Diagnosis and management of colovesical fistulae

Abstract

Introduction Colovesical fistulae (CVF) are the relatively uncommon presentation in colorectal surgical practice. However, the rarity of the disease gives rise to problems in diagnosis and treatment as adequately powered data is lacking in published literature. Furthermore, the aetiology of CVF in Asia differs from the West which plays an important role in patient management. Methods The records of all the patients with CVF managed in the Gastrointestinal and Urological surgical units of a tertiary care centre over a nine-year period were collected and analysed. Follow-up data have been collected prospectively to assess the outcome. Results A total of 11 patients (M: F=9:2) with a median age of 59 years were studied. Faecaluria, pneumaturia and recurrent urinary tract infections were the commonest presenting symptoms. The diagnosis was based on clinical evaluation. Cystoscopy, colonoscopy and CECT were utilized to identify the underlying pathology, complications and for staging. Commonest benign pathology was diverticular disease (n=7), followed by tuberculosis (n=1). Adenocarcinoma of the sigmoid colon and squamous cell Carcinoma of the bladder were reported in three patients. Majority of patients (n=9) were managed successfully by open-left colonic resection with or without temporary ileostomy and bladder repair, while inoperable patients were managed with a stoma. Conclusion CVF is a relatively uncommon condition in our setup and mostly related to isolated diverticular disease of the sigmoid colon. Diagnosis of CVF can be made with accuracy by proper clinical assessment. Cystoscopy and LGIE are essential components of the diagnostic workup of a patient with suspected CVF. During surgery, segmental resection of the colon is favoured than local repair.