Colovesical Fistula Research Articles

Retained Surgical Instruments in The Pelvis Complicated by Colo-vesical Fistula

Retained Surgical Instruments in The Pelvis Complicated by Colo-vesical Fistula

A case in which a near-infrared ray catheter (NIRC) was effectively applied in laparoscopic sigmoidectomy for a sigmoidovesical fistula.

A 40-year-old man visited the hospital for a refractory urinary tract infection. A sigmoidovesical fistula resulting from a sigmoidovesical diverticulum was diagnosed, and laparoscopic surgery was performed. To avoid ureteral injury during surgery for highly advanced cancer and inflammatory diseases, a ureteral stent is generally placed before the procedure. However, in this case, surgery was performed using a near-infrared ray catheter (NIRC), which emits fluorescence when irradiated with near-infrared light. By clearly observing the pathway of the ureter via near-infrared light, the integrity of the ureter could be preserved, and sigmoidectomy was safely performed. The visual navigation of the ureter with NIRC was especially useful during surgery for a colovesical fistula with marked surrounding inflammatory changes and a high risk of ureteral damage.

Endoscopic management of colovesical and colovaginal fistulas with over-the-scope clips: A single-institution case series.

Conventional surgical management of colovesical and colovaginal fistulas can be morbid and is contraindicated in many patients. Our aim in this work is to evaluate our experience in the management of colovesical and colovaginal fistulas with endoscopic over-the-scope (OTS) clips. A retrospective review of all patients who underwent attempted endoscopic OTS clip management of colovesical and colovaginal fistulas between 2013 and 2020 was performed. Preoperative risk factors, operative details and postoperative outcomes are reported. Ten patients were identified. Fistula types were: colovesical (five), rectovesical (two), colovaginal (two) and rectovaginal (one). The aetiology of the fistula was diverticular disease in seven (70%) cases and surgical complication of pelvic surgery in three (30%). The mean defect age was 157±98days, the mean defect diameter was 4.5mm (range 2-10mm) and the mean fistula length was 15mm (range 2-25mm). In nine (90%) cases, fistula identification and cannulation were performed through the nonenteric lumen of the fistula. Initial management with an OTS clip was technically successful in eight (80%) patients. Of the eight patients who underwent OTS clip placement, long-term success (mean follow-up 218days, range 25-673days) was achieved after initial intervention in four (50%) patients. One patient underwent serial OTS clip procedures and achieved long-term success after four interventions; three patients have not undergone a repeat procedure after initial failure. Endoscopic management of colovesical and colovaginal fistulas with OTS clips offers a promising therapeutic option for patients with contraindications to conventional surgical management. Immediate technical success and long-term success rates are similar to other gastrointestinal tract applications of OTS clips.

Management of colovesical fistula: a systematic review.

Colovesical fistulas (CVFs) account for approximately 95% enterovesical fistulas (EVFs). About 2/3 CVF cases are diverticular in origin. It mainly presents with urological signs such as pneumaturia and fecaluria. Diagnostic investigations aim at confirming the presence of a fistula. Although conservative management can be chosen for selected individuals, most patients are mainly treated through surgical interventions. CVF represents a challenging condition, which records high rates of morbidity and mortality. Our systematic review aimed at achieving deeper knowledge of both indications, in addition to short- and long-term outcomes related to CVF management. We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Pubmed/MEDLINE, Embase, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. The 22 included articles covered an approximately 37 years-study period (1982-2019), with a total 1365 patient population. CVF etiology was colonic diverticulitis in most cases (87.9%). Pneumaturia (50.1%), fecaluria (40.9%) and urinary tract infections (46.6%) were the most common symptoms. Abdomen computed tomography (CT) scan (80.5%), colonoscopy (74.5%) and cystoscopy (55.9%) were the most frequently performed diagnostic methods. Most CVF patients underwent surgery (97.1%) with open approach (63.3%). Almost all patients had colorectal resection with primary anastomosis with or without ostomy and 53.2% patients underwent primary repair or partial/total cystectomy. Four percent anastomotic leak, 1.8% bladder leak and 3.1% reoperations rates were identified. In an average 5-68-month follow-up, overall morbidity, overall mortality and recurrences rates recorded were 8-49%, 0-63% and 1.2%, respectively. CVF mainly affects males and has diverticular origin in almost all cases. Pneumaturia, fecaluria and urinary tract infections are the most characteristic symptoms. Endoscopic tests and imaging are critical tools for diagnostic completion. Management of CVFs depends on the underlying disease. Surgical treatment represents the final approach and consists of resection and reanastomosis of offending intestinal segment, with or without bladder closure. In many cases, a single-stage surgical strategy is selected. Perioperative and long-term outcomes prove good.

