1
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Medina LG, Lee RA, Celis V, Rodriguez V, Poncel J, Sayegh AS, Sotelo R. Robotic management of urinary fistula. Asian J Urol 2024; 11:357-365. [PMID: 39139533 PMCID: PMC11318412 DOI: 10.1016/j.ajur.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/13/2023] [Indexed: 08/15/2024] Open
Abstract
Objectives To highlight critical preoperative and intraoperative considerations in approaching fistula repair robotically. Methods A search of the literature was conducted to identify relevant articles pertaining to robotic management of urinary fistulae. Results Fistulae of the genitourinary tract can be a challenging dilemma for urologists, as definitive management may require surgical intervention. Pathogenesis of both enteric and non-enteric fistulae are multifactorial, and successful repair hinges on the meticulous perioperative evaluation, planning, and execution. Traditional open techniques can subject patients to increased morbidity and prolonged hospitalizations. Since its introduction, the robotic surgical platform has continued to expand its indications. Its three-dimensional visualization and tremor free wristed instrument movements have made the robotic platform an attractive option for genitourinary fistula reconstruction. Conclusion Robotic management of complex urinary fistulae is feasible in expert hands; more studies are needed to define its role in the treatment algorithm of this devastating conditions.
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Affiliation(s)
- Luis G. Medina
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Randall A. Lee
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Valeria Celis
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Veronica Rodriguez
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jaime Poncel
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aref S. Sayegh
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rene Sotelo
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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2
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Touati MD, Ben Othmane MR, Belhadj A, Saïdi A, Saidani A, Chebbi F. A rare case report of an appendico-sigmoid fistula complicating untreated acute appendicitis: Unraveling complexity in diagnosis and treatment. Int J Surg Case Rep 2024; 116:109298. [PMID: 38342027 PMCID: PMC10943657 DOI: 10.1016/j.ijscr.2024.109298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/13/2024] Open
Abstract
INTRODUCTION Appendiculocolonic fistulas, often arising from benign conditions like abscess-forming appendicitis, manifest subtly. This case emphasizes their rarity, intraoperative discovery during acute appendicitis, and explores diagnostic intricacies, sensitive imaging, and distinctions in managing benign versus malignant cases. CASE PRESENTATION A 23-year-old intellectually disabled patient, lacking regular medical follow-up and surgical history, presented to our emergency department with persistent right iliac fossa pain six months ago. Due to financial constraints, a CT scan was not performed despite an inflammatory syndrome, and the patient left against medical advice. Currently experiencing the same symptoms, investigations led to the diagnosis of acute appendicitis with a probable appendico-sigmoid fistula. Surgical exploration confirmed the appendico-sigmoid fistula and the presence of an uncomplicated Meckel's diverticulum. A conservative approach, including appendectomy, Meckel's diverticulum resection, and sigmoid fistula suturing, yielded favorable results. CLINICAL DISCUSSION Appendiculocolonic fistulas often arise from acute or chronic appendicitis with local abscess formation. Our case highlights the unusual progression of untreated acute appendicitis, evolving into an appendico-sigmoid fistula. While generally benign, documented cases of malignant causes, such as appendiceal cancer, exist. Diagnosis is intricate, requiring diverse methods, with abdominal CT as a sensitive imaging tool. Conservative approaches are generally recommended for benign cases. CONCLUSION Appendiculocolonic fistulas, though rare, pose a clinical challenge due to their elusive symptoms. Primarily associated with benign conditions, notably abscess-forming appendicitis, or, as in our case, untreated acute appendicitis. This case underscores the role of abdominal CT in precise diagnosis, guiding treatment decisions based on the lesion's nature.
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Affiliation(s)
- Med Dheker Touati
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia.
| | - Mohamed Raouf Ben Othmane
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Anis Belhadj
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Aymen Saïdi
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Ahmed Saidani
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Faouzi Chebbi
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
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3
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VanFleet AX, Kinkead Z, Daniel J, Derr C. Utilization of point-of-care ultrasound to evaluate for enterovesical fistula. Emerg Radiol 2024; 31:113-115. [PMID: 38030949 DOI: 10.1007/s10140-023-02192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
Enterovesical fistula formation is a relatively rare disease process although a common complication for patients with inflammatory bowel disease (IBD), notably Crohn's disease. Enterovesical fistulas most commonly arise from diverticulitis (65-80%), cancer (10-20%), or Crohn's disease (5-7%). An increasing amount of evidence supports the use of ultrasonography as the primary imaging method for the monitoring of complications in individuals with a documented history of IBD. Our case report presents a 30-year-old female with a history of Crohn's disease who presented to the Emergency Department with concern for possible enterovesical fistula formation. Using bedside gray-scale ultrasonography, a fistulous tract clearly visualizing air bubbles and fecal matter actively moving from bowel to the bladder through the fistula was visualized confirming the diagnosis of an enterovesical fistula. While CT imaging is instrumental in identifying mural and extramural complications of IBD, performing ultrasonography in patients with IBD serves as an efficient, inexpensive, and noninvasive diagnostic aid for the diagnosis of enterovesical fistula.
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Affiliation(s)
| | - Zoe Kinkead
- University of South Florida Emergency Medicine, Tampa, FL, USA
| | - Jeannez Daniel
- University of South Florida College of Medicine, Tampa, FL, USA
| | - Charlotte Derr
- University of South Florida Emergency Medicine, Tampa, FL, USA
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4
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Sahay SC, Mangla V, Kesarwani P, Goel A. Robotic-Assisted Colovesical Fistula Repair: A Case Report. Cureus 2024; 16:e54404. [PMID: 38505449 PMCID: PMC10950097 DOI: 10.7759/cureus.54404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/21/2024] Open
Abstract
Colovesical fistulas present a diagnostic and therapeutic challenge, commonly arising from complications of diverticular disease. In our case, a 71-year-old male with colovesical fistula symptoms underwent robotic-assisted surgery for complicated sigmoid diverticulitis. Intraoperatively, meticulous adhesiolysis and fistula repair were performed. Histopathology confirmed diverticular disease. Postoperatively, the patient recovered well. Colovesical fistulas may indicate underlying malignancy in diverticulitis. With a lack of standardized protocols, our case suggests that robotic-assisted surgery offers improved outcomes, better vision, and ergonomics. To conclude, robotic-assisted colovesical fistula repair and sigmoidectomy demonstrated excellent outcomes, suggesting a promising approach for enhanced postoperative recovery.
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Affiliation(s)
- Shailesh C Sahay
- Urology, Max Super Speciality Hospital, Patparganj, New Delhi, IND
| | - Vivek Mangla
- Gastrointestinal Surgery, Max Super Speciality Hospital, Patparganj, New Delhi, IND
| | - Pawan Kesarwani
- Urology, Max Super Speciality Hospital, Patparganj, New Delhi, IND
| | - Abhigyan Goel
- Urology, Max Super Speciality Hospital, Patparganj, New Delhi, IND
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5
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Tang S, Li X, Guo D, Zhuo F. Positive outcomes with neoadjuvant chemotherapy in the management of colovesical fistula in cancer: a case report and literature review. Front Pharmacol 2024; 14:1284316. [PMID: 38298269 PMCID: PMC10828894 DOI: 10.3389/fphar.2023.1284316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/08/2023] [Indexed: 02/02/2024] Open
Abstract
Colovesical fistula (CVF) is usually developed from colonic diverticulitis, followed by tumor. Traditional surgery is usually completed in one or more stages. For complex cancerous CVF, radical resection is more difficult. We report a 62-year-old male patient diagnosed with sigmoid colon cancer combined with sigmoid vesical fistula. In the course of treatment, in addition to conventional surgery, neoadjuvant chemotherapy (NAC) was innovatively used. The sigmoid tumor and fistula were significantly shrunken. Radical surgery achieved negative margins.
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Affiliation(s)
- Song Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Xinjun Li
- Department of Oncological Surgery, Guangzhou Royallee Cancer Center, Guangzhou, Guangdong, China
| | - Donghua Guo
- Medical Imaging Unit, Guangzhou Royallee Cancer Center, Guangzhou, Guangdong, China
| | - Fan Zhuo
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
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6
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Guo L, Shen G. Enterovesical Fistula in a Lymphoma Patient Revealed by FDG PET/CT With an Oral Contrast Agents. Clin Nucl Med 2024; 49:e38-e39. [PMID: 37976526 DOI: 10.1097/rlu.0000000000004954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
ABSTRACT A 60-year-old man with colonic diffuse large B-cell lymphoma was referred for FDG PET/CT for initial staging. He was suspected of enterovesical fistula. After oral administration, large amounts of contrast agents accumulated in the bowel lumen and leaked into the bladder through a well-marked fistulous tract. Corresponding to the fistula, a linear pattern of FDG uptake extended from the bladder into the colonic lumen, and the measured SUV max inside the lesion was as high as that of the urinary bladder. Cystography confirmed the presence of the enterovesical fistula.
