Management of Colovesical Fistulae Caused by Diverticulitis: 12 Years of Experience in One Medical Centre

Abstract

Background : Diverticulitis can be complicated by a colovesical fistula (CVF). This phenomenon is relatively uncommon in surgical practice. The aim of this study was to evaluate diagnostic and surgical management of CVF at our medical centre.Material and Methods : In this retrospective study, details of 31 patients undergoing surgery for CVF between January 1998 and March 2010 were recorded. These patient records were analysed for presenting symptoms, diagnostic investigations and surgical procedures.Results : The most common presenting symptoms were pneumaturia, urinary tract infections, abdominal pain, and fecaluria. CT identified CVF in 28 patients (92.2%), cystoscopy in 4 patients (23.5%), and barium enema in 3 patients (13.6%). Surgical management was resection of the diseased colon segment with primary anastomosis in 29 of 31 patients. The bladder fistulae were oversewn and an omental plasty was placed between bowel anastomosis and bladder. There was only one postoperative leak and one case of mortality (3.2%).Conclusions : CT is the most sensitive test in identifying CVF. Resection of the diseased colon segment and primary anastomosis seems to be an effective and safe surgical method for treating CVF. This surgical treatment has an acceptable risk for anastomotic leak and mortality.