Enterovesical Fistula Research Articles

Outcomes of surgical treatment for enterovesical fistula in Crohn's disease.

Enterovesical fistula (EVF) in Crohn's disease (CD) often does not improve with medical treatment and requires surgical treatment. The surgical treatment strategy for EVF in CD is definitive resection of the intestinal tract side, and performing a leak test using dye injection into the bladder after EVF dissection to determine the appropriate surgical procedure for the bladder side. This study aimed to evaluate the outcomes of surgical treatment for EVF in CD. Twenty-one patients who underwent surgery for EVF between 2006 and 2021 were included and retrospectively evaluated for clinical background, surgical procedures, and postoperative complications. The most common origin of EVF was the ileum (17 cases; 81%), and the most common site of EVF formation was the apex (12; 57%). Surgical approaches were laparotomy in 11 (52%) cases and laparoscopy in 10 (48%). Surgical procedures on the bladder side were fistula dissection in 13 (62%) cases and sutured closure of fistula in 8 (38%). A comparison of approaches revealed no significant difference in operative time, but the amount of blood loss was significantly less in the laparoscopy (p < 0.01). There was no significant difference in the occurrence of postoperative complications between approaches. Postoperative anti-TNF-α antibody agents were used in 17 (81%) cases, and there were no cases of recurrent EVF. In conclusion, definitive resection of the intestinal tract and minimal treatment on the bladder side were sufficient to achieve satisfactory outcomes for EVF in CD.

P866 Management of fistulizing Crohn's Disease in a moroccan population: about 125 cases

Abstract Background Crohn's disease is an inflammatory enterocolitis, which may be complicated by enteroenteric, enterovesical, rectovaginal, enterocutaneous and anoperineal fistulas. This is a retrospective study of fistulizing Crohn's disease cases followed in our gastroenterology department. Methods We report a retrospective and descriptive study, covering all cases of fistulizing Crohn's disease, collected in the hepato-gastroenterology department at our university hospital center during a 9-year study period, from 2015 to 2023. All patients with digestive and/or anal crohn's fistula were included. Comparison of categorical variables was performed with Fisher's exact test using SPSS 10.0 software. The significance level was p &amp;lt; 0.05. Results 125 patients had a fistulizing form of Crohn's disease. The location of fistulas was represented by anoperineal fistulas (32.6%), followed by enteroenteral (22.9%) and enterocutaneous (23%) fistulas, then enterovesical (9%) and rectovaginal (3.8%) fistulas. Surgical treatment was immediately indicated in all cases of enterocutaneous and enterovesical fistulas, and 66.7% of rectovaginal fistulas. Proctological drainage was performed in 57.1% of cases of anoperineal fistulas. 33 cases of anoperineal fistulas and one case of recto-vaginal fistulas were treated with infliximab. Clinical remission was also significantly associated with medical treatment with biologics versus immunosuppressants (P=0.0018). Surgical treatment remains indicated in the majority of cases of fistulizing Crohn's disease. Conclusion Fistulizing Crohn's disease poses a problem for medical and surgical management. Surgical treatment remains indicated in the majority of Crohn's fistula cases. This study also showed that endoscopic recurrence and clinical remission were significantly associated with the type of postoperative medical treatment.

V08-04 UROLOGIC COMPLICATIONS DURING HARTMANN REVERSAL PROCEDURE: ROBOTIC-ASSISTED MANAGEMENT OF TWO CASES OF ENTEROVESICAL FISTULAE