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Affiliation(s)
- Linlin Guo
- From the Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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7
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Dagnesses Fonseca JO, Teja García G, Luengo Batres P, Calvo Espino P. Iatrogenic enterovesical fistula secondary to a permanent urinary catheter. BMJ Case Rep 2023; 16:e257476. [PMID: 38056931 PMCID: PMC10711913 DOI: 10.1136/bcr-2023-257476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
An enterovesical fistula is a rare entity resulting from inflammatory, neoplastic and iatrogenic processes. It can manifest clinically as pneumaturia and recurrent urinary tract infections. Its diagnosis is supported by imaging examinations and its treatment is primarily surgical.
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8
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Hsu MW, Chen WC, Wei TN, Huang CP. Management of Enterovesical Fistula in a Patient with Crohn's Disease: A Case Report and Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13091527. [PMID: 37174919 PMCID: PMC10177369 DOI: 10.3390/diagnostics13091527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Enterovesical fistula (EVF) is a rare complication of Crohn's disease (CD), characterized by recurrent urinary tract infections, fecaluria, and pneumaturia. However, most diagnostic tools have low sensitivity for EVF. Management consists of conservative and surgical approaches. Conservative treatment is usually adopted first. However, the appropriate time to consider surgery remains controversial. Herein, we report on the case of a 34-year-old male who presented with diffuse abdominal pain with fullness for one day. Enteroscopy and biopsy confirmed the diagnosis of Crohn's disease. Contrast-enhanced computed tomography (CT) suggested a fistula between the ileum and urinary bladder; however, cystoscopy did not find an obvious tract. The patient initially received medical treatment, but the symptoms persisted with recurrent urinary tract infections and subsequent bilateral hydronephrosis. He then underwent successful fistulectomy, partial cystectomy, and two segmental resections of the small bowel with end-to-end primary sutures. No complications or symptomatic urinary tract infections were noted during 30 months of follow-up after surgery, suggesting no recurrence of EVF. Surgical intervention is warranted when medical treatment fails or complications occur. Clinical symptoms and laboratory data are often less informative for the diagnosis of EVF, and CT is the most helpful diagnostic modality. Our management strategy provides an option for such patients.
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Affiliation(s)
- Ming-Wei Hsu
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
| | - Wen-Chi Chen
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404328, Taiwan
| | - Ting-Na Wei
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
- School of Medicine, China Medical University, Taichung 404328, Taiwan
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9
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Sidhu K, Seyfi D, Byrne C. Right-Sided Epididymo-Orchitis as a Presentation of Diverticular Colovesical Fistula. Cureus 2023; 15:e35376. [PMID: 36987474 PMCID: PMC10039812 DOI: 10.7759/cureus.35376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 02/25/2023] Open
Abstract
A colovesical fistula is a recognized complication of diverticulitis. Although the underlying pathology is usually of colonic origin, the majority of patients present with urological symptoms, classically pneumaturia, and urinary tract infection. Epididymo-orchitis is a rare presentation. It is important to identify elderly males who present with recurrent urosepsis and/or epididymo-orchitis refractory to medical treatment as they may have an underlying benign or malignant etiology. The diagnostic challenge in these cases is to confirm the presence of a fistula, exclude malignancy, and determine the underlying pathology. We present a case of diverticular colovesical fistula in an elderly male who presented with symptoms of epididymo-orchitis on a background of recurrent urinary tract infections. The presence of intravesical gas within the left posterolateral bladder wall and soft tissue thickening continuous with the mid-sigmoid colon was consistent with a colovesical fistula. This patient underwent elective laparoscopic anterior resection and repair of colovesical fistula.
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10
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A case report of small bowel bladder fistula after rectal cancer operation. Asian J Surg 2022; 46:1792-1793. [PMID: 36581544 DOI: 10.1016/j.asjsur.2022.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/13/2022] [Indexed: 12/28/2022] Open
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11
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Short Term Outcomes of Open and Minimally Invasive Approaches to Segmental Colectomy for Benign Colovesical Fistula. Surg Res Pract 2022; 2022:9242813. [DOI: 10.1155/2022/9242813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022] Open
Abstract
Background. We speculated that a minimally invasive (MIS) colectomy for colovesical fistula is associated with less morbidity compared to an open colectomy. Methods. Multivariate analysis using logistic regression was used to investigate the outcomes of patients who underwent colectomy for benign colovesical fistula during 2012–2017 by surgical approach using the NSQIP database. Results. We identified 748 patients underwent partial colectomy for benign colovesical fistula during 2012–2017. Surgeons used the MIS approach in 72.7% of operations, with a conversion rate of 13.1%. The MIS approach was associated with lower morbidity (27.4% vs. 43.1%, AOR: 0.46,
) compared to the open approach. The mean operation duration was longer in MIS operations compared to open (225 min vs. 201 min,
). The robotic approach to colectomy showed no significant difference in morbidity (28.4% vs. 27.2%,
) but a decrease in conversion rate (8.1% vs. 13.8%,
) and an increase in operation length (249 min vs. 222 min, mean difference: 27 min,
) compared to a laparoscopic approach. There was no significant difference in the anastomotic leak rate between MIS and open approaches (3.7% vs. 5.4%,
) and between laparoscopic and robotic approaches (2.8% vs. 3.8%,
). Conclusions. We found a 72.7% utilization rate of MIS approach to colectomy for benign colovesical fistula in the NSQIP hospitals with a 13.6% conversion rate. Patients with MIS approach had significantly lower morbidity compared to open. A robotic approach to partial colectomy has the same morbidity risk with a decreased conversion rate compared to laparoscopic approach.
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12
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Tornero-Aguilera JF, Sánchez-Molina J, Parraca JA, Morais A, Clemente-Suárez VJ. Are Crohn's Disease Patients Limited in Sport Practise? An UltraEndurance Case-Control Study Response. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10007. [PMID: 36011641 PMCID: PMC9407764 DOI: 10.3390/ijerph191610007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to analyze the psychophysiological response of a Crohn's Disease patient in an ultra-endurance event. The psychophysiological responses of a Crohn's Disease and non-Crohn's Disease participant were analysed before during and after an 8 h ultra-endurance running event. Results showed how Crohn's patient presented a similar psychophysiological response than non-Crohn's participant in the ultra-endurance event, except for a higher pre- and post-event sympathetic modulation, lower event sympathetic tone, and lower event body temperature. This study could contribute to improving physical activity recommendations for persons with Crohn's Disease and open a new research line for an improved understanding of psychophysiological modifications of Crohn's Disease patients during exercise.
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Affiliation(s)
- José Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Research Center in Applied Combat (CESCA), 45007 Toledo, Spain
| | | | - Jose A. Parraca
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7004-516 Évora, Portugal
| | - Ana Morais
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7004-516 Évora, Portugal
| | - Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Research Center in Applied Combat (CESCA), 45007 Toledo, Spain
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
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13
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Hobday A, Chung M, Rola D, Zacharias B, Potdar S. Enterovesical fistula as an iatrogenic complication of foley catheter use: A case report. Urol Case Rep 2022; 43:102065. [PMID: 35368979 PMCID: PMC8965901 DOI: 10.1016/j.eucr.2022.102065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 12/04/2022] Open
Abstract
Enterovesical fistulas can represent a rare complication of long-term indwelling urinary catheters. It can lead to significant morbidity and mortality and usually requires emergent intervention. An elderly nursing home resident presented with abdominal pain and fecal matter in her urine. She was found to have a foley catheter bulb in the small bowel and successfully underwent open repair of the bladder defect along with partial small bowel resection. The diagnosis and management of Enterovesical fistulas as an iatrogenic complication of Foley catheter use is discussed.
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14
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Yan H, Wu YC, Wang X, Liu YC, Zuo S, Wang PY. Appendico-vesicocolonic fistula: A case report and review of literature. World J Clin Cases 2022; 10:3241-3250. [PMID: 35647117 PMCID: PMC9082718 DOI: 10.12998/wjcc.v10.i10.3241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/30/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Appendico-vesicocolonic fistulas and appendiceal-colonic fistulas are two kinds of intestinal and bladder diseases that are rarely seen in the clinic. To our knowledge, no more than 4 cases of appendico-vesicocolonic fistulas have been publicly reported throughout the world, and no more than 100 cases of appendiceal-colonic fistulas have been reported. Although the overall incidence is low, an early diagnosis is difficult due to their atypical initial symptoms, but these diseases still require our attention.
CASE SUMMARY Here, we report a case of a 77-year-old male patient diagnosed with an appendico-vesicocolonic fistula combined with an appendiceal-colonic fistula. The main manifestations were diarrhea and urine that contained fecal material. The diagnosis was confirmed by multiple laboratory and imaging examinations. A routine urinalysis showed red blood cells and white blood cells. Abdominal and pelvic computed tomography scans showed close adhesions between the bowels and the bladder, and fistulas could be seen. Colonoscopy and cystoscopy and some other imaging examinations clearly showed fistulas. The preoperative diagnoses were a colovesical fistula and an appendiceal-colonic fistula. The fistulas were repaired by laparoscopic surgical treatment. The diseased bowel and part of the bladder wall were removed, followed by a protective ileostomy. The postoperative diagnosis was an appendico-vesicocolonic fistula combined with an appendiceal-colonic fistula, and the pathology suggested inflammatory changes. The patient recovered well after surgery, and all his symptoms resolved.
