Colovesical Fistula Research Articles

Laparoscopic Surgery for Diverticular Fistulas: Outcomes of 111 Consecutive Cases at a Single Institution

BackgroundThe purpose of this study was to review our experience with laparoscopic colectomy and fistula resection, evaluate the frequency of conversion to open, and to compare the perioperative courses of the complete laparoscopic and conversion groups. MethodsThis study is a retrospective analysis of 111 consecutive adult patients with diverticular fistulae diagnosed clinically or radiographically over 11 years at a single institution. Five patients were excluded for preoperative comorbidities. The remaining 106 consecutive patients underwent minimally invasive sigmoid colectomy with primary anastomosis. Preoperative, intraoperative, and postoperative variables were collected from the colorectal surgery service database. A retrospective cohort analysis was performed between laparoscopic and converted groups. ResultsWithin the group, 47% had colovesical fistulas, followed by colovaginal, coloenteric, colocutaneous, and colocolonic fistulas. The overall conversion rate to laparotomy was 34.7% (n = 37). The most common reason for conversion was dense fibrosis. Mean operative time was similar between groups. Combined postoperative complications occurred in 26.4% of patients (21.4% laparoscopic and 37.8% converted, p = 0.075). Length of stay was significantly shorter in the laparoscopic group (5.8 vs 8.1 days, p = 0.014). There were two anastomotic leaks, both in the open group. There were no 30-day mortalities. ConclusionsLaparoscopic sigmoid colectomy for diverticular fistula is safe, with complication rates comparable to open sigmoid resection. We identify a conversion rate which allows the majority of patients to benefit from minimally invasive procedures.

Laparoscopic treatment of a vesicointestinal fistula due to a Meckel’s diverticulum: a case report and review of the literature

While there have been numerous reports about colovesical fistulas and ruptured intestinal diverticula, there have been far fewer reports about vesicointestinal fistulas caused by Meckel's diverticula. Most Meckel's diverticula are asymptomatic. Furthermore, they seldom cause vesicointestinal fistulas, and the associated complications are non-specific. Thus, their preoperative diagnosis is difficult. We experienced a case in which a vesicointestinal fistula was caused by a Meckel's diverticulum and was treated with laparoscopic surgery. A 46-year-old male was referred to our hospital after exhibiting hematuria. Cystoscopy revealed a fistula between the small intestine and bladder. Contrast-enhanced computed tomography and magnetic resonance imaging showed a diverticulum in the ileum and a fistula between the ileum and bladder, which passed through the diverticulum. A Meckel's diverticulum was suspected. We conducted a laparoscopic operation. We dissected the Meckel's diverticulum with an automatic suturing device and removed it together with part of the ileum. The patient's postoperative course was good. We experienced a case in which a vesicointestinal fistula was caused by a Meckel's diverticulum and was successfully treated with laparoscopic surgery. In selected cases of Meckel's diverticulum, the dissection of the diverticulum with an automatic suturing device is appropriate.

Surgical protocol and outcome for sigmoidovesical fistula secondary to diverticular disease of the left colon: A retrospective cohort study

BackgroundDiverticular disease of sigmoid colon can rarely be complicated by a connective track to urinary bladder. Pneumaturia and fecaluria are the pathognomonic symptoms. Resection surgery is the preferred treatment to overcome the renal sequellae of the disease. The purpose of this study is to propose a guiding classification to help general surgeons during surgical management of diverticular disease complicated by sigmoidovesical fistula (SVF). Patients and methodsThe data of 40 cases with colovesical fistula due to diverticular disease of sigmoid colon were retrospectively analyzed. Clinicopathological variables, imaging reports, types of treatment and patient outcome were evaluated. ResultsThere were 36 men (90%) and four women (10%) in which the ages ranged from 32 to 79 with a mean of 58.1 years. Pneumaturia was the most common presenting symptom in 38 cases (95%) followed by urinary symptoms in 35 cases (87.5%) then fecaluria in 33 cases (82.5%). 37 patients underwent surgical resection while three patients were in poor general condition to withstand major resection. 16 patients underwent one stage resection and anastomosis, 16 patients were managed by two stage procedure and the remaining 5 patients were treated by three stages operation. ConclusionsAdequately performed CT followed by colonoscopy is the mainstay for diagnosis. Type 1 SVF should be treated in a single stage by complete resection and immediate anastomosis without a stoma. Type 2 cases are best managed in two stages while those with type 3 SVF are emergently managed by three stage procedure. Treatment of type 4 should be individualized.

Tu1684 - Surgical Management of Colovesical Fistula in Complicated Diverticular Disease

Tu1684 - Surgical Management of Colovesical Fistula in Complicated Diverticular Disease

Tu2021 - Early Foley Catheter Removal after Sigmoid Colectomy for Diverticular Colovesical Fistula

Tu2021 - Early Foley Catheter Removal after Sigmoid Colectomy for Diverticular Colovesical Fistula

Congenital pouch colon associated with anorectal malformation: A rare anomaly of Asian Region - experience of Kurdish centre.

