data; Le PH decided the treatment plan, wrote and revised the manuscript.
Informed consent statement: The study participant provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Puo-Hsien Le, MD, Assistant Professor, Department of Gastro-enterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, No. 5 Fuxing Street, Guishan District, Taoyuan 333, Taiwan. puohsien@gmail.com
Received: October 12, 2020
Peer-review started: October 12, 2020
First decision: November 23, 2020
Revised: December 8, 2020
Accepted: January 6, 2021
Article in press: January 6, 2021
Published online: February 7, 2021
Abstract
BACKGROUND

Fistula and intraabdominal abscess are common complications of Crohn’s disease (CD), but complex rectal fistula with abscess formation is rare. Tumor necrosis factor antagonists combined with percutaneous drainage or surgical intervention is optimal treatment for fistulizing CD with intraabdominal abscess. There is no study showing the efficacy of vedolizumab in such complicated condition.

CASE SUMMARY

A 47-year-old man has decompensated liver cirrhosis, Child B. He suffered from abdominal pain, bloody diarrhea, fever, and body weight loss. CD with rectoprostatic fistula, rectopresacral fistula, presacral abscess and cyto-megalovirus (CMV) infection were noted. He received antibiotics, anti-viral therapy, transverse colostomy and vedolizumab treatment. Six months later, he had deep remission and complete fistula tracts closure.

CONCLUSION

Early vedolizumab and stool diversion are effective and safe in treating CD with complex rectal fistula with abscess formation.

Keywords: Vedolizumab, Crohn's disease, Rectoprostatic fistula, Rectal presacral fistula, Presacral abscess, Case report

Core Tip: Fistulas and intraabdominal abscess are common complications of Crohn’s disease (CD) and tumor necrosis factor antagonists combined with percutaneous drainage or surgical intervention is the optimal treatment for fistulizing CD with intraabdominal abscess. However, no previous study has reported the efficacy of vedolizumab in this complicated situation. This 47-year-old male presented with CD with complex fistulas and presacral abscess. He received vedolizumab with transverse colostomy and the follow-up sigmoidoscopy 6 mo later showed mucosal healing without any visible fistula tracts. We think early vedolizumab treatment with stool diversion are effective and safe in treating CD with complex fistulas and abscess formation.