CONCLUSION The final diagnosis in this case was a double fistula consisting of an appendico-vesicocolonic fistula combined with an appendiceal-colonic fistula.
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Affiliation(s)
- Han Yan
- Department of General Surgery, Peking University First Hospital, Beijing 100032, China
| | - Ying-Chao Wu
- Department of General Surgery, Peking University First Hospital, Beijing 100032, China
| | - Xin Wang
- Department of General Surgery, Peking University First Hospital, Beijing 100032, China
| | - Yu-Cun Liu
- Department of General Surgery, Peking University First Hospital, Beijing 100032, China
| | - Shuai Zuo
- Department of General Surgery, Peking University First Hospital, Beijing 100032, China
| | - Peng-Yuan Wang
- Department of General Surgery, Peking University First Hospital, Beijing 100032, China
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15
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Beaman HT, Howes B, Ganesh P, Monroe MBB. Shape memory polymer hydrogels with cell-responsive degradation mechanisms for Crohn's fistula closure. J Biomed Mater Res A 2022; 110:1329-1340. [PMID: 35218140 DOI: 10.1002/jbm.a.37376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/28/2022] [Accepted: 02/17/2022] [Indexed: 11/11/2022]
Abstract
Crohn's disease, a form of inflammatory bowel disease, commonly results in fistulas, tunneling wounds between portions of the urinary, reproductive, and/or digestive systems. These tunneling wounds cause pain, infection, and abscess formation. Of Crohn's patients with fistula formation, 83% undergo surgical intervention to either drain or bypass the fistula openings, and ~23% of these patients ultimately require bowel resections. Current treatment options, such as setons, fibrin glues, and bioprosthetic plugs, are prone to infection, dislodging, and/or require a secondary removal surgery. Thus, there is a need for fistula filling material that can be easily and stably implanted and then degraded during fistula healing to eliminate the need for removal. Here, the development of a shape memory polymer hydrogel foam containing polyvinyl alcohol (PVA) and cornstarch (CS) with a disulfide polyurethane crosslinker is presented. These materials undergo controlled degradation by amylase, which is present in the digestive tract, and by reducing thiol species such as glutathione/dithiothreitol. Increasing CS content and using lower molecular weight PVA can be used to increase the degradation rate of the materials while maintaining shape memory properties that could be utilized for easy implantation. This material platform is based on low-cost and easily accessible components and provides a biomaterial scaffold with cell-responsive degradation mechanisms for future potential use in Crohn's fistula treatment.
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Affiliation(s)
- Henry T Beaman
- Department of Biomedical and Chemical Engineering, Syracuse BioInspired Institute, Syracuse University, Syracuse, New York, USA
| | - Bryanna Howes
- Department of Chemistry, LeMoyne College, Syracuse, New York, USA
| | - Priya Ganesh
- Department of Biomedical and Chemical Engineering, Syracuse BioInspired Institute, Syracuse University, Syracuse, New York, USA
| | - Mary Beth Browning Monroe
- Department of Biomedical and Chemical Engineering, Syracuse BioInspired Institute, Syracuse University, Syracuse, New York, USA
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16
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Widia F, Firman M, Irdam GA, Syaiful RA. A six years' experience with 41 cases of enterovesical fistula in a Tertiary National Hospital in Indonesia: A retrospective study. Ann Med Surg (Lond) 2022; 73:103102. [PMID: 35028134 PMCID: PMC8715043 DOI: 10.1016/j.amsu.2021.103102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The incidence of Enterovesical Fistula (EVF) is relatively low. Currently, there is no agreement about the best methods for EVF management. This study was performed to investigate the characteristics of EVF to find the optimal diagnostic and management pattern. METHODS Data were collected retrospectively from the medical record at Cipto Mangunkusumo Hospital. Patients diagnosed with EVF between January 2014 and April 2019 were included. They were evaluated for demographics, characteristics, diagnostic modalities, and treatment modalities. RESULTS From 41 patients, 26 (63.3%) are male, and 15 (36.6%) are female. Peak incidence was 51-60 years old. The most common symptoms are fecaluria found in 32 (78%) patients. The common etiology is gastrointestinal cancer found in 17 (41.5%) patients, followed by gynecologic cancer and diverticulitis found in both 9 (22%) patients. The rectovesical fistula was seen in 25 (61%) patients with an advanced stage rectosigmoid cancer, followed by colovesical in 14 (34.1%) of patients with sigmoid diverticulitis (p 0.038). The common diagnostic modalities performed are cystoscopy in 32 (78%), followed by colonoscopy in 11 (26.8%) patients. The preferred modalities that were used in most cases were surgery in 35 (85.4%) patients. A two-stage surgical approach was used in 28 (68.3%) patients. CONCLUSION The incidence of EVF is uncommon. Malignancy was the leading cause of EVF in this study. Combined diagnostic modalities are recommended in EVF cases. The two-stage surgical approach was the preferred modality. Further prospective studies are mandatory to analyze this condition.
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Affiliation(s)
- Fina Widia
- Department of Urology, Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Salemba, Jakarta Pusat, DKI Jakarta, 10430, Jakarta, Indonesia
| | - Muhammad Firman
- Department of Urology, Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Salemba, Jakarta Pusat, DKI Jakarta, 10430, Jakarta, Indonesia
| | - Gampo Alam Irdam
- Department of Urology, Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Salemba, Jakarta Pusat, DKI Jakarta, 10430, Jakarta, Indonesia
| | - Ridho Ardhi Syaiful
- Department of Surgery, Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Salemba, Jakarta Pusat, DKI Jakarta, 10430, Jakarta, Indonesia
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Rajan YRD, Priyanka C. A Case of Rectovesical Fistula Following Blunt Trauma in a Child. Cureus 2021; 13:e18931. [PMID: 34812315 PMCID: PMC8604205 DOI: 10.7759/cureus.18931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Rectovesical fistulae (RVF) are uncommon entities and usually occur after surgery for prostate, radiation, and sometimes due to penetrating trauma. However, RVF occurrence after blunt trauma to the abdomen or perineum is very rare. The management of RVF is challenging, and treatment options should be considered according to the individual. Here we present a case of a 10-year-old boy who presented with fecaluria, pneumaturia, the passage of urine per rectum, and burning micturition for four days after incurring a blunt injury to the perineum. Cystography revealed leakage of contrast material into the rectum and an MRI of the pelvis was done for confirmation, which revealed a 1.3 cm thick fistulous tract of 2.7 cm length with openings at the posterior bladder wall and anterior rectal wall. After conservative management for 14 days failed to show any improvement, primary repair of the fistulous tract along with fecal diversion and urinary diversion were done. The suprapubic catheter was removed after four weeks, and at the two-month follow-up, colostomy closure was done. No recurrence was found in the six-month follow-up period. In cases of small traumatic RVF where conservative management fails, fecal and urinary diversion can be considered, as it is associated with successful outcomes and less recurrence.
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18
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Zizzo M, Tumiati D, Bassi MC, Zanelli M, Sanguedolce F, Porpiglia F, Fiori C, Campobasso D, Castro Ruiz C, Bergamaschi FA, Maestroni UV, Carrieri G, Cormio L, Biolchini F, Palicelli A, Soriano A, Sassatelli R, Ascani S, Annessi V, Giunta A. Management of colovesical fistula: a systematic review. Minerva Urol Nephrol 2021; 74:400-408. [PMID: 34791866 DOI: 10.23736/s2724-6051.21.04750-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Colovesical fistulas (CVFs) account for approximately 95% enterovesical fistulas (EVFs). About 2/3 CVF cases are diverticular in origin. It mainly presents with urological signs such as pneumaturia and fecaluria. Diagnostic investigations aim at confirming the presence of a fistula. Although conservative management can be chosen for selected individuals, most patients are mainly treated through surgical interventions. CVF represents a challenging condition, which records high rates of morbidity and mortality. Our systematic review aimed at achieving deeper knowledge of both indications, in addition to short- and long-term outcomes related to CVF management. EVIDENCE ACQUISITION We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Pubmed/MEDLINE, Embase, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. EVIDENCE SYNTHESIS The 22 included articles covered an approximately 37 years-study period (1982-2019), with a total 1,365 patient population. CVF etiology was colonic diverticulitis in most cases (87.9%). Pneumaturia (50.1%), fecaluria (40.9%) and urinary tract infections (46.6%) were the most common symptoms. Abdomen computed tomography (CT) scan (80.5%), colonoscopy (74.5%) and cystoscopy (55.9%) were the most frequently performed diagnostic methods. Most CVF patients underwent surgery (97.1%) with open approach (63.3%). Almost all patients had colorectal resection with primary anastomosis with or without ostomy and 53.2% patients underwent primary repair or partial/total cystectomy. 4% anastomotic leak, 1.8% bladder leak and 3.1% reoperations rates were identified. In an average 5-68 month follow-up, overall morbidity, overall mortality and recurrences rates recorded were 8%-49%, 0%-63% and 1.2%, respectively. CONCLUSIONS CVF mainly affects males and has diverticular origin in almost all cases. Pneumaturia, fecaluria and urinary tract infections are the most characteristic symptoms. Endoscopic tests and imaging are critical tools for diagnostic completion. Management of CVFs depends on the underlying disease. Surgical treatment represents the final approach and consists of resection and re-anastomosis of offending intestinal segment, with or without bladder closure. In many cases, a single-stage surgical strategy is selected. Perioperative and long-term outcomes prove good.