Near-infrared fluorescence for minimally invasive management of colovesical fistula.

Near-infrared fluorescence for minimally invasive management of colovesical fistula.

187 A Rare Case of Colovesical Fistula in A Patient with Situs Inversus

Abstract A 47 year old man with no past medical history presented to the urology clinic with recurrent urinary tract infections caused by E.Coli. He subsequently had a number of investigations including imaging and cystoscopy which showed a high possibility for a colovesical fistula and incidentally demonstrated subdiaphragmatic Situs inversus. The sigmoid colon was inflamed and adherent to the posterior wall of the bladder. Surgical management following a multi-disciplinary decision resulted in an elective Ureteric stent insertion followed by laparotomy with sigmoid colectomy and primary anastomosis. The bladder wall defect caused by fistula formation was repaired. We report an extremely rare case of colovesical fistula in the setting of subdiaphragmatic situs inversus in a relatively young patient. This would likely be seen in older patients with more severe diverticulitis and usually in an acute setting. Anatomical variation resulted in more severe diverticular disease and predisposed to fistula formation.

Commentary.

Colovesical fistula is a well-known complication of pelvic radiation, especially when the latter is combined with surgery [1]. Interventional management is usually necessary but difficult, with surgery preferably avoided as these patients are poor surgical candidates and the irradiated field is an unfriendly surgical environment [1] [2]. In this e-Video, the authors elegantly demonstrate how a patient with sepsis due to a fistula between a neobladder and the rectum was successfully treated with placement of an atrial septal defect closure device. These devices have been used for treatment of tracheoesophageal fistulas [3] but seem to be effective in the lower gastrointestinal (GI) tract as well. Among the highlights of the case, one should point out the interdisciplinary approach, with co-operation between GI endoscopists and urologists for effective device placement, and the trend of modern GI endoscopy to expand into spaces adjacent to but outside of the GI tract.

Colon diverticulosis adherent to mesh plug migration after laparoscopic hernia repair: A case study and review of literature.

IntroductionInguinal hernia repair has evolved from open suture methods to mesh repair which is preformed either open or laparoscopically. Mesh hernia repair has improved the outcome in regards to patient care and recurrence rate but it is also associated with a number of complications. The complications of mesh hernia repair such as deep seated infections, mesh erosion and mesh perforation into nearby viscera has been scarcely reported in literature.Case presentationWe report a 43 years old male case of diverticulosis adherent to a migrated mesh plug from previous laparoscopic inguinal hernia repair procedure.DiscussionThe choice of mesh material, appropriate suture placement and closure of the peritoneum after mesh repair is very crucial to avoid long term mesh complications.ConclusionThe aim of this case report is to present a rare complication of mesh erosion with colovesical fistula and abscess formation.

Laparoscopic colorectal resections during the COVID-19 pandemic - business as usual?