You have accessJournal of UrologyCME1 Apr 2023V08-04 UROLOGIC COMPLICATIONS DURING HARTMANN REVERSAL PROCEDURE: ROBOTIC-ASSISTED MANAGEMENT OF TWO CASES OF ENTEROVESICAL FISTULAE Jaime Poncel, Aref S. Sayegh, Alexandre K. Hidaka, Maria A. Lizana, Sij Hemal, Luis G. Medina, and Rene Sotelo Jaime PoncelJaime Poncel More articles by this author , Aref S. SayeghAref S. Sayegh More articles by this author , Alexandre K. HidakaAlexandre K. Hidaka More articles by this author , Maria A. LizanaMaria A. Lizana More articles by this author , Sij HemalSij Hemal More articles by this author , Luis G. MedinaLuis G. Medina More articles by this author , and Rene SoteloRene Sotelo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hartmann procedure is the resection of the rectosigmoid colon, closure of the rectal stump, and creation of an end colostomy. Unfortunately, a Hartmann reversal to re-establish intestinal continuity carries high morbidity with a complication rate of up to 58%. Urological complications during Hartmann’s reversal procedure are rare however low rates of bladder injury (8.16-16%) and fistula formation (0.6-4.08%) have been reported in the literature. This video presents a step-by-step robotic surgical technique for the repair of two entero-vesical fistulae likely caused due to the incorrect use of the circular surgical stapler during a Hartmann’s reversal. METHODS: Two consecutive cases of entero-vesical fistulae were treated through a novel robotic transabdominal approach by a single surgeon. Surgical steps were performed as illustrated in the video. Perioperative and functional outcomes were evaluated and reported. Continuous variables were reported as median and quartiles, whereas categorical variables were presented as frequencies and percentages. RESULTS: Two cases are reported with a median age of 71 (59-83). Both surgeries were uneventful with no intraoperative complications reported. Median operative time estimated blood loss, and length of stay were 557 (454-660) minutes, 150 (100-200) cc, and 3 (2-4) days, respectively. Median Jackson-Pratt drain removal time was 6.5 (4-9) days. Median catheter removal time was 18 (14-22) days. One case of urinary tract infection occurred during the postoperative period, which was successfully treated. No fistula recurrence was reported. CONCLUSIONS: Hartmann reversal is a morbid procedure that carries a small risk of urological complications, which may have a significant impact on patient's quality of life. Herein, we present the robotic-assisted management of enterovesical fistula formation following two Hartmann reversals and demonstrate the feasibility and safety of utilizing a minimally invasive approach. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e749 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jaime Poncel More articles by this author Aref S. Sayegh More articles by this author Alexandre K. Hidaka More articles by this author Maria A. Lizana More articles by this author Sij Hemal More articles by this author Luis G. Medina More articles by this author Rene Sotelo More articles by this author Expand All Advertisement PDF downloadLoading ...

Enterovesical Fistula Presenting with Gross Hematuria and Fecaluria after Pelvic Radiation Therapy and Transurethral Resection of Bladder Tumor: A Case Report and Literature Review

&lt;p&gt;本案例為一名75歲女性表現為肉眼可見的血尿兩天，過去病史有10年前子宮頸癌第四期接受過骨盆腔放射治療、高血壓及第2型糖尿病。病人到本院急診就醫後住院接受進一步檢查，住院後第2天膀胱鏡發現出血性膀胱炎，住院後第4天接受經尿道膀胱腫瘤切除術，病理報告顯示為膀胱急慢性發炎併出血。病人於手術後第四天出院。病人於手術後第10天出現下腹痛、肉眼可見的血尿及糞尿，安排腹部電腦斷層及腸胃道鋇劑攝影均顯示迴腸膀胱廔管。後續安排住院接受剖腹探查、廔管及迴腸切除術及膀胱修補術。病理報告顯示為迴腸憩室和潰瘍伴有急性和慢性發炎。病人於術後第7天併發膀胱出血及膀胱滲漏，經膀胱鏡清血塊及腹腔引流後，於術後第36天出院。本文討論腸道膀胱廔管的病態生理學、危險因子、常見症狀、診斷及治療、手術併發症處理等。此案例提醒基層醫師若病人有肉眼可見的血尿合併骨盆腔放射線治療的病史應鑑別診斷腸道膀胱廔管，需儘早安排腸胃道鋇劑攝影或腹部電腦斷層，以免延誤診斷時機。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;The patient was a 75-year-old woman who presented with gross hematuria for two days. Her medical history included cervical cancer, stage IV treated with pelvic radiation therapy (RT) 10 years ago, hypertension, and type 2 diabetes mellitus. The patient visited the emergency department of our hospital on May 29, 2016, and was hospitalized for further evaluation. Cystoscopy on the 2nd day after admission revealed hemorrhagic cystitis. Transurethral resection of bladder tumor (TURBT) was performed on the 4th day after admission. The pathology report revealed acute and chronic bladder inflammation and bleeding. The patient was discharged on the 8th day after admission. However, the patient developed lower abdominal pain, gross hematuria, and fecaluria on the 10th postoperative day. Abdominal computed tomography (CT) and gastrointestinal tract (GI) series were performed, all of which showed an ileum-vesical fistula. Exploratory laparotomy, resection of the fistula and ileum, and bladder repair, were performed on June 17, 2016, fifteen days after her first operation. The surgeries were successful and uneventful. Pathological examination revealed a diverticulum and ulcer with transmural mixed acute and chronic inflammation. Unfortunately, the patient developed intraperitoneal bladder perforation on the 7th postoperative day. After adequate abdominal drainage and cystoscopy-assisted blood clot evacuation, she was discharged from the hospital on the 36th postoperative day. This article discusses the pathophysiology of enterovesical fistula, risk factors, common symptoms, diagnosis and treatment, and the management of surgical complications. Clinicians should keep this clinical scenario in mind if the patient has gross hematuria combined with a history of pelvic RT. This combination of symptoms and history should suggest a differential diagnosis of enterovesical fistula and arrangement of GI series or abdominal CT should be performed as soon as possible to avoid delaying the diagnosis.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