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Affiliation(s)
- Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy - .,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy -
| | - David Tumiati
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria C Bassi
- Medical Library, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, Foggia, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Carolina Castro Ruiz
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Franco A Bergamaschi
- Urology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.,Department of Urology, Bonomo Teaching Hospital, Andria, Barletta-Andria-Trani, Italy
| | - Federico Biolchini
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Soriano
- Gastroenterology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Romano Sassatelli
- Gastroenterology and Digestive Endoscopy Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Ascani
- Hematology Unit, CREO, Azienda Ospedaliera di Perugia, University of Perugia, Perugia, Italy.,Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, Terni, Italy
| | - Valerio Annessi
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Giunta
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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19
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Trejo-Avila M, Vergara-Fernández O. Open versus laparoscopic surgery for the treatment of diverticular colovesical fistulas: A systematic review and meta-analysis. ANZ J Surg 2021; 91:E570-E577. [PMID: 34056819 DOI: 10.1111/ans.16985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/12/2021] [Accepted: 05/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to analyze the evidence regarding open versus laparoscopic surgery for the treatment of diverticular colovesical fistula (CVF) in terms of perioperative outcomes. METHODS A systematic review was performed using PubMed, Cochrane, Google Scholar, and Web of Science databases for studies comparing laparoscopic versus open surgery for CVF. We pooled odds ratios (OR) and mean differences (MD) using random or fixed effects models. RESULTS Five non-randomized studies with 227 patients met the inclusion criteria. All were retrospective studies, published between 2014 and 2020. For laparoscopic surgery, the pooled rate for conversion to laparotomy was 36%. Laparoscopic and open procedures required similar operative time (MD: -11.62; 95% confidence interval [CI]: -51.41 to 28.16). No difference was found in terms of stoma rates between laparoscopic and open surgery (OR: 1.12; 95% CI 0.44-2.86). Overall, the rate of total postoperative complications was lower in the laparoscopic group (OR: 0.55; 95% CI: 0.30-0.99). The pooled analysis showed equivalent rates of anastomotic leaks (OR: 0.61; 95% CI 0.15-2.45), surgical site infections (OR: 0.44; 95% CI 0.19-1.01), and mortality (OR: 0.18; 95% CI 0.03-1.15). The length of stay was significantly reduced with laparoscopic surgery (MD: -2.89; 95% CI -4.20 to -1.58). CONCLUSION Among patients with CVF, the laparoscopic approach appears to have shorter hospital length of stay, with no differences in anastomotic leaks, surgical site infections, stoma rates, and mortality, when compared with open surgery.
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Affiliation(s)
- Mario Trejo-Avila
- Department of Colon and Rectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Omar Vergara-Fernández
- Department of Colon and Rectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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20
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Mejias E, Robles Y, Olivella G, Bolaños G. Gouverneur' syndrome in a young Hispanic patient: A case report of a rare presentation of a rectal adenocarcinoma tumor. J Surg Case Rep 2020; 2020:rjaa064. [PMID: 32595919 PMCID: PMC7303105 DOI: 10.1093/jscr/rjaa064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/15/2020] [Indexed: 11/14/2022] Open
Abstract
This is an unusual case report of 32-year-old Hispanic male who presented with an early-onset advanced stage colorectal cancer with an enterovesical fistula. A 32-year-old man presented to our institution referring suprapubic pain, urinary frequency, dysuria and tenesmus for several weeks suggesting Gouverneur’s syndrome. Patient had been treated with oral antibiotics for his recurrent urinary tract infections without resolution. Associated unintentional weight loss, decreased appetite and suprapubic pain raised concern for occult malignancy. Abdominopelvic computed tomography scan revealed a rectal mass with invasion to bladder. Colonoscopy biopsy confirmed diagnosis of moderately differentiated rectal adenocarcinoma. This report provides vital information about clinical presentations of enterovesical fistula in an imposed rectal adenocarcinoma in a young Hispanic adult with no previous family or medical history. A thorough clinical assessment must be taken to ensure accurate diagnosis and early detection of colorectal cancer in the young Hispanic population.
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Affiliation(s)
- Emanuel Mejias
- General Surgery Residency, Hospital Episcopal San Lucas, Ponce, Puerto Rico
| | - Yarret Robles
- General Surgery Residency, Hospital Episcopal San Lucas, Ponce, Puerto Rico
| | - Gerardo Olivella
- Transitional Year Residency Program, Hospital Episcopal San Lucas Ponce, Ponce, Puerto Rico
| | - Guillermo Bolaños
- General Surgery Residency, Hospital Episcopal San Lucas, Ponce, Puerto Rico
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21
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Keady C, Hechtl D, Joyce M. When the bowel meets the bladder: Optimal management of colorectal pathology with urological involvement. World J Gastrointest Surg 2020; 12:208-225. [PMID: 32551027 PMCID: PMC7289647 DOI: 10.4240/wjgs.v12.i5.208] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/10/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023] Open
Abstract
Fistulae between the gastrointestinal and urinary systems are rare but becoming increasingly more common in current surgical practice. They are a heterogeneous group of pathological entities that are uncommon complications of both benign and malignant processes. As the incidence of complicated diverticular disease and colorectal malignancy increases, so too does the extent of fistulous connections between the gastrointestinal and urinary systems. These complex problems will be more common as a factor of an aging population with increased life expectancy. Diverticular disease is the most commonly encountered aetiology, accounting for up to 80% of cases, followed by colorectal malignancy in up to 20%. A high index of suspicion is required in order to make the diagnosis, with ever improving imaging techniques playing an important role in the diagnostic algorithm. Management strategies vary, with most surgeons now advocating for a single-stage approach to enterovesical fistulae, particularly in the elective setting. Concomitant bladder management techniques are also disputed. Traditionally, open techniques were the standard; however, increased experience and advances in surgical technology have contributed to refined and improved laparoscopic management. Unfortunately, due to the relative rarity of these entities, no randomised studies have been performed to ascertain the most appropriate management strategy. Rectourinary fistulae have dramatically increased in incidence with advances in the non-operative management of prostate cancer. With radiotherapy being a major contributing factor in the development of these complex fistulae, optimum surgical approach and exposure has changed accordingly to optimise their management. Conservative management in the form of diversion therapy is effective in temporising the situation and allowing for the diversion of faecal contents if there is associated soiling, macerated tissues or associated co-morbidities. One may plan for definitive surgical intervention at a later stage. Less contaminated cases with no fibrosis may proceed directly to definitive surgery if the appropriate expertise is available. An abdominal approach with direct repair and omentum interposition between the repaired tissues has been well described. In low lying fistulae, a transperineal approach with the patient in a prone-jack knife position provides optimum exposure and allows for the use of interposition muscle grafts. According to recent literature, it offers a high success rate in complex cases.
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Affiliation(s)
- Conor Keady
- Department of Colorectal Surgery, Galway University Hospital, Galway H91 YR71, Ireland
| | - Daniel Hechtl
- Department of Colorectal Surgery, Galway University Hospital, Galway H91 YR71, Ireland
| | - Myles Joyce
- Department of Colorectal Surgery, Galway University Hospital, Galway H91 YR71, Ireland
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22
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Kitaguchi D, Enomoto T, Ohara Y, Owada Y, Hisakura K, Akashi Y, Takahashi K, Ogawa K, Shimomura O, Oda T. Laparoscopic surgery for diverticular colovesical fistula: single-center experience of 11 cases. BMC Res Notes 2020; 13:177. [PMID: 32209133 PMCID: PMC7092560 DOI: 10.1186/s13104-020-05022-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/16/2020] [Indexed: 12/26/2022] Open
Abstract
Objective Laparoscopic surgery for diverticular colovesical fistula (CVF) is technically challenging, and the incidence of conversion to open surgery (COS) is high. This study aimed to review our experience with laparoscopic surgery for diverticular CVF and identify preoperative risk factors for COS. Results This was a single institution, retrospective, observational study of 11 patients (10 males and 1 female) who underwent laparoscopic sigmoid colon resection with fistula resection for diverticular CVF from 2014 to 2019. Preoperative magnetic resonance imaging (MRI) was performed to evaluate the fistula location in the bladder, patency of the rectovesical pouch (i.e., the destination of dissection procedure between sigmoid colon and bladder) and estimate the contact area between the sigmoid colon and bladder. The relationship between preoperative variables and COS incidence was analyzed between completed laparoscopy and COS groups. The overall incidence of postoperative morbidity (Clavien–Dindo classification Grade II or higher) was 36% (4/11). Severe morbidity, reoperation, and mortality were not observed. The incidence of COS was 27% (3/11). Posterior bladder fistulas were significantly associated with COS. CVFs located on the posterior bladder appears to be a risk factor for COS. Identifying risk factors for COS preoperatively could help guide the intraoperative course.
