Commentary.

Abstract

Colovesical fistula is a well-known complication of pelvic radiation, especially when the latter is combined with surgery [1]. Interventional management is usually necessary but difficult, with surgery preferably avoided as these patients are poor surgical candidates and the irradiated field is an unfriendly surgical environment [1] [2]. In this e-Video, the authors elegantly demonstrate how a patient with sepsis due to a fistula between a neobladder and the rectum was successfully treated with placement of an atrial septal defect closure device. These devices have been used for treatment of tracheoesophageal fistulas [3] but seem to be effective in the lower gastrointestinal (GI) tract as well. Among the highlights of the case, one should point out the interdisciplinary approach, with co-operation between GI endoscopists and urologists for effective device placement, and the trend of modern GI endoscopy to expand into spaces adjacent to but outside of the GI tract.