To analyse the outcomes of major colorectal resections performed during the COVID-19 pandemic, to assess safety and explore all precautionary measures. All patients who underwent major elective colorectal resections at St Helens and Knowsley Teaching Hospital NHS Trust between 24th March 2020 (the date that the Royal Colleges of Surgery produced their guidelines re operating during the pandemic) and 17th April 2020 were analysed from a prospectively maintained database. The primary outcome was 7-day mortality and secondary outcomes were the development of a positive COVID-19 test consequent to hospital stay and the overall complication rate. In this 24 day time frame 27 patients (17 males) underwent elective colorectal resections at St Helens and Knowsley NHS Trust. The median age was 69 (41-84) years and median ASA was 2 (1-3). The median Body Mass Index was 30 (21-40.7). Twenty-five patients underwent surgery for cancer and two patients had urgent resections for low-grade sepsis secondary to diverticular colovesical fistulae. 24 patients underwent laparoscopic colorectal resections and 3 patients underwent planned open surgery. 7-day mortality was 0%, and no patients/staff contracted COVID-19 during the post-operative period. The overall complication rate was 14.8%. At a median follow-up of 29 (17-44) days via telephone, there have been no reported COVID-19 related symptoms in any of these patients. Our experience demonstrated that it was possible to undertake laparoscopic colorectal resections despite the COVID-19 pandemic posing a major threat to humanity, providing that adequate and stringent precautions are undertaken.

FÍSTULA VESICOSIGMOIDEA EN ENFERMEDAD DIVERTICULAR, REPORTE DE CASO Y REVISIÓN DE LITERATURA.

Introduction Colovesical fistulas (CVF) are pathologic communications between bowel and bladder. They represent 1 in 3000 surgical hospital admissions per year. Imaging studies play a crucial role establishing the site, course and complexity of the fistulas, and in identifying their etiology. The management of CVF depends on the underlying pathology, the site of the intestinal injury, and the preoperative state of the patient. A surgical and non-surgical approach can be performed. Case description A clinical case of an 82-year-old patient with multiple comorbidities is reported, who suddenly presented dysuria, stranguria and fecaluria. The abdominal and pelvic tomography revealed diverticulitis with the presence of a fistulous tract from the colon to the bladder. During his hospitalization, the patient presented septic shock of urinary focus due to colovesical fistula, which required management by intensive therapy. Broad-spectrum antibiotic therapy was started. Once stable, we opted for surgical resolution with partial cystectomy plus fistulectomy and Hartmann-type colostomy. After the procedure, the patient evolved favorably with resolution of the condition. Conclusion The nonsurgical approach may be a viable option in patients with poor preoperative condition, an inability to tolerate general anesthesia, or in cancer patients with a short life expectancy. Spontaneous closure of fistulas occurs in approximately 2% of patients and, since up to 75% may have septic complications, the presence of a FCV is an indication for surgery in all patients without contraindications for it. The most widely used surgical approach consists of resection of the compromised intestinal segment with primary anastomosis, without a protective stoma, and closure of the bladder defect. At present, there is no consensus on which is the best surgical strategy due to the lack of clinical trials. An updated review of the subject and its therapeutic management is carried out.

Endoscopic closure of a radiation induced colovesical fistula using the novel over-the-scope Padlock Clip system—a case report

Endoscopic closure of a radiation induced colovesical fistula using the novel over-the-scope Padlock Clip system—a case report

Open versus laparoscopic surgery for the treatment of diverticular colovesical fistulas: A systematic review and meta-analysis.

The aim of this study was to analyze the evidence regarding open versus laparoscopic surgery for the treatment of diverticular colovesical fistula (CVF) in terms of perioperative outcomes. A systematic review was performed using PubMed, Cochrane, Google Scholar, and Web of Science databases for studies comparing laparoscopic versus open surgery for CVF. We pooled odds ratios (OR) and mean differences (MD) using random or fixed effects models. Five non-randomized studies with 227 patients met the inclusion criteria. All were retrospective studies, published between 2014 and 2020. For laparoscopic surgery, the pooled rate for conversion to laparotomy was 36%. Laparoscopic and open procedures required similar operative time (MD: -11.62; 95% confidence interval [CI]: -51.41 to 28.16). No difference was found in terms of stoma rates between laparoscopic and open surgery (OR: 1.12; 95% CI 0.44-2.86). Overall, the rate of total postoperative complications was lower in the laparoscopic group (OR: 0.55; 95% CI: 0.30-0.99). The pooled analysis showed equivalent rates of anastomotic leaks (OR: 0.61; 95% CI 0.15-2.45), surgical site infections (OR: 0.44; 95% CI 0.19-1.01), and mortality (OR: 0.18; 95% CI 0.03-1.15). The length of stay was significantly reduced with laparoscopic surgery (MD: -2.89; 95% CI -4.20 to -1.58). Among patients with CVF, the laparoscopic approach appears to have shorter hospital length of stay, with no differences in anastomotic leaks, surgical site infections, stoma rates, and mortality, when compared with open surgery.