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Affiliation(s)
- Daichi Kitaguchi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Tsuyoshi Enomoto
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yusuke Ohara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yohei Owada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Katsuji Hisakura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yoshimasa Akashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kazuhiro Takahashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Koichi Ogawa
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Osamu Shimomura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tatsuya Oda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Mishra K, Hoy NY, Wood HM, Angermeier KW. Rectourethral Fistula—Review of Current Practices, Developments, and Outcomes. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00544-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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24
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Tomizawa K, Toda S, Tate T, Hanaoka Y, Moriyama J, Matoba S, Kuroyanagi H. Laparoscopic surgery for colovesical fistula associated with sigmoid colon diverticulitis: a review of 39 cases. JOURNAL OF THE ANUS RECTUM AND COLON 2019; 3:36-42. [PMID: 31559365 PMCID: PMC6752128 DOI: 10.23922/jarc.2018-008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022]
Abstract
Objectives: Colonic diverticular disease is widespread in Western countries and its associated with aging. In Japan, diverticulitis and colovesical fistula are also occurring more frequently. Colonic resection for diverticula-related fistulas is frequently technically demanding because of associated acute or chronic inflammation. We evaluated the safety and efficacy of a standardized laparoscopic procedure. Methods: Data from 39 consecutive patients who had undergone laparoscopic surgery for colovesical fistula between October 2006 and August 2017 were retrospectively reviewed. Results: The patients' median age was 60 years and comprised 35 men and four women. Sigmoidectomy was performed in 33 patients, Hartmann's procedure in four, and anterior resection in two. The median operative time was 203 minutes and estimated blood loss 15 mL. There were no intraoperative complications or conversion to open surgery. No patients required bladder repair; three had minor postoperative complications, and none had recurrent diverticulitis or fistula at a mean follow-up of 5.1 years. Conclusions: The magnified vision and minimal invasiveness make a laparoscopic approach the ideal means of managing colovesical fistula. To our knowledge, this is the largest study of colovesical fistula managed by a standardized laparoscopic procedure.
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Affiliation(s)
- Kenji Tomizawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Shigeo Toda
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Tomohiro Tate
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Yutaka Hanaoka
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Jin Moriyama
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Shuichiro Matoba
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Hiroya Kuroyanagi
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
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25
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Smith CY, Bitter CC. Male With Diarrhea and Decreased Urine Output. Ann Emerg Med 2019; 74:492-520. [PMID: 31543122 DOI: 10.1016/j.annemergmed.2019.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Candace Y Smith
- Department of Surgery, Division of Emergency Medicine, Saint Louis University School of Medicine, Saint Louis, MO
| | - Cindy C Bitter
- Department of Surgery, Division of Emergency Medicine, Saint Louis University School of Medicine, Saint Louis, MO
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26
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de Groof EJ, Bruggeman AE, Buskens CJ, Tanis PJ, Bemelman WA. Selective use of cystogram following segmental bowel resection in patients with enterovesical fistula. Colorectal Dis 2019; 21:1045-1050. [PMID: 30993858 DOI: 10.1111/codi.14652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/12/2019] [Indexed: 02/08/2023]
Abstract
AIM Patients undergoing resectional surgery for enterovesical fistulas generally have an indwelling urinary catheter postoperatively to prevent a recurrent fistula. The aim of this study was to assess the role of a cystogram as part of the postoperative follow-up of such surgery, when it should be performed and for how long the bladder should be drained after surgery. METHOD A retrospective single-centre study of all patients undergoing ileocaecal or sigmoid resection for surgery for enterovesical fistula with the primary end-point of recurrent urinary fistula. RESULTS Between 1994 and 2015, 46 patients (23 male; mean age 55.4 ± 18.3 years) underwent surgery [23 (50%) for diverticular disease, 16 (34.8%) for Crohn's disease, five (10.9%) for malignancy and two (4.3%) for previous radiotherapy]. Closure of the bladder fistula was by simple suture in 21 (46%) patients and with an omental pedicle in 16 (36%). Overall median duration of urinary drainage was 10.5 [interquartile range (IQR): 7.3-14.0] days. A postoperative cystogram was performed in 26 (57%) patients after a median of 10.0 (IQR: 8.0-13.0) days. This demonstrated persistent leakage in three patients, of whom two had undergone surgical closure of the bladder. This group required prolonged drainage (7, 19 and 40 days). One patient who had undergone surgery following radiotherapy for urothelial cancer developed a recurrent malignant fistula at 9 months, even though the postoperative cystogram had been negative. CONCLUSION This study suggests that a routine postoperative cystogram after surgery for enterovesical fistula may not be necessary for all patients if the bladder is drained for 1-2 weeks after bowel resection.
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Affiliation(s)
- E J de Groof
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - A E Bruggeman
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - C J Buskens
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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27
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Dolejs SC, Penning AJ, Guzman MJ, Fajardo AD, Holcomb BK, Robb BW, Waters JA. Perioperative Management of Patients with Colovesical Fistula. J Gastrointest Surg 2019; 23:1867-1873. [PMID: 30411309 DOI: 10.1007/s11605-018-4034-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 10/23/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Colovesical fistula (CVF) is an uncommon complication of diverticulitis. Substantial heterogeneity exists in the perioperative management of this condition. We seek to evaluate the role of bladder leak testing, closed suction drainage, prolonged bladder catheter usage, and routine postoperative cystogram in the management of CVF. STUDY DESIGN This is a retrospective study from a single academic health center investigation patients undergoing operation for diverticular CVF from 2005 to 2015 (n = 89). RESULTS Patients undergoing operative repair for diverticular CVF resection had a mortality of 4% and overall morbidity of 46%. Intraoperative bladder leak test was performed in 36 patients (40%) and demonstrated a leak in 4 patients (11%). No patients with a negative intraoperative bladder leak test developed a urinary leak. Overall, five (6%) patients developed postoperative bladder leak. Three were identified by elevated drain creatinine and two by cystogram. The diagnostic yield of routine cystogram was 3%. All bladder leaks were diagnosed between postoperative day 3 and 7. Of patients with a postoperative bladder leak, none required reoperation and all resolved within 2 months. CONCLUSIONS There is significant variability in the management of patients undergoing operation for CVF. Routine intraoperative bladder leak test should be performed. Cystogram may add cost and is low yield for routine evaluation for bladder leak after operation for CVF. Urinary catheter removal before postoperative day 7 should be considered.
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Affiliation(s)
- Scott C Dolejs
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Alyssa J Penning
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Michael J Guzman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Alyssa D Fajardo
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Bryan K Holcomb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Bruce W Robb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Joshua A Waters
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA. .,, 1801 N. Senate Blvd., Suite 635, Indianapolis, IN, 46202, USA.
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Is suturing of the bladder defect in benign Enterovesical fistula necessary? BMC Surg 2019; 19:85. [PMID: 31286905 PMCID: PMC6615302 DOI: 10.1186/s12893-019-0542-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 06/24/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Enterovesical fistula (EVF) is a abnormal connection between the intestine and the bladder. The aim of the study was to analyze whether closure of the defect in the bladder wall during surgery is always necessary. METHODS Fifty-nine patients with benign EVF undergoing surgical treatment were enrolled. A one-stage surgical procedure was performed in all patients. After the separation of the diseased bowel segment, methylene blue was introduced. Through a catheter into the bladder. Only patients with urinary bladder leakage were sutured. RESULTS The most common intestinal fistula involving the urinary bladder was colovesical fistula, observed in 53% of cases. Two-thirds of patients had diverticular disease as the underlying pathology. There was no relationship between suturing of the bladder and perioperative complications. Recurrent EVF was observed in one patient with bladder suturing and in two patients without suture. CONCLUSIONS These findings suggest that closure of the bladder defect is not necessary in cases where a leak is not demonstrated from the bladder intraoperatively. This study is limited by its retrospective design and small numbers and a randomized controlled trial is recommended to answer this question definitively.
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Khor V, Aslim EJ, Ng LG, Lim JKS. 'Pop goes the whistle' - Noisy micturition as the main presentation of pneumaturia. Urol Case Rep 2019; 23:106-107. [PMID: 30740312 PMCID: PMC6357691 DOI: 10.1016/j.eucr.2019.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 01/15/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Vincent Khor
- Corresponding author. Permanent Address: MOH Holdings Pte Ltd., 1 Maritime Square, 099253, Singapore.
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Bugeja M, Mizzi C, Ellul E, Bugeja S, Mattocks S. Enterovesical Fistula Secondary to Transitional Cell Carcinoma of the Bladder. Surg J (N Y) 2018; 4:e201-e204. [PMID: 30474067 PMCID: PMC6193805 DOI: 10.1055/s-0038-1673663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022] Open
Abstract
Although fistulae between the urinary bladder and the gastrointestinal tract are not uncommon, those caused by carcinoma of the urinary bladder are rare. This report describes the case of an 85 years old male who was diagnosed with a mass involving the small bowel and the urinary bladder during the course of investigation for recurrent urinary tract infections. At laparotomy, the presence of an enterovesical fistula involving the ileum and bladder was confirmed. Histopathological examination of the resected mass showed poorly differentiated urothelial carcinoma. No early postoperative complications were encountered and postoperative cystography showed healing of the bladder without evidence of leakage. Due to the patient's age and comorbidities, no further oncological treatment was offered. Three months later the patient was readmitted to hospital with a severe pneumonia to which he succumbed.