Background:Congenital pouch colon (CPC) is an unusual malformation associated with anorectal malformations (ARMs) that are seen especially in Asia. The aim of this study was to analyse our series of CPC associated with ARM in our centre and report our experience based on the rarity of pathology.Materials and Methods:This is a retrospective study conducted at the Department of Paediatric Surgery in North Iraq. We identified patients from a prospectively kept database, including all patients managed between 1997 and 2014.Results:In total, 17 patients (3 females and 14 males) were included; all had CPC and high ARM; male:female ratio was 5.6:1. Two females had colo-vestibular fistula, 1 had a colo-cloacal fistula, all males had imperforate anus with colovesical fistula. Pre-operative diagnosis of CPC was made in eight patients (47%). Four patients (23.5%) had an incomplete pouch colon (Type III and IV), and 13 (76%) had complete pouch colon (Type I and II). All patients were managed with staged surgery. Mortality rate was 17.6% (3/17).Conclusions:CPC associated with ARM can be defined as 'Asian' complex malformation. Few cases are reported in Literature from Europe and USA. However, it is known that it is ever more frequent the collaboration between Asian and European surgeons (as in our study), so the suspicion should be considered in all patient high ARM who come from Asian region. We reviewed literature and report our experience of 15 years, after a retrospectively analysis, to share it and add our data to their reported.

Colovesical Fistula: 1 Patientʼs Saga and Review of Varied Approaches to Treatment

Colovesical Fistula: 1 Patientʼs Saga and Review of Varied Approaches to Treatment

Diagnosis and treatment of enterovesical fistulas

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

P24: DUAL EFFECT OF PHENYLEPHRINE TO IMPROVE CORONARY PERFUSION DURING ANAPHYLAXIS MANAGEMENT

Adrenaline, the drug of choice in anaphylaxis may produce side effects like tachycardia resulting in impaired coronary perfusion in the setting of severe hypotension. In this situation, Phenylephrine was used to improve coronary perfusion by Increasing coronary flow time from reflex bradycardia and an increase in coronary perfusion pressure resulting from an overall increase in systemic blood pressure. We describe a situation where at the end of an elective high anterior resection for colovesical fistula, immediately after administering reversal agents (Neostigmine and glycopyrrolate), there was severe hypotension with systolic blood pressure of 40m mmHg unresponsive to Ephedrine and Metaraminol. Adrenaline boluses resulted in tachycardia with marked ST segment elevation and slight increase in blood pressure. Intravenous Phenylephrine 100 mcg bolus was given and repeated twice over a period of 15 minutes which reduced the heart rate from 130 to 100 beats/minute as well as increased the blood pressure with ST segment returning to baseline. ANZAAG guidelines were followed to maximise management and team efficiency during and after the crisis and resulted in an uneventful recovery. A 10 fold increase in serum Tryptase confirmed anaphylaxis. Anaphylaxis to reversal agents (Neostigmine and Glycopyrrolate) is rare1 and in this situation it was complicated by ECG evidence of tachycardia induced ST segment elevation after administration of 2 doses of 100 mcg increments of adrenaline with only small increase in blood pressure. Phenylephrine improved the myocardial perfusion and blood pressure. We recommend that Phenylephrine should be considered in the presence of Adrenaline induced tachycardia to improve myocardial perfusion during anaphylaxis management. 1. McNicholas JJ, Harban FM. Anaphylaxis caused by neostigmine. Anaesthesia 2000; 55: 1039.

Colovesical fistula: visualization of the bladder during colonoscopy

Colovesical fistula: visualization of the bladder during colonoscopy

Mo1621 - Early Removal of Foley Catheter After Surgery for Colovesical Fistula Secondary to Diverticulitis: Friend or Foe?

Mo1621 - Early Removal of Foley Catheter After Surgery for Colovesical Fistula Secondary to Diverticulitis: Friend or Foe?

Congenital Pouch Colon.

Congenital pouch colon (CPC) is an unusual abnormality in which a pouch-like dilatation of a shortened colon is associated with an anorectal malformation. It is categorized into four subtypes (Types I–IV) based on the length of normal colon proximal to the colonic pouch. In males, the pouch usually terminates in a colovesical fistula just proximal to the bladder neck. In girls, the terminal fistula opens either into the urethra or in the vestibule, close to the urethral opening. Girls usually have a double vagina with a wide inter-vaginal bridge, a monocornuate uterus on each side, and urinary incontinence due to a widely open bladder neck. Associated major malformations are uncommon with CPC but sometimes, especially in reports from outside India, major abnormalities are present suggesting an early, severe error in embryogenesis. The more severe Types I/II CPC can usually be diagnosed by a large gas shadow or air-fluid level on X-Ray abdomen. For all subtypes of CPC, it is preferable to preserve a segment of the pouch by fashioning a narrow colonic tube for pull-through, the technique known as coloplasty or tubular colorraphy. Girls need additional management of the genitourinary abnormalities. Postoperatively, fecal continence levels are usually poor, especially with Types I/II CPC.