Indications and outcomes of enterovesical and colovesical fistulas: systematic review of the literature and meta-analysis of prevalence

BackgroundEntero-colovesical fistula is a rare complication of various benign and malignant diseases. The diagnosis is prominently based on clinical symptoms; imaging studies are necessary not only to confirm the presence of the fistula, but more importantly to demonstrate the extent and the nature of the fistula. There is still a lack of consensus regarding the if, when and how to repair the fistula. The aim of the study is to review the different surgical treatment options, focus on surgical indications, and explore cumulative recurrence, morbidity, and mortality rates of entero-vesical and colo-vesical fistula patients.MethodsA systematic review of the literature was conducted according to PRISMA guidelines. Random effects meta-analyses of proportions were developed to assess primary and secondary endpoints. I2 statistic and Cochran’s Q test were computed to assess inter-studies’ heterogeneity.ResultsTwenty-two studies were included in the analysis with a total of 861 patients. Meta-analyses of proportions pointed out 5, 22.2, and 4.9% rates for recurrence, complications, and mortality respectively. A single-stage procedure was performed in 75.5% of the cases, whereas a multi-stage operation in 15.5% of patients. Palliative surgery was performed in 6.2% of the cases. In 2.3% of the cases, the surgical procedure was not specified. Simple and advanced repair of the bladder was performed in 84.3% and 15.6% of the cases respectively.ConclusionsAlthough burdened by a non-negligible rate of complications, surgical repair of entero-colovesical fistula leads to excellent results in terms of primary healing. Our review offers opportunities for significant further research in this field. Level of Evidence Level III according to ELIS (SR/MA with up to two negative criteria).

Ureteral navigation using a fluorescent ureteral catheter during laparoscopic colorectal surgery.

Ureteral injury is the most common urological complication of pelvic surgery, with a reported incidence during colon resection of 0.3-1.5%. Ureteral stenting is commonly performed preoperatively to prevent ureteral injury. Because tactile sensation is not reliable during laparoscopic surgery, the effect of the ureteral stent is considered limited. Recently, fluorescence imaging has been used in laparoscopic surgery. The Near-Infrared Ray Catheter (NIRC™) fluorescent ureteral catheter (NIRFUC) is a new catheter with built-in NIR fluorescent resin. This pilot study was performed to evaluate the utility of fluorescence ureteral navigation using the NIRFUC during laparoscopic colorectal surgery. We evaluated the intraoperative utility of the NIRFUC and the short-term outcomes in 20 patients treated with colorectal surgery at Kawaguchi Municipal Medical Center between February and July 2020. In all, 18 patients with malignant tumors and 2 patients with benign disease, i.e., a sigmoid colovesical fistula, were included. Ten patients developed preoperative intestinal obstruction. One patient experienced preoperative perforation. Nine patients developed preoperative peritumoral abscesses. Laparoscopic surgery was performed with the VISERA ELITE2 system. In all cases, the ureters were very clearly identified as fluorescent without the need for dissection. In all cases, only a moment was required to identify the ureter by fluorescence observation. In all cases, R0 resection was performed. The mean surgical duration was 334min (161-1014), the mean blood loss was 10ml (1-500), and the mean postoperative hospital stay was 11days (8-47). There were no cases of ureteral injury. The NIRFUC was very clearly identified as fluorescent in a moment during surgery without dissection around the ureter. Fluorescence ureteral navigation using the NIRFUC may make colorectal surgery easier and facilitate completion of complex minimally invasive surgery, especially during surgery in patients with invasion of the surrounding tissue or a history of pelvic surgery or radiation.

