Diagnosis and treatment of enterovesical fistulas

Abstract

A fistula is an atypical connection between two epithelial surface. We studied retrospectively four male pa­tients with enterovesical fistulas treated in our departments between March 2016 - March 2017. These in­cluded colovesical, rectovesical and ileovesical fistulas. Patients presented with urinary symptoms (pneu­maturia, faecaluria and recurrent urinary tract infections). One patient had received radiotherapy after rec­tal resection for rectal carcinoma. For another of the cases the fistula was being due to periprostatic abscess. The third patient was diagnosed with bladder carcinoma with rectal invasion. The fourth patient was with direct invasion of sigmoid cancer to the bladder. The most common investigations included abdominal ul­trasound, CT scan, cystoscopy and colonoscopy. Enteral stoma was performed in all cases as a part of sur­gical treatment. All patients underwent open procedure, as a main rule enteral stoma was performed to cease the contami­nation, and primary repair of the bladder was performed. No recurrences were recorded, but there were sev­eral complications, including Clavien-Dindo gr. V. Most of the complications were treated by interventional urology. In conlusion, enteral division and primary repair of the bladder are safe approaches for treatment of enterovesical fistulas. As a rule ceasing of contamination should always be performed. Cystoscopy can manage most of the complications occurring in the early postoperative period. Scr Sci Med 2017; 49(3): 53-56