S2197 A Case of Recurrent Urinary Tract Infections Secondary to Vaginovesicular and Vaginorectal Fistula

Introduction: Enterovesical fistulas are a rare disease with an annular incidence of 0.5 per 100,000. The most common clinical presentations of enterovesicular fistulas are urinary tract infection. We present a rare case of a chemotherapy-induced vagionvesicular and vagionrectal fistula. Case Description/Methods: Our patient is a 78-year-old female with a history of squamous cell anal cancer status post chemotherapy, cervical cancer status post total abdominal hysterectomy and recurrent E. coli urinary tract infections who presented with 3 weeks of painless, bright red blood per rectum without associated abdominal pain, nausea or vomiting. The patient’s last colonoscopy was 6 years prior which had revealed a hyperplastic polyp. In the ED, she was found to have a hemoglobin of 7.2 with an MCV of 92.8. An abdominal CT scan revealed an ill-defining hyperattenuating material with single focus of gas between urinary bladder and rectum with concern for a possible colovesicular fistula. A CT Cystogram was unable to be obtained as the patient denied a foley placement. A CT abdomen/pelvis with oral and rectal contrast revealed nodular hyperdense material anterior to the rectum and along the posterior margin of the presumed urinary bladder confirming a colovesicular fistula. The patient was transferred to a tertiary care center for colorectal surgery (Figure). Discussion: A radiation-induced fistula is a chronic and serious condition with a significant impact on quality of life. To our knowledge, this is the first case that reveals both a vaginovesicular and vaginorectal fistula secondary to chemotherapy treatement of squamous cell anal cancer.Figure 1.: Sagittal image of the right paramedian aspect of the pelvis shows 2 prominent locules of air within the vaginal vault and the decompressed urinary bladder. There are subtle curvilinear tracts of air extending from these locules.

S2042 Hydronephrosis: An Unusual Complication of Diverticular Abscess

Introduction: Acute diverticulitis is inflammation due to microperforation of diverticulum in the colon. Ureteral complications from inflammatory bowel disease and colon cancer have been extensively documented, however, hydronephrosis as a complication of diverticulitis is rarely reported. We present a case of a patient with a diverticular abscess who developed left-sided hydronephrosis. Case Description/Methods: A 40-year-old man with a past medical history of laparoscopic cholecystectomy presented with left lower quadrant cramping abdominal pain for 2 weeks. He endorsed constipation for 3 months but denied other symptoms. His physical examination was significant for a palpable phlegmon in the left lower quadrant with mild tenderness to palpation. Laboratory values revealed hemoglobin of 11.4 g/dl, platelet count of 499 k/ul and unremarkable basic metabolic panel. Computed tomography (CT) scan of the abdomen with contrast revealed severe sigmoid diverticulitis and perisigmoid abscess measuring 6 x 2.6 cm (Figure A). It further revealed moderate left hydronephrosis with narrowing of the ureter, concerning for external ureteral compression by the diverticular abscess (Figure B). After multidisciplinary discussion with interventional radiology, urology, and surgery, recommendation was made to undergo surgical intervention after the resolution of acute diverticulitis. The patient was treated with intravenous antibiotics with symptomatic relief and discharged with plan for outpatient surgery. The patient was unfortunately lost to follow-up. He presented 3 months later with perforated diverticulitis, persistent hydronephrosis, colovesical and colocutaneous fistula requiring exploratory laparotomy and repair. His surgical pathology was negative for malignancy and revealed severe diverticulitis. Patient was discharged home in stable condition. Discussion: Ureteral complications in diverticulitis can occur due to the close anatomical location of the left ureter to the descending and sigmoid colon. Common urologic complications include the development of enterovesical fistulas and urinary calculi and obstruction. Physicians should be aware of this association to ensure a repeat CT scan is performed 4-6 weeks after acute diverticulitis to document resolution. Figure 1.: A. CT scan of the abdomen revealing 60.1 x 26.3 mm diverticular abscess. B. CT scan of the abdomen showing left hydronephrosis and dilation of the ureter.