EFFECTIVENESS OF RADIOLOGICAL IMAGING TECHNIQUES (X-RAYS, MDCT, AND MRI) FOR DIAGNOSIS OF PELVIC FISTULA: A SYSTEMATIC REVIEW

This study aimed to evaluate the diagnostic performance of different imaging techniques for preoperative detection of pelvic fistula. Imaging and classification of female genital abnormalities considerably pelvic floor fistulas are significant. We conducted a systematic review of the available literature to highlight the effectiveness of different radiological imaging techniques (X-RAY,U/S,CT,MRI) for the diagnosis of different types of pelvic fistulas to see the limitations of conventional scanning and testing over modern imaging techniques and to show the effectiveness of choosing one imaging modality over other depending upon multiple dynamics e.g., site and types of fistula. The controlled and regular research cases (n= 9) available in English from 2011 to 2020 were included in criteria of research. The evidence databases were used for assessment of certain studies analytically by way of PEDro scale and explicated under decision guidelines. In all relevant articles were identified and included in this systematic review. The radiological techniques showed improved diagnostic performance that established the effectiveness of imaging advancement for administration and treatment of pelvic fistula. Conventional methods have less sensitivity and specificity as compared to modern techniques. X-RAY fistulography and ultrasonography has less sensitivity and specifity as compared to CT scan but still found beneficial in the diagnosis of colovaginal, uterovesical fistula and considered as the most basic clue about the existence of a malignant fistula respectively.it is verified that MDCT is the safer accurate and offered more detailed defects in diagnosis of urogenital, urethrorectal, lower urogenital tract fistulas, upper and middle vaginal fistulas colovesical fistulas(along with X-RAY) and prostate symphyseal fistula(along with MRI).It has been concluded that MRI can access colovesical fistulas inherited vaginal fistulas and prostate symphyseal fistulas(along with CT) more efficiently. It has been concluded that diagnostic imaging for all pelvic fistula is useful, to help the physicians, particularly radiologists, in diagnosis of pelvic fistulas. The choice of imaging technique is dependent upon multiple factors. Advanced medical imaging techniques XRAY,MDCT MRI) are considered more recommended choices as compared to conventional imaging.

Outcomes of Partial or Total Cystectomy in Advanced Colon Cancer with Suspected Bladder Invasion—Our 8-Year Experience and Literature Review

Advanced colon cancers with bladder invasion pose a heavy burden and challenge towards patients and surgeons. Herein, we report our series with regards to operative and oncological outcomes in our 8years of experience. All patients with advanced colonic tumours and suspected bladder invasion being operated from 2012 to 2020 were included. The histological findings, clinical and oncological outcomes were evaluated. Twenty-two patients were included. Partial cystectomy was performed in 17 of them (77%). No neoadjuvant treatment was prescribed. All preoperative computed tomography (CT) scan showed bladder invasion or colovesical fistula. True tumour invasion to bladder (T4b disease) was confirmed in 17 patients (77%) by histopathology. The 3-year overall survival and recurrence rates were 82% and 9%, respectively. En bloc resection of colonic tumour with adherent bladder in advanced colon cancers can achieve a good operative and oncological outcome without neoadjuvant therapy. The relatively low concordance rate between preoperative CT scan and final histopathology may limit the benefit of routine administration of neoadjuvant therapy as it may overtreat and delay subsequent oncological treatment of our patients with possible added morbidity.

Novel Endoscopic Management of Colovesical Fistula Secondary to Colonic Diverticular Disease

AbstractColovesical fistula (CVF) is an abnormal communication between bowel and urinary bladder. Most common cause is complicated colonic diverticular disease. The treatment of choice for CVF is surgery. Conservative treatment is reserved for highly selected patients who are unfit for definitive surgery. We report the case of an 86-year-old gentleman with multiple comorbidities, who presented with pneumaturia, fecaluria, and recurrent urinary tract infection. He was diagnosed to have sigmoid colonic diverticulosis with a CVF and was successfully managed with the novel combined endoscopic approach (a simultaneous cystoscopy and flexible colonoscopy), which could be the first to be reported from India.

