Colovesical Fistula Research Articles

Tratamiento laparoscópico de las fístulas colovesicales: experiencia preliminar

BackgroundDiverticular disease of the colon is common in the western world. After the first episode of diverticulitis, many patients benefit from medical therapy, but 10-20% develop abscesses, obstruction, or fistula. AimTo describe the laparoscopic treatment of sigmoidovesical fistula secondary to diverticular disease. Material and methodsAn observational, retrospective study was conducted on 10 consecutive patients within the time frame of 2011-2015 that had undergone: 1) colovesical fistula resection and primary closure of the bladder and sigmoid colon or 2) laparoscopic sigmoidectomy with the NOSE technique (transanal extraction of the specimen and colorectal anastomosis with primary closure of the bladder). ResultsTen patients were operated on within the time frame of February 2011 and February 2015. The mean age of the patients was 60.7(49-71) years. Sigmoidectomy with primary anastomosis was performed on 4 patients and resection and primary closure on 6 patients. Surgery duration was 140.4 (80-210) min, blood loss was 195 (80-210) ml, and length of time before beginning oral diet was 4.3 (3–5) days. The drain was left in place in all the patients for 10 days and the transurethral catheter for 2 weeks. Up to the present time, none of the patients has presented with fistula recurrence or data consistent with intestinal anastomosis stricture. ConclusionsReports on the use of laparoscopy for the treatment of colovesical fistulas have demonstrated acceptable results. Only a few studies concentrate exclusively on colovesical fistula; in general the reports include other types of fistula (colovaginal and colocutaneous), as well. Colovesical fistula is a pathology that can be resolved safely and efficaciously through laparoscopy.

Appearance of a colovesical fistula at cystoscopy.

Key Clinical MessageColovesical fistulae typically present with pneumaturia and/or fecaluria. Diverticulitis, inflammatory bowel disease, and malignancies of the colon are the commonest causes. The fistulous tract and adjacent organs are best demonstrated by contrast-enhanced CT scan with rectal contrast or MRI. Biopsy at cystoscopy/colonoscopy is necessary for complete evaluation and treatment planning.

Colovesical Fistula After Renal Transplantation: Case Report

Colovesical fistula is a relatively rare condition that is primarily related to diverticular disease. There are few reports of colovesical fistula after renal transplantation. We report of a 53-year-old man who was diagnosed with colovesical fistula after recurrent urinary tract infection, 5 months after undergoing cadaveric renal transplantation. Laparoscopic partial resection of the sigmoid colon with the use of the Hartmann procedure was performed. Six months after that surgery, there was no evidence of recurrent urinary tract infection and the patient's renal graft function was preserved. Physicians should keep colovesical fistula in mind as a cause of recurrent urinary tract infection in renal transplant recipients, especially in those with a history of diverticular disease.

Rare anorectal malformation with a non-terminal colovesical fistula

We describe a unique case of anorectal malformation (ARM) with a non-terminal colovesical fistula. While some aspects are similar to the congenital pouch colon (CPC), the differences make it a distinct form.

Rare Case of Sigmoid-Perianal Fistula due to Sigmoid Diverticular Disease: Report of a Case and Review of Literature

Diverticular disease of colon is a common problem of western countries and its incidence usually increases with age. The natural history of diverticular disease is usually benign with only few patients developing episode of acute diverticulitis. Some patients may develop more complicated courses like hemorrhage, obstruction, stricture or fistulas. While colovesical and colovaginal fistulas are the common types of fistula, perianal fistula due to diverticular disease is an extremely rare complication of diverticular disease. We report a case of sigmoid-perianal fistula due to diverticular disease in a 53-year-old female patient without any signs or symptoms of sigmoid diverticulitis. Diagnosis was established in early course of disease by computed tomogram (CT) scan and a one-stage anterior resection was performed without any complication. We also performed literature review for similar cases and how they were managed. J Med Cases. 2015;6(3):122-124 doi: http://dx.doi.org/10.14740/jmc2065w

Different strategies for treating a colovesical fistula.

