Martius flap closure of rectovaginal fistula in a 12-year-old girl with Crohn’s disease

Abstract

Rectovaginal fistulas (RVFs) are rare but severe complications of Crohn's disease (CD), particularly uncommon in the pediatric population. They present with debilitating symptoms and are notoriously difficult to manage. We report the case of a 12-year-old girl with CD who presented with vaginal passage of stool and gas. Examination under anesthesia revealed a low RVF, and rectoscopy demonstrated distal rectal incomplete stenosis. Given the severity of inflammation and poor local healing conditions, a protective ileostomy was performed prior to definitive surgical repair. Once the perineal environment stabilized, the fistula was successfully treated using a Martius flap-a technique involving transposition of the bulbocavernosus muscle into the rectovaginal septum. Postoperative recovery was uneventful with no recurrence. This case highlights the importance of a multidisciplinary, staged approach in managing complex RVFs in pediatric CD and supports the use of Martius flap repair as a viable sphincter-preserving technique in selected cases.