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Affiliation(s)
- Mark Bugeja
- Department of Surgery, Mater Dei Hospital, Msida, Malta
| | | | - Ernest Ellul
- Department of Surgery, Mater Dei Hospital, Msida, Malta
| | - Simon Bugeja
- Department of Urology, Mater Dei Hospital, Msida, Malta
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Nguyen TC, Jaffe AM, Gray D, Cain J, Brown T. Colovesical Fistula As An Uncommon Presentation Of Metastatic Lung Cancer. Cureus 2018; 10:e2767. [PMID: 30101046 PMCID: PMC6082581 DOI: 10.7759/cureus.2767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Colovesical fistula is an atypical communication between the colon and the bladder. The most common causes of colovesical fistula are diverticulitis, inflammatory bowel disease, lymphoma and complication from radiation therapy. Patients with colovesical fistula present with recurrent urinary tract infections (UTI), dysuria, frequency, abdominal pain, pneumaturia, faecaluria, and hematuria. We present a case of a patient with stage IV lung adenocarcinoma presented with abdominal pain, dysuria, and faecaluria who was found to have a colovesical fistula. Although colovesical fistula may be sequelae of advanced colon or bladder cancer, it is a very uncommon presentation of metastatic cancer from distant sites. Our case is the first to show that colovesical fistula may present from metastatic lung adenocarcinoma. Clinical awareness of this very unusual presentation of metastatic cancer can lead to faster diagnosis and treatment, possibly minimizing excessive use of antibiotics.
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Affiliation(s)
- Thu-Cuc Nguyen
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Aaron M Jaffe
- Internal Medicine, University of Central Florida College of Medicine/Ocala Health, Orlando, USA
| | | | - John Cain
- Radiology, University of Central Florida College of Medicine/Ocala Health, Orlando, USA
| | - Thomas Brown
- Internal Medicine, University of Central Florida College of Medicine/Ocala Health, Orlando, USA
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Laparoscopic approaches to complicated diverticulitis. Langenbecks Arch Surg 2017; 403:11-22. [PMID: 28875302 DOI: 10.1007/s00423-017-1621-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 08/28/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The objective of this article is to review the evolving role of laparoscopic surgery in the treatment of complicated diverticulitis. PURPOSE The authors attempted to give readers a concise insight into the evidence available in the English language literature. This study does not offer a systematic review of the topic, rather it highlights the role of laparoscopy in the treatment of complicated diverticulitis. CONCLUSIONS New level 1 evidence suggest that observation rather than elective resection following nonoperative management of diverticulitis with abscess and/or extraluminal air is not below the standard of care. Implementation of nonoperative management may result in increased prevalence of sigmoid strictures.
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Smith ZL, Johnson SC, Golan S, McGinnis JR, Steinberg GD, Smith ND. Fistulous Complications following Radical Cystectomy for Bladder Cancer: Analysis of a Large Modern Cohort. J Urol 2017; 199:663-668. [PMID: 28859892 DOI: 10.1016/j.juro.2017.08.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Fistula formation is a rare and poorly described complication following radical cystectomy with urinary diversion. We sought to identify patients who experienced any type of fistulous complication and we analyzed risk factors for formation as well as management outcomes. MATERIALS AND METHODS We retrospectively reviewed the records of patients who underwent radical cystectomy for bladder cancer at our institution. Patients who experienced any fistula were identified. Risk factors, management strategies and outcomes were analyzed. Patients underwent initial conservative treatment and those in whom this treatment failed underwent surgical repair. Univariable and multivariable analyses were performed to identify predictors of fistula formation as well as the need for surgical repair. RESULTS Of the 1,041 patients 31 (3.0%) experienced fistula formation. Median time to fistula presentation was 31 days. Enterodiversion was the most common fistula type, noted in 54.8% of patients, followed by enterocutaneous and diversion cutaneous treatment in 29.0% and 12.9%, respectively. On multivariable analyses a history of radiation therapy (OR 3.1, p = 0.03) and an orthotopic neobladder (OR 3.1, p = 0.04) were predictors of fistula formation. Conservative management was successful in 41.9% of cases. There were no predictors of failed conservative management. Of patients who required surgical repair success was achieved in 94.4% at a single operation. CONCLUSIONS Fistulas are rare after radical cystectomy and they are most common between the urinary diversion and the small bowel. A history of radiation therapy and a orthotopic neobladder are risk factors for formation. When required, surgical repair is generally successful at a single operation.
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Affiliation(s)
- Zachary L Smith
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
| | - Scott C Johnson
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Shay Golan
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - J Riley McGinnis
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Gary D Steinberg
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Norm D Smith
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
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Risk factors associated with postoperative morbidity in over 500 colovesical fistula patients undergoing colorectal surgery: a retrospective cohort study from ACS-NSQIP database. Int J Colorectal Dis 2017; 32:469-474. [PMID: 27915373 DOI: 10.1007/s00384-016-2721-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate the impact of various factors on 30-day postoperative morbidity in patients who underwent colorectal surgery (CRS) for colovesical fistula (CVF) in the elective and emergency settings. METHODS Patients who underwent CRS for CVF between 2005 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database by using current procedural terminology codes. Demographics, perioperative, and operative factors were assessed and compared between two groups classified according to the presence or absence of postoperative complications. RESULTS Five hundred twelve patients met the inclusion criteria [mean age of 61.4 (±14.7) years, female 214 (42%)]. Etiology of fistula was diverticulitis [N = 438 (85.5%)], colon cancer [N = 39 (7.6%)], and Crohn's disease [N = 35 (6.8%)]. One hundred fifty-two procedures (29.7%) were performed laparoscopically. In 186 patients (36%), no bladder intervention was performed. One hundred forty-nine patients (29.1%) had at least one postoperative complication. Patients who developed complication were older (P = <0.001), more often female (P = <0.001), hypertensive (P = 0.005), anemic (P = <0.001), preoperatively transfused (P = 0.02), and with class 2-3 wound classification (P = 0.01). Independent risk factors affecting morbidity were increased age [odds ratio (OR) 1.23 (1.03-1.47), P = 0.01], decreased hematocrit level [OR 3.04(1.83-5.06), P < 0.0001], and open approach [OR 2.56 (1.35-4.84), P = 0.003]. CONCLUSIONS Morbidity for CVF remains high. Lower preoperative hematocrit level and increased age were associated with higher risk of complication. Laparoscopic surgery may be preferable when possible as morbidity is less with this approach.
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Yamashita M, Hotta M, Yoshino K, Hidaka Y, Kimura T. A Food Debris–Like Component in the Urine Sediment From a Urostomy Pouch. Lab Med 2017; 48:178-182. [DOI: 10.1093/labmed/lmx001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Albrecht R, Weirich T, Reichelt O, Settmacher U, Bochmann C. [Colovesical fistulas : An interdisciplinary challenge]. Chirurg 2016; 88:687-693. [PMID: 27995299 DOI: 10.1007/s00104-016-0347-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of treatment of patients with colovesical fistulas should be prompt elimination of the infection and the social burden. We focused on the question whether a minimally invasive surgical approach as a cooperation between surgeons and urologists is possible. This requires effective diagnostics prior to the operation. METHODS Since 2007 a total of 32 patients with the clinical suspicion of colovesical fistula have undergone extensive preoperative diagnostics. Operative treatment aimed primarily for a minimally invasive approach. In particular, the validity of preoperative diagnostics was analyzed and surgical results were characterized by clinical success, complications and long-term effects. RESULTS The medical history significant for colovesical fistula and detected urinary infection provided the best evidence for the specific diagnosis. Cystoscopy, computed tomography (CT) scan and colonoscopy were only partially effective for predicting a fistula as subsequently diagnosed by histopathological investigations. Fistulas due to diverticulitis of the sigmoid colon occurred in 28 cases, while in 3 subjects there was a gynecological and inflammatory cause (malignant tumor growth, n = 1). A laparoscopic approach achieving repair and healing of the fistula was possible in 29 cases including conversion in 3 subjects because of intraoperative complications. The remaining patients underwent conventional treatment. The disease-related complication rate as revealed during follow-up was 10%. DISCUSSION Laparoscopic repair and healing of a colovesical fistula is possible in the majority of cases by the recommended preoperative ureteral stenting. As part of diagnostic measures, the medical history significant for a fistula and detection of urinary infections are the most reliable aspects. In the case of this combination together with a further diagnostic measure, a laparoscopic approach is always recommended. The recurrency rate is 0%.