See Article on Page 57-62 A colovesical fistula (CVF) represents an abnormal communication between the colon and the bladder. Although CVFs are uncommon, they cause significant morbidity and may markedly affect the patient's quality of life. Colovesical fistulae most frequently are the consequence of advanced-stage malignant disease, inflammatory bowel disease, and traumatic or iatrogenic injuries. The diagnosis of a CVF can be challenging and is often delayed for several months after symptoms begin. Colovesical fistulae most commonly occur between the sigmoid colon and the bladder, although cases of fistulae between the small bowel and the ureter have also been reported [1]. Colovesical fistulae are usually more common in men because the uterus acts as a protective barrier in women. Many women with colovesical fistulae have had a previous hysterectomy [2]. The exact method of investigating and treating colovesical fistulae varies considerably from both a geographical and temporal perspective. The authors looked at a series of consecutive patients presenting with colovesical fistulae over a ten year period. They found that despite a similar clinical presentation, colovesical fistulae of various etiologies differed significantly in management and outcome [3]. The author's study is a retrospective one and has a limited numbers of the patients. However, based on the foundation of this study, we can find the right treatment for colovesical fistulae. The study also shows the different methods of treatment that are required, depending on the cause of the colovesical fistula.

Refractory urinary tract infection in a male with colovesical fistula

A colovesical fistula is a communication between the lumen of the colon and the bladder, which sometimes results from diverticulitis. The left or sigmoid colon is the most commonly involved segment. The most usual presenting symptoms are pneumaturia and fecaluria, followed by dysuria, abdominal pain and, rarely, hematuria; these patients also often present with symptoms of recurrent/chronic urinary tract infection. Â We present here the case of a 57-year-old man complaining of recurrent lower urinary tract symptoms followed by pneumaturia and fecaluria. Computed tomography of the abdomen and pelvis revealed a colovesical fistula due to sigmoid diverticulitis. After locating the fistula, the lesion was totally removed, including the segmental sigmoid colon and partial bladder. The anastomosis was completed with a circular stapler and the bladder defect wall was repaired with double suture. The patient was doing well 3 months post-operatively and showed no evidence of urinary tract infection. Patients with repeated and refractory urinary tract infections should be considered for anatomical disorders such as colovesical fistula.

Colovesical fistula: should it be considered a single disease?

PurposeThis research was conducted to compare the management and the outcome of patients with colovesical fistulae of different aetiologies.MethodsRetrospective data were collected from 2002 to 2012 and analyzed with SPSS ver. 17. Age, gender, aetiology, management, hospital stay, postoperative complications, and mortality were studied and compared among colovesical fistulae of different aetiologies.ResultsA total of 55 patients, 46 males (84%) and 9 females (16%), with a median age of 65 years (interquartile range [IQR], 48-75 years) were studied. Diverticular disease was the most common benign cause and recto-sigmoid cancer the most common malignancy. Anterior resection and bladder repair were the most frequent operations in benign cases, as was total pelvic exenteration in the malignant group. Multiple intestinal loop involvement and subsequent resection were significantly higher in those with Crohn disease than it was in patients of colovesical fistula due to all other causes collectively (60% vs. 6%, P = 0.006). Patients with malignancy had a higher postoperative complication rate than patients who did not (12 [80%] vs. 7 [32%], P = 0.0005). Pelvic collection (11, 22%) was the most frequent early complication (predominantly in the malignant group) whereas incisional hernia (8, 22%) was the most common late complication, with a predominance in the benign group. The median hospital stay was significantly prolonged in the malignant group (32 days; IQR, 17-70 days vs. 16 days; IQR, 11-25 days; P < 0.001).ConclusionDespite their having similar clinical presentation, colovesical fistulae of various aetiologies differ significantly in management and outcome.