Ureteral stent migration through colovesical and vesicovaginal fistulas in a patient with stage IV cervical cancer treated with pelvic radiation

Introduction: Pelvic radiation is often used as radical treatment or additional therapy in patients with gynecologic malignancies. Irradiation damages deoxyribonucleic acid (DNA) of tumor cells by an inflammatory process with several inciting factors. The inflammatory process continues well after the treatment has been given and its effects can present decades after initial treatment. Complications of radiation are related to tissue damage due to parenchymal and vascular endothelial cell death as well as fibrosis resulting from innate immune response. Fibrosis is a late complication of radiation therapy and can present as stenosis or fistulas. Fistulas have an annual incidence rate of up to 5% and can develop anywhere in the irradiated field. Case Report: This case describes a patient with vesicovaginal fistula secondary to stage IV cervical cancer treated with pelvic radiation. The patient had ureteral stent placement for radiation-induced ureteral stricture which exited the body through the anus through the vesicovaginal fistula and a colovesical fistula which developed over the course of 10 years after initial treatment with radiation therapy. Conclusion: As cancer survivorship rates increase with improved treatments, it is important to anticipate continuing radiation damage in patients who have received radiation therapy.

Five Cases of Colovesical Fistula due to Diverticulitis Treated by Laparoscopic Surgery

Five Cases of Colovesical Fistula due to Diverticulitis Treated by Laparoscopic Surgery

S1640 Primary Colonic Lymphoma Manifesting as Colovesical Fistula

INTRODUCTION: Gastrointestinal (GI) tract is the most common extranodal site of Non-Hodkin lymphoma (NHL) and constitutes about 4% of all GI malignancies. The most common sites of involvement in the GI tract are stomach followed by the small intestine. We report a case of primary colonic lymphoma manifesting with colovesical fistula in a patient with human immunodeficiency virus (HIV) infection. CASE DESCRIPTION/METHODS: A 50-year-old male with a history of HIV on antiretroviral therapy with undetectable viral load and a CD4 count of 260 cells/µL, presented with burning micturition, intermittent passage of air and feculent material in urine, on and off for one year. He has chronic nonbloody diarrhea and noticed thirty-pound weight loss over the past three months. At admission, he was afebrile, hypotensive, and had sinus tachycardia (114/min). Physical examination was significant for palpable, tender left lower quadrant mass but no hepatosplenomegaly, bowel distention, or peripheral lymphadenopathy. Laboratory data revealed anemia (HB 8.5 g/dl), leukocytosis (WBC 14000/µl), mildly elevated platelet count (422,000/µl), acute kidney injury (serum creatinine 2.50, baseline 0.81 mg/dL) and normal CEA level. Urine was brown, turbid with microscopy showing RBC and WBC ( >180/hpf). CT scan of abdomen and pelvis with contrast revealed a large circumferential mass measuring 14.5 cm × 10 cm in sigmoid colon with a fistulous communication to the urinary bladder suggestive of colovesical fistula. Colonoscopy confirmed a partially obstructing, large circumferential, ulcerated mass within the proximal sigmoid colon. Pathology was consistent with diffuse large B-cell lymphoma (+BCL2, +MYC). PET-CT scan showed increased FDG uptake in the sigmoid colon along with adrenal gland and bone but no involvement of lymph nodes, liver, or spleen. A diverting colostomy was performed and subsequently, he was started on dose-adjusted R-EPOCH Regimen. The patient received 5 cycles of chemotherapy and a repeat PET-CT scan showed resolution of activity in the sigmoid colon, bone, and adrenal gland. Retroperitoneal ultrasound during chemotherapy showed persistence of colovesical fistula. DISCUSSION: HIV-AIDS predisposes patients to different malignancies including NHL in about 10% of patients. Colonic involvement of primary NHL is exceedingly rare. High viral load and low CD4 counts (< 100) are risk factors for NHL in HIV patients. We describe here an unusual presentation of NHL manifesting as colovesical fistula, in a patient with HIV.Figure 1.: Computed tomographic scan of abdomen & pelvis in sagittal view showing large sigmoid mass (long arrow). Air-fluid level of orally administered contrast noted in the urinary bladder. (short arrow).Figure 2.: Colonoscopy shows a fungating, ulcerating mass in the sigmoid colon, nearly obstructing the lumen.Figure 3.: Initial PET tumor imaging whole body.