Laparoscopic anterior pelvic exenteration with sigmoid colon resection (clinical observation)

The clinical observation demonstrates a successful surgical treatment of a 61-year-old female patient K. (body mass index 38.4) diagnosed with locally advanced sigmoid colon cancer protruded into the bladder and uterus (сT4bN2M0) with formation of a colovesical fistula. The patient underwent surgical treatment in the form of laparoscopic resection of the sigmoid colon and supralevator anterior pelvic exenteration with formation of a Bricker conduit. Intraoperative blood loss was 200 ml. Postoperative period was smooth, with fast track rehabilitation; the patient was discharged on day 9. Considering cancer stage, the patient received XELOX as adjuvant chemotherapy for 6 months after the surgery. During a year of follow-up, no signs of disease progression were evident. The patient is fully socially rehabilitated.

Risk factors associated with postoperative morbidity in over 500 colovesical fistula patients undergoing colorectal surgery: a retrospective cohort study from ACS-NSQIP database

The aim of this study was to evaluate the impact of various factors on 30-day postoperative morbidity in patients who underwent colorectal surgery (CRS) for colovesical fistula (CVF) in the elective and emergency settings. Patients who underwent CRS for CVF between 2005 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database by using current procedural terminology codes. Demographics, perioperative, and operative factors were assessed and compared between two groups classified according to the presence or absence of postoperative complications. Five hundred twelve patients met the inclusion criteria [mean age of 61.4 (±14.7) years, female 214 (42%)]. Etiology of fistula was diverticulitis [N=438 (85.5%)], colon cancer [N=39 (7.6%)], and Crohn's disease [N=35 (6.8%)]. One hundred fifty-two procedures (29.7%) were performed laparoscopically. In 186 patients (36%), no bladder intervention was performed. One hundred forty-nine patients (29.1%) had at least one postoperative complication. Patients who developed complication were older (P=<0.001), more often female (P=<0.001), hypertensive (P=0.005), anemic (P=<0.001), preoperatively transfused (P=0.02), and with class 2-3 wound classification (P=0.01). Independent risk factors affecting morbidity were increased age [odds ratio (OR) 1.23 (1.03-1.47), P=0.01], decreased hematocrit level [OR 3.04(1.83-5.06), P<0.0001], and open approach [OR 2.56 (1.35-4.84), P=0.003]. Morbidity for CVF remains high. Lower preoperative hematocrit level and increased age were associated with higher risk of complication. Laparoscopic surgery may be preferable when possible as morbidity is less with this approach.

A Creative Solution to an Uncommon Complication: Endoscopic Treatment of a Colovesical Fistula

A Creative Solution to an Uncommon Complication: Endoscopic Treatment of a Colovesical Fistula

Su1767 Does Colovesical Fistula Secondary to Diverticulitis Have Similar Outcomes Under the 50-Age-Group?

Su1767 Does Colovesical Fistula Secondary to Diverticulitis Have Similar Outcomes Under the 50-Age-Group?

Stable gastric pentadecapeptide BPC 157 heals rat colovesical fistula

To establish the effects of BPC 157 on the healing of rat colovesical fistulas, Wistar Albino male rats were randomly assigned to different groups. BPC 157, a stable gastric pentadecapeptide, has been used in clinical applications—specifically, in ulcerative colitis—and was successful in treating both external and internal fistulas. BPC 157 was provided daily, perorally, in drinking water (10µg/kg, 12ml/rat/day) until sacrifice or, alternatively, 10µg/kg or 10ng/kg intraperitoneally, with the first application at 30min after surgery and the last at 24h before sacrifice. Controls simultaneously received an equivolume of saline (5.0ml/kg ip) or water only (12ml/rat/day). Assessment (i.e., colon and vesical defects, fistula leaking, fecaluria and defecation through the fistula, adhesions and intestinal obstruction as healing processes) took place on days 7, 14 and 28. Control colovesical fistulas regularly exhibited poor healing, with both of the defects persisting; continuous fistula leakage; fecaluria and defecation through the fistula; advanced adhesion formation; and intestinal obstruction. By contrast, BPC 157 given perorally or intraperitoneally and in µg- and ng-regimens rapidly improved the whole presentation, with both colon and vesical defects simultaneously ameliorated and eventually healed. The maximal instilled volume was continuously raised until it reached the values of healthy rats, there were no signs of fecaluria and no defecation through the fistula, there was counteraction of advanced adhesion formation or there was an intestinal obstruction. In conclusion, BPC 157 effects appear to be suited to inducing full healing of colocutaneous fistulas in rats.

A Case of a Colovesical Fistula Caused by an Ingested Fish Bone Incidentally Diagnosed by Sudden Melena

A Case of a Colovesical Fistula Caused by an Ingested Fish Bone Incidentally Diagnosed by Sudden Melena

Acquired Colovesical Fistula

Acquired Colovesical Fistula

The use of inflammation-related markers to predict outcome in rectal cancer

The use of inflammation-related markers to predict outcome in rectal cancer