Nonfluoroscopic well-tempered pressure augmented distal colostogram in high-type anorectal malformation: Our experience

Background: Accurate imaging of rectourethral fistula is essential for optimal surgical management of infants with high-type anorectal malformation (ARM). The aim of this study was to study the role of nonfluoroscopic well-tempered pressure-augmented distal colostogram in high-type ARM in demonstrating rectourinary fistula, bladder anomalies, and for the presence of vesicoureteral reflux (VUR). Patients and Methods: We present a prospective study of 10 male infants who underwent a diverting colostomy in the neonatal period from January 2011 to December 2012. Our method of performing a colostogram is similar to conventional colostogram, but involves (a) meticulous bowel preparation preoperatively, ensuring that while doing the last distal colostomy wash before colostogram there is passage of clear saline from the urethral meatus to establish the presence of rectourinary fistula; (b) nonfluoroscopic study (c) performed with gentle and sustained pressure of contrast media, maintained over the period of the investigation; (d) bladder is completely filled with contrast media through rectourinary fistula and it is confirmed clinically; and (e) radiographic films in addition are taken in the micturating phase. Results: Rectourinary fistula was demonstrated in all (100%) cases. Rectoprostatic urethral fistula was present in three (30%) infants, rectobulbar urethral fistula in six (60%) patients, and one (10%) infant had type 4 congenital pouch colon (CPC) with colovesical fistula. Also three (30%) patients demonstrated unilateral primary vesicoureteral reflux (VUR), which was previously undiagnosed in all of them, as micturating cystourethrogram (MCU) was not attempted. Conclusions: Our study confirmed the level of anomaly and accurately demonstrated the type of fistula in all patients. It also detected the undiagnosed VUR in three (30%) cases. It obviated the need for a MCU.

Liver Abscess Secondary to Asymptomatic Sigmoid Diverticulitis: Case Report and Literature Review

Pyogenic liver abscess commonly occurs as a complication of biliary tract and gastrointestinal infections, with diverticulitis and perforated bowel becoming leading causes in recent years. We report the first case of liver abscess as a complication of asymptomatic diverticulitis with no bacteremia, as well as colovesical fistula. And, with this case presentation, we stress the importance of considering diverticulitis in asymptomatic patients with liver abscess, as well as the importance of early and prompt treatment with antibiotics and percutaneous drainage.

Conventional and Papillary Renal Cell Carcinomas and Focal Segmental Glomerulosclerosis in a Nephrectomy

This is a case report of a 63-year-old morbidly obese (body mass index, 46.5 kg/m2) African American woman with a medical history of recurrent urinary tract infections, diverticulosis/diverticulitis, duodenitis, colovesical fistula, gout, hypertension, degenerative joint disease, carpal tunnel syndrome, a 20-pack-year history of tobacco use, and bilateral axillary hidradenitis suppurativa. After multiple episodes of gross hematuria and suprapubic discomfort, a computed tomographic scan showed a solid mass in the lower pole of the right kidney. The patient underwent right open radical nephrectomy in May 2010 without major complications. A conventional (clear cell) renal cell carcinoma and a small papillary renal cell carcinoma were found upon histopathologic examination of the kidney. Examination of the nonneoplastic renal parenchyma revealed changes indicative of focal segmental glomerulosclerosis, as well as mild arterial nephrosclerosis. No tumor metastases were detected at 5 years after nephrectomy. Her serum creatinine and estimated glomerular filtration rate gradually deteriorated in the 5 years after nephrectomy. The gradual, less steep renal function deterioration of this patient emphasizes the importance of reporting nonneoplastic renal lesions/diseases in nephrectomies for kidney and renal pelvis tumors. She developed edema, progressive proteinuria reaching 6.5 g/d, and serum creatinine level of 4.2 mg/dL (baseline serum creatinine at time of nephrectomy was 0.7 mg/dL). The early diagnosis helped medically manage and delay the progression of the medical renal disorder. An easy algorithmic approach for nonneoplastic renal parenchymal tissue should be adopted by general/surgical pathologists when evaluating surgical nephrectomies.