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Affiliation(s)
- R Albrecht
- Klinik für Allgemein-, Viszeral- und Minimal-invasive Chirurgie, HELIOS Klinikum Aue, Gartenstraße 6, 08280, Aue, Deutschland.
| | - T Weirich
- Klinik für Urologie und Kinderurologie, HELIOS Klinikum Aue, Aue, Deutschland
| | - O Reichelt
- Klinik für Urologie und Kinderurologie, HELIOS Klinikum Aue, Aue, Deutschland
| | - U Settmacher
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Friedrich-Schiller-Universität Jena, Jena, Deutschland
| | - C Bochmann
- Klinik für Allgemein-, Viszeral- und Minimal-invasive Chirurgie, HELIOS Klinikum Aue, Gartenstraße 6, 08280, Aue, Deutschland
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Li S, Chen Z, Zhang Q, Huang C, Wang Z, Du S. Four cases of enterovesical fistula and the importance of CT in the diagnosis. BJR Case Rep 2016; 3:20150124. [PMID: 30363344 PMCID: PMC6159305 DOI: 10.1259/bjrcr.20150124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/12/2016] [Indexed: 11/05/2022] Open
Abstract
Enterovesical fistula is an abnormal communication between the urinary bladder and intestine. Diverticulitis is the most common aetiology, accounting for approximately 50-70% of cases, and malignancy is the second most common cause, accounting for approximately 20% of cases. However, most patients are hospitalized because of urinary symptoms. The disease can be misdiagnosed if patients have been symptomatic for a long time before the diagnosis is made. Detection of enterovesical fistula and the underlying disease is important. However, the optimal diagnostic methods have not been clarified. CT scan is the most sensitive diagnostic modality, but should be backed up with cystoscopy, cystography, colonoscopy and barium enema.
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Affiliation(s)
| | - Zhipeng Chen
- Department of Urology, Weifang People's Hospital, Weifang, 261042, Shandong, China
| | - Qian Zhang
- Department of Urology, Research Institute of China Medical University The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Chuanyang Huang
- Department of Urology, Research Institute of China Medical University The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Zhe Wang
- Department of Urology, Research Institute of China Medical University The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Shuqi Du
- Department of Urology, Research Institute of China Medical University The First Affiliated Hospital of China Medical University, Shenyang, PR China
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Lee YT, Chen YY, Wu CY, Chen HM, Tzeng CH, Chiou TJ. Enterovesical fistula caused by regressive change of non-Hodgkin's lymphoma: A case report. Oncol Lett 2016; 12:331-333. [PMID: 27347146 DOI: 10.3892/ol.2016.4561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/22/2016] [Indexed: 12/13/2022] Open
Abstract
Enterovesical fistula (EVF) is a rare complication of diverticulitis, as well as Crohn's disease, intestinal malignancy, radiotherapy and trauma. EVF formation is associated with inflammation of the involved bowel segments. The current study presents the case of a 35-year-old man with non-Hodgkin's lymphoma who developed pneumaturia, fecaluria and recurrent urinary tract infections following chemotherapy, accompanied by regressive change of the lymphoma. Abdominal computed tomography scans revealed that the terminal ileum had adhered to the bladder wall. The patient underwent exploratory laparotomy and partial resection of the terminal ileum, and EVF was confirmed. Histological examination revealed an inflammatory response but no evidence of residual lymphoma. The diagnosis of EVF is occasionally difficult and requires appropriate radiographic examination. Surgical treatment is recommended.
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Affiliation(s)
- Yu-Ting Lee
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan, R.O.C.; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan, R.O.C
| | - Ying-Yuan Chen
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan, R.O.C.; Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan, R.O.C
| | - Chia-Yun Wu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan, R.O.C.; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan, R.O.C
| | - Hung-Ming Chen
- Division of Hematology and Oncology, Department of Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan, R.O.C
| | - Cheng-Hwai Tzeng
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan, R.O.C.; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan, R.O.C
| | - Tzeon-Jye Chiou
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan, R.O.C.; Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan, R.O.C
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Is laparoscopic surgery the best treatment in fistulas complicating diverticular disease of the sigmoid colon? A systematic review. Int J Surg 2015; 24:95-100. [PMID: 26584958 DOI: 10.1016/j.ijsu.2015.11.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 11/01/2015] [Accepted: 11/05/2015] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Laparoscopic surgery is considered in the treatment of diverticular fistula for the possible reduction of overall morbidity and complication rate if compared to open surgery. Aim of this review is to assess the possible advantages deriving from a laparoscopic approach in the treatment of diverticular fistulas of the colon. METHODS Studies presenting at least 10 adult patients who underwent laparoscopic surgery for sigmoid diverticular fistula were reviewed. Fistula recurrence, reintervention, Hartmann's procedure or proximal diversion, conversion to laparotomy were the outcomes considered. RESULTS 11 non randomized studies were included. Rates of fistula recurrence (0.8%), early reintervention (30 days) (2%) and need for Hartmann's procedure or proximal diversion (1.4%) did not show significant difference between laparoscopy and open technique. DISCUSSION there is still concern about which surgery in complicated diverticulitis should be preferred. Laparoscopic approach has led to less postoperative pain, shorter hospital stay, faster recovery and better cosmetic results. Laparoscopic resection and primary anastomosis is a possible approach to sigmoid fistulas but its advantages in terms of lower mortality rate and postoperative stay after colon resection with primary anastomosis should be interpreted with caution. When there is firm evidence supporting it, it is likely that minimally invasive surgery should become the standard approach for diverticular fistulas, thus achieving adequate exposure and better visualization of the surgical field. CONCLUSION The lack of RCTs, the small sample size, the heterogeneity of literature do not allow to draw statistically significant conclusions on the laparoscopic surgery for fistulas despite this approach is considered safe.
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Testicular Interposition Flap for Repair of Perineal Urinary Fistulae: A Novel Surgical Technique. Case Rep Urol 2015; 2015:836454. [PMID: 26483985 PMCID: PMC4592900 DOI: 10.1155/2015/836454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 09/13/2015] [Indexed: 12/03/2022] Open
Abstract
Rectourinary fistulae and urinary-cutaneous fistulae are a rare yet devastating complication. Current options for tissue interposition include rectus, gracilis, or gluteal muscle, omentum, or intestine for use in coloanal pull-through procedures. In elderly patients, testicular interposition flaps may be an excellent tissue option to use when vitalized tissue is necessary to supplement fistula repair. Elderly patients frequently have increased spermatic cord length, potentially offering a longer flap reach than use of a muscle flap. Additionally, mobilizing one of the testicles and developing it through the external inguinal ring may be a less morbid and less costly procedure than harvesting and tunneling a muscle flap. Longer follow-up and further studies are needed to determine the outcomes of this novel technique.
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Enterovesical fistula caused by a toothpick. Case Rep Urol 2015; 2015:902673. [PMID: 25838964 PMCID: PMC4369900 DOI: 10.1155/2015/902673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 02/10/2015] [Indexed: 11/17/2022] Open
Abstract
We present a case of enterovesical fistula caused by an accidental ingestion of a foreign body. A 23-year-old man presented to our hospital with pneumaturia, fecaluria, and abdominal pain but no recent possible causes of enterovesical fistula at anamnesis. Cystoscopy, cystography, and also colonoscopy were not able to detect the fistulous tract. Computer tomography (CT) revealed a fistula between bladder and bowels caused by a toothpick accidentally swallowed 2 years earlier. We tried to remove the foreign body endoscopically by cystoscopy and colonoscopy but with no success. The failure of endoscopic procedures required a surgical treatment. The patient underwent laparoscopic segmental resection of the sigmoid colon to remove the fistulous tract and the foreign body. The cystography revealed no external leakage of contrast from the bladder with complete resolution of the problem.
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Eswara JR, Raup VT, Heningburg AM, Brandes SB. Pelvic radiation is associated with urinary fistulae repair failure and need for permanent urinary diversion. Urology 2015; 85:932-6. [PMID: 25817118 DOI: 10.1016/j.urology.2014.11.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 11/24/2014] [Accepted: 11/25/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To review our experience with nonmuscle flap repairs of enterourinary fistulae (EUF) and urinary cutaneous fistulae (UCF). EUF and UCF can be treated either with temporary urinary diversion allowing for healing by secondary intention or primary closure of the defect using an interposing omental, sliding, or muscle flap. Even after successful fistula repair, permanent urinary diversion can be required because of persistent urinary incontinence. MATERIALS AND METHODS We reviewed 86 patients who underwent treatment of EUF or UCF at Washington University between the years 1998 and 2013. Of these, 39 patients underwent fistula repair, whereas 47 patients underwent either surgical or nonsurgical urinary diversion. Outcomes measured included postoperative fistula closure, need for permanent urinary diversion, and urinary incontinence. RESULTS The mean age in our series was 59 years (21-87 years) at the time of surgery, with median follow-up of 20 months (1-137 months). Among patients who underwent surgical repair, radiation was associated with higher rates of repair failure (P = .0002), postsurgical incontinence (P <.0001), and the need for permanent urinary diversion (P = .0076). At the time of final follow-up, 32 of the 44 radiated patients had required permanent diversion (72%) compared with 3 of the 42 nonradiated patients (7%; P <.0001). CONCLUSION Patients who undergo pelvic radiation before EUF and UCF repairs are at higher risk for developing repair failure and postsurgical incontinence. Many patients eventually require permanent urinary diversion. Therefore, EUF and UCF repairs in radiated patients should be undertaken with caution, and patients should be counseled about the possibility of urinary diversion as primary therapy.
