Persistent fistula in a 25 years old male with a Colectomy and Pouch treated with FMT

Patient with Ulcerative Colitis since he was 15 years old. Treated with many drugs without any positive response.

At the age of 18 he undergoes a total colectomy with ileal pouch anal anastomosis (IPAA) or “J” Pouch. Since the first year postop he developed a “pouchitis” that needed the usage of antibiotics on a permanent base.

He consulted with us because now he has a fistula and an a perianal abscess that does not respond to any surgical or medical approach. When we examined the zone we found a deep open abscess with purulent content and a seton drainage connecting the fistula and the rectal cavity.

fistula1
Initial situation. November 17, 2015

We started to perform Fecal Microbiota Transplants (FMT) via rectal catheter, the antibiotics were interrupted 10 days before the first procedure. The FMTs were performed every day. There were no side effects nor aggravation of his symptoms.

fistula2
Evolution on December 3, 2015

Less drainage.

fistula3
Evolution on December 11, 2015

The abscess is almost totally covered with new tissue and the seton can be freely moved without purulent material.

fistula4
Final phase. January 4

A week later the seton is removed. The patient felt his initial symptoms related to the abscess and the fistula were relieved, the pouchitis persisted although he saw some improvements during the treatment with FMTs.