Surgical Management of Enterovesical Fistula in Crohn's Disease in the Biologic Era.

Lay SummaryEnterovesical fistula in Crohn’s disease that require surgery may be managed safely laparoscopically with similar morbidity to open repair and a shorter length of stay. Preoperative biologic exposure does not affect surgical morbidity.

Hyperchloremic metabolic acidosis caused by enterovesical fistula: A case report

Hyperchloremic metabolic acidosis caused by enterovesical fistula: A case report

Images - Appendico-vesical fistula.

Appendico-vesical fistula (AVF) is an uncommon type of enterovesical fistula that can present with symptoms of recurrent or persistent urinary tract infection (UTI) and, in some instances, with gastrointestinal symptoms. AVFs occur more commonly in males and are mainly attributed to unrecognized or conservatively managed appendicitis.1 Herein, we describe a case of a 21-year-old male who presented with fevers, urgency, and hematuria and on extensive workup was found to have an AVF requiring surgical repair. Drawing from our case and the literature, we conclude that AVF occurs rarely and requires a high index of suspicion among physicians. Past medical history of previous acute appendicitis and UTIs with or without gastrointestinal symptoms should raise suspicion for AVF.

The Role of MR Enterography in Crohn’s Disease

Aim: The aim of this study was to investigate the efficacy of magnetic resonance enterography (MRE) in the diagnosis and follow-up of Crohn’s Disease. Material and Methot: Between November 2013 and April 2014, patients who were MRE examinations for a preliminary or definitive diagnosis of Crohn’s Disease were reviewed retrospectively. MRE imaging of the patients was performed on an 8-channel 1.5 Tesla MRI device. Primary and secondary MRE results and contrast enhancement patterns of active and chronic inflammation of Crohn’s disease in jejunum, ileum, terminal ileum, and colon segments were evaluated by two radiologists. Results: The results consistent with Crohn’s Disease were detected in 19 (10 male, 9 female) of 42 patients (24 male, 18 female, mean age was 40.64 years, min-max: 20-69, SD±14.27). Signs of active inflammation which were intestinal wall thickening, T2 signal reduction, and pathological mucosal contrast enhancement were observed in 19 patients (26 intestinal segments). Active inflammation findings were most common in the terminal ileum, with 16 (61.5%), followed by 5 (19.2%) in the ascending colon, 2 (7.6%) in the jejunum, 2 (7.6%) in the nonterminal ileum, and 1 (3.8%) in the sigmoid colon. Chronic inflammation findings such as intestinal stenosis (18 intestinal segments), submucosal fat deposition (16 intestinal segments), and prestenotic dilatation (13 intestinal segments) were observed in 13 patients. There was an ileosigmoid fistula in 1 patient, enterovesical fistula in 1 patient, and enterocutaneous fistula in 1 patient. Conclusion: MRE is an appropriate diagnostic method without ionizing radiation, which can be used to detect the stage of inflammation (active or chronic) in the diseased intestinal segments in the diagnosis and follow-up of Crohn’s disease.