Anorectal Malformation with Colovesical and Colourethral Fistula in Two Calves

Anorectal Malformation with Colovesical and Colourethral Fistula in Two Calves

Rare Case of Sigmoid-Perianal Fistula due to Sigmoid Diverticular Disease: Report of a Case and Review of Literature

Diverticular disease of colon is a common problem of western countries and its incidence usually increases with age. The natural history of diverticular disease is usually benign with only few patients developing episode of acute diverticulitis. Some patients may develop more complicated courses like hemorrhage, obstruction, stricture or fistulas. While colovesical and colovaginal fistulas are the common types of fistula, perianal fistula due to diverticular disease is an extremely rare complication of diverticular disease. We report a case of sigmoid-perianal fistula due to diverticular disease in a 53-year-old female patient without any signs or symptoms of sigmoid diverticulitis. Diagnosis was established in early course of disease by computed tomogram (CT) scan and a one-stage anterior resection was performed without any complication. We also performed literature review for similar cases and how they were managed. J Med Cases. 2015;6(3):122-124 doi: http://dx.doi.org/10.14740/jmc2065w

Transvesical Colorectal Anastomosis: An Unusual Complication inReversal of HartmannÂ’s Procedure

It is described an unusual complication after colorectal surgery for reversal of Hartmann’s procedure. The female patient had been operated on for diverticulitis (Hinchey III) according to Hartmann’s procedure. Six months later she underwent restorative surgery with circular stapler for end-to-end transanal anastomosis. The onset of symptoms such as fever, abdominal pain, fecaluria and pneumaturia had forced the patient to a hospital readmission. Diagnostic examinations had revealed colovesical fistula. The cause of this complication was that staple line of colorectal anastomosis had incorporated the bladder wall to full thickness. It was necessary to reoperation for the resolution of the damage. The resection of fistulised tract, the colorectal reanastomosis and the reconstruction of the bladder were performed.

腹腔鏡下手術で治癒したS状結腸膀胱瘻の２例

腹腔鏡下手術で治癒したS状結腸膀胱瘻の２例

Colovesical Fistula: A Rare Complication of Diverticulitis in Young Male

Herniation of colonic mucosa through the circular muscles at the point of penetration of blood vessels results in diverticuli formation. It is seen most commonly in the large bowel in sigmoid colon. Common complications of diverticular disease are inflammation and bleeding per rectum and rarely fistula formation which are seen mostly in elderly patients. A case of colovesical fistula with diverticulitis in young male aged 30 years is reported.

Robot-Assisted, Extraperitoneal Transvesical Repair of a Colovesical Fistula

Abstract Introduction: Colovesical fistula is a rare, but well-recognized complication of abdominopelvic surgery, diverticular disease, and pelvic radiation therapy. Management is often challenging...

Anastomotic salvage after rectal cancer resection using the Turnbull-Cutait delayed anastomosis.

Turnbull-Cutait abdominoperineal pull-through followed by delayed coloanal anastomosis (DCA) was first described in 1961. Studies have described its use for challenging colorectal conditions. We reviewed our experience with Turnbull-Cutait DCA as a salvage procedure for complex failure of colorectal anastomosis. We performed a retrospective cohort study from October 2010 to September 2011, with analysis of postoperative morbidity and mortality. Seven DCAs were performed for anastomotic complications (3 chronic leaks, 2 rectovaginal fistulas, 1 colovesical fistula, 1 colonic ischemia) following surgery for rectal cancer. Six patients had a diverting ileostomy constructed as part of previous treatment for anastomotic complications before the salvage procedure. No anastomotic leaks were observed. All procedures but 1 were completed successfully. One patient who underwent DCA subsequently required an abdominoperineal resection and a permanent colostomy for postoperative extensive colonic ischemia. No 30-day mortality occurred. Salvage Turnbull-Cutait DCA appears to be a safe procedure and could be offered to patients with complex anastomotic complications. This procedure could be added to the surgeon's armamentarium as an alternative to the creation of a permanent stoma.

