Is suturing of the bladder defect in benign Enterovesical fistula necessary?

Ł Dziki,M Włodarczyk,R Trzciński,A Sobolewska-Włodarczyk,A Dziki,A G Hill,M Mik

doi:10.1186/s12893-019-0542-4

Abstract

BackgroundEnterovesical 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.MethodsFifty-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.ResultsThe 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.ConclusionsThese 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.

Highlights

Enterovesical fistula (EVF) is a abnormal connection between the intestine and the bladder
EVF is classified based on the bowel segment that is involved in the abnormal communication with the bladder
Fifty-nine patients were confirmed with benign EVF, including thirty-two males

Summary

Introduction

Enterovesical fistula (EVF) is a abnormal connection between the intestine and the bladder. Enterovesical fistula (EVF) is characterized by an abnormal communication between the bladder and the intestine. EVF most commonly occurs due to malignancy or inflammatory diseases [1, 2]. EVF is relatively rare it causes significant morbidity and may noticeably affect the quality of life of the patient. A diagnosis of EVF can be challenging and is often delayed for several months after symptoms begin. EVF is classified based on the bowel segment that is involved in the abnormal communication with the bladder. Colovesical fistula is the most common form, and is most frequently located between the sigmoid colon and the dome of the bladder [5, 6]

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