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Affiliation(s)
- Jairam R Eswara
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Valary T Raup
- Division of Urologic Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO
| | - Avory M Heningburg
- Division of Urologic Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO
| | - Steven B Brandes
- Division of Urologic Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO
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Presley BC, Hayden GE. More than just hematuria. J Emerg Med 2014; 47:e149-e150. [PMID: 25242097 DOI: 10.1016/j.jemermed.2014.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 06/30/2014] [Indexed: 06/03/2023]
Affiliation(s)
- Bradley C Presley
- Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Geoffrey E Hayden
- Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
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Laparoscopic management of diverticular colovesical fistula: experience in 15 cases and review of the literature. Int Surg 2014; 98:101-9. [PMID: 23701143 DOI: 10.9738/intsurg-d-13-00024.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Colovesical fistulas secondary to diverticular disease may be considered a contraindication to the laparoscopic approach. The feasibility of laparoscopic management of complicated diverticulitis and mixed diverticular fistulas has been demonstrated. However, few studies on the laparoscopic management of diverticular colovesical fistulas exist. A retrospective analysis was performed of 15 patients with diverticular colovesical fistula, who underwent laparoscopic-assisted anterior resection and bladder repair. Median operating time was 135 minutes and median blood loss, 75 mL. Five patients were converted to an open procedure (33.3%) with an associated increase in hospital stay (P = 0.035). Median time to return of bowel function was 2 days and median length of stay, 6 days. Overall morbidity was 20% with no major complications. There was no mortality. There was no recurrence during median follow-up of 12.4 months. These results suggest that laparoscopic management of diverticular colovesical fistulas is both feasible and safe in the setting of appropriate surgical expertise.
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Chebli JMF, Figueiredo AA, Gaburri PD. Gouverneur's syndrome in a patient with abdominal pain: mind Crohn's disease! Rev Assoc Med Bras (1992) 2014; 60:196-7. [PMID: 25004262 DOI: 10.1590/1806-9282.60.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Cirocchi R, Cochetti G, Randolph J, Listorti C, Castellani E, Renzi C, Mearini E, Fingerhut A. Laparoscopic treatment of colovesical fistulas due to complicated colonic diverticular disease: a systematic review. Tech Coloproctol 2014; 18:873-85. [PMID: 24848529 DOI: 10.1007/s10151-014-1157-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 04/13/2014] [Indexed: 12/19/2022]
Abstract
Colovesical fistulas originating from complicated sigmoid diverticular disease are rare. The primary aim of this review was to evaluate the role of laparoscopic surgery in the treatment of this complication. The secondary aim was to determine the best surgical treatment for this disease. A systematic search was conducted for studies published between 1992 and 2012 in PubMed, the Cochrane Register of Controlled Clinical Trials, Scopus, and Publish or Perish. Studies enrolling adults undergoing fully laparoscopic, laparoscopic-assisted, or hand-assisted laparoscopic surgery for colovesical fistula secondary to complicated sigmoid diverticular disease were considered. Data extracted concerned the surgical technique, intraoperative outcomes, and postoperative outcomes based on the Cochrane Consumers and Communication Review Group's template. Descriptive statistics were reported according to the PRISMA statement. In all, 202 patients from 25 studies were included in this review. The standard treatment was laparoscopic colonic resection and primary anastomosis or temporary colostomy with or without resection of the bladder wall. Operative time ranged from 150 to 321 min. It was not possible to evaluate the conversion rate to open surgery because colovesical fistulas were not distinguished from other types of enteric fistulas in most of the studies. One anastomotic leak after bowel anastomosis was reported. There was zero mortality. Few studies conducted follow-up longer than 12 months. One patient required two reoperations. Laparoscopic treatment of colovesical fistulas secondary to sigmoid diverticular disease appears to be a feasible and safe approach. However, further studies are needed to establish whether laparoscopy is preferable to other surgical approaches.
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Affiliation(s)
- R Cirocchi
- Department of General and Oncologic Surgery, St. Maria Hospital, University of Perugia, Località Sant'Andrea delle Fratte, Via Gambuli n.1, 06156, Perugia, Italy
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Lundeby E, Tahir AR, Grøtta OJ, Frich L. A woman in her 60s with pneumaturia. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:530-3. [PMID: 24621912 DOI: 10.4045/tidsskr.13.0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
| | | | | | - Lars Frich
- Avdeling for plastikk- og rekonstruktiv kirurgi Oslo universitetssykehus
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Golabek T, Szymanska A, Szopinski T, Bukowczan J, Furmanek M, Powroznik J, Chlosta P. Enterovesical fistulae: aetiology, imaging, and management. Gastroenterol Res Pract 2013; 2013:617967. [PMID: 24348538 PMCID: PMC3857900 DOI: 10.1155/2013/617967] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 10/29/2013] [Indexed: 12/26/2022] Open
Abstract
Background and Study Objectives. Enterovesical fistula (EVF) is a devastating complication of a variety of inflammatory and neoplastic diseases. Radiological imaging plays a vital role in the diagnosis of EVF and is indispensable to gastroenterologists and surgeons for choosing the correct therapeutic option. This paper provides an overview of the diagnosis of enterovesical fistulae. The treatment of fistulae is also briefly discussed. Material and Methods. We performed a literature review by searching the Medline database for articles published from its inception until September 2013 based on clinical relevance. Electronic searches were limited to the keywords: "enterovesical fistula," "colovesical fistula" (CVF), "pelvic fistula", and "urinary fistula". Results. EVF is a rare pathology. Diverticulitis is the commonest aetiology. Over two-thirds of affected patients describe pathognomonic features of pneumaturia, fecaluria, and recurrent urinary tract infections. Computed tomography is the modality of choice for the diagnosis of enterovesical fistulae as not only does it detect a fistula, but it also provides information about the surrounding anatomical structures. Conclusions. In the vast majority of cases, this condition is diagnosed because of unremitting urinary symptoms after gastroenterologist follow-up procedures for a diverticulitis or bowel inflammatory disease. Computed tomography is the most sensitive test for enterovesical fistula.
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Affiliation(s)
- Tomasz Golabek
- Department of Urology, Collegium Medicum of the Jagiellonian University, Ulica Grzegorzecka 18, 31-531 Cracow, Poland
| | - Anna Szymanska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Ulica Jaczewskiego 8, 20-954 Lublin, Poland
| | - Tomasz Szopinski
- Department of Urology, Collegium Medicum of the Jagiellonian University, Ulica Grzegorzecka 18, 31-531 Cracow, Poland
| | - Jakub Bukowczan
- Department of Endocrinology and Diabetes, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - Mariusz Furmanek
- Department of Radiology, Central Clinical Hospital Ministry of Interior in Warsaw, ul. Wolowska 137, 02-507 Warsaw, Poland
| | - Jan Powroznik
- The 1st Department of Urology, Postgraduate Medical Education Centre, European Health Centre in Otwock, ul. Borowa 14/18, 05-400 Otwock, Poland
| | - Piotr Chlosta
- Department of Urology, Collegium Medicum of the Jagiellonian University, Ulica Grzegorzecka 18, 31-531 Cracow, Poland
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Radwan R, Saeed ZM, Phull JS, Williams GL, Carter AC, Stephenson BM. How safe is it to manage diverticular colovesical fistulation non-operatively? Colorectal Dis 2013; 15:448-50. [PMID: 22966940 DOI: 10.1111/codi.12025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM Colovesical fistula (CVF) is an uncommon condition. Diagnosis and management varies according to presentation and aetiology. The identification of patients suitable for conservative management and their outcome following this approach has not been well documented. METHODS The clinical outcomes of all patients diagnosed with a CVF over a 7-year period from an uro-radiological database were reviewed. Cases secondary to diverticular disease were analysed with respect to the approach by which they were managed: those treated surgically and those managed conservatively. RESULTS Sixty-two patients (32 men) were diagnosed with CVF of whom 53 (85%) had diverticular disease. Twenty-seven (mean age 69 years, range 42-90) underwent surgery (with a stoma in 59%) with a 30-day mortality of 15%. Those managed conservatively (n = 26) were older (mean age 76 years, range 39-87) and frailer (62% American Society of Anesthesiologists Grades III and IV). At 1 and 3 years following diagnosis there was no difference in mortality between these two groups and only one death was as a consequence of urosepsis. CONCLUSION Many patients with CVF secondary to diverticular disease can be safely managed non-operatively.
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Affiliation(s)
- R Radwan
- Departments of Urology and Colorectal Surgery, Royal Gwent Hospital, Newport, South Wales, UK
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Dynamic FDG PET/CT Imaging With Diuresis Demonstrates an Enterovesical Fistula in a Lymphoma Patient With Repeated Colon Diverticulitis. Clin Nucl Med 2013; 38:272-5. [DOI: 10.1097/rlu.0b013e3182817c5f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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