A Case of Polymicrobial Septicemia Unraveling to Be Due to Colovesical Fistula

Introduction: Fistula is a rare outcome of complicated diverticular disease (2%). We present a case of septicemia with known diverticular disease and recurrent urinary tract infections (UTIs) that turned out to be due to colovesical fistula. Case Report: A 57-year-old white male with history of liver cirrhosis, alcoholism, benign prostatic hypertrophy, and recurrent UTIs for 1 year presented with altered mental status. He denied history of pneumaturia and fecaluria. Vital signs: temperature 104° F, heart rate 118 bpm, respirations 26 breaths/min, and blood pressure 120/54 mmHg. No abdominal tenderness, mass, or ascites noted. Admission labs revealed white cell count 1.9 x 103 cm, platelets 85 x 103/μL, total bilirubin 5.2 mg/dL, INR 1.8, creatinine 1.09 mg/dL, lactate 3.4 mg/dL, and bicarbonate 16 mEq/L. Urine was cloudy and positive for blood, leukocytes, and bacteria. Vancomycin and cefepime were initiated after obtaining blood and urine cultures. Blood cultures grew pan-sensitive Escherichia coli and streptococcal infantarius, while urine culture was positive for pan-senstive Klebsiella pneumonie. After acute management of sepsis, further work-up was initiated to investigate the source of infection in light of polymicrobial septicemia in setting of recurrent UTIs. CT abdomen with PO and IV contrast showed air fluid level in the bladder that was suggestive of thickened bladder and a possible fistulous tract between sigmoid colon and bladder. Previous CT scan showed severe diverticular disease with no prior history of diverticulitis. Urology was consulted and poppy seed test was performed. He was given 1.25 ounce of poppy seeds mixed with a 6-ounce serving of yogurt orally. Poppy seeds were seen in urine in next 24 hours. This confirmed the abnormal fistulous tract between colon and bladder. No surgical intervention was done due to sepsis. The patient continued on broad spectrum antibiotics with no significant improvement. The patient later developed acute respiratory distress syndrome and opted for comfort measures. Unfortunately, other causes of colovesical fistula, such as malignancy, could not be ruled out. Discussion: Colovesical fistula is a rare complication and should be considered in differential diagnosis in patient with history of diverticular disease, recurrent UTIs, and poly-microbial sepsis. CT abdomen with contrast and poppy seed test are preferred diagnostic tools. Poppy seed test is highly sensitive and cost-effective. Early fistulectomy with open or laparoscopic approach is the treatment of choice. Early correction of fistula may improve mortality and morbidity in patients not responding to broad spectrum antibiotics.

Single-Port Laparoscopic Fecal Diversion

Single-port laparoscopic surgery is usually performed on patients with minor comorbidities. The aim of the study was to evaluate feasibility and efficacy of single-port fecal diversion in patients who had previous abdominal operations or comorbidities. Between October 2010 and March 2012, 14 patients with a median age of 57 years were diverted. The reasons for diversion were perianal infection/abscess (n=5), anal incontinence (n=3), radiation proctitis (n=2), colovesical fistula causing sepsis (n=1), outlet obstruction of ileal S pouch (n=1), perforation during pouchoscopy (n=1), and peritoneal carcinomatosis with enterocutaneus fistula (n=1). Median estimated blood loss was 20 mL, operative time was 52 minutes, and length of hospital stay was 4 days. Two patients had ileus postoperatively. One patient had a parastomal hernia 4 months after diversion. Single-port laparoscopic fecal diversion is a safe and feasible operation for patients with significant comorbidities and a history of multiple abdominal operations.