Enterovesical fistula secondary to migrated transpapillary stent

Enterovesical fistula secondary to migrated transpapillary stent

A six years’ experience with 41 cases of enterovesical fistula in a Tertiary National Hospital in Indonesia: A retrospective study

IntroductionThe incidence of Enterovesical Fistula (EVF) is relatively low. Currently, there is no agreement about the best methods for EVF management. This study was performed to investigate the characteristics of EVF to find the optimal diagnostic and management pattern. MethodsData were collected retrospectively from the medical record at Cipto Mangunkusumo Hospital. Patients diagnosed with EVF between January 2014 and April 2019 were included. They were evaluated for demographics, characteristics, diagnostic modalities, and treatment modalities. ResultsFrom 41 patients, 26 (63.3%) are male, and 15 (36.6%) are female. Peak incidence was 51–60 years old. The most common symptoms are fecaluria found in 32 (78%) patients. The common etiology is gastrointestinal cancer found in 17 (41.5%) patients, followed by gynecologic cancer and diverticulitis found in both 9 (22%) patients. The rectovesical fistula was seen in 25 (61%) patients with an advanced stage rectosigmoid cancer, followed by colovesical in 14 (34.1%) of patients with sigmoid diverticulitis (p 0.038). The common diagnostic modalities performed are cystoscopy in 32 (78%), followed by colonoscopy in 11 (26.8%) patients. The preferred modalities that were used in most cases were surgery in 35 (85.4%) patients. A two-stage surgical approach was used in 28 (68.3%) patients. ConclusionThe incidence of EVF is uncommon. Malignancy was the leading cause of EVF in this study. Combined diagnostic modalities are recommended in EVF cases. The two-stage surgical approach was the preferred modality. Further prospective studies are mandatory to analyze this condition.

Interdisciplinary approach and staged treatment of a patient with Crohn’s disease complicated by stricture of the ileum with penetration and the formation of enterovesical fistula

An observation from practice was devoted to the experience of an interdisciplinary approach in the diagnosis and surgical treatment of a patient with complicated course of Crohn’s disease against the background of the formation of a stricture of the terminal ileum, an enterovesical fistula, the penetration into the mesentery of the sigmoid colon.

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.

Live ascaris in urinary bladder: a case report

IntroductionAscaris in urinary bladder is an extremely rare phenomenon. It may occur after fistula formation between urinary and gastrointestinal tract or by retrograde migration of adult worm, and is associated with complications.Case presentationA 47-year-old Amhara woman from rural northwest Ethiopia presented with a complaint of difficulty to fully evacuate her bladder of 1 year duration. Ultrasonography showed thickened bladder wall with echo debris. There were also thickened bowel and fluid-filled loops of intestine adjacent to urinary bladder. On cystoscopy examination, there was live ascaris swimming inside the bladder. Enterovesical fistula was entertained and explorative laparotomy performed. Findings confirmed presence of iliovesical fistula. The fistula was divided and the continuity of the intestine restored. The inflammatory mass was subjected to histopathology study and turned out to be benign inflammatory reaction. She was also given antihelminthics. Postoperatively, her course was uneventful, and she was discharged cured.ConclusionThough it is extremely rare to have urinary symptoms from ascariasis, it is important to have a high index of suspicion for all possibilities.

Characteristics of Enterovesical Fistula Patients Visiting the Urology Department of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from 2015 to 2019

Enterovesical fistula (EVF) represents an abnormal channel between the intestine and the bladder. The EVF is a complication of inflammatory or neoplastic diseases and injuries. Diagnosis of EVF can be challenging and often delayed up to several months after the onset of the symptoms. This study aimed to determine the characteristics of patients with enterovesical fistula visiting Dr. Hasan Sadikin General Hospital Bandung, Indonesia. This retrospective descriptive study used the medical records of EVF patients treated in the urology department of Dr. Hasan Sadikin General Hospital from 2015 to 2019 as the secondary data to be analyzed. A total of 58 patients with EVF were enrolled in this study. By gender, that more than half of the patients were male patients (n=30, 51.7%) and 45% of patients were between 41 and 50 years old. The most common symptoms of EVF were pneumaturia and fecaluria which were seen in 30 (51.7%) and 20 (34.5%) patients, respectively. Twenty-nine (50%) patients experienced malnutrition and 18 (31.1%) patients had diabetes mellitus as a comorbid. The most common type of fistula was rectovesical fistula (n=45, 77.6%) and 26 (66.6%) patients suffered from rectosigmoid cancer and malignancy (68.95) had become the most predominant etiology. Escherichia coli was found in 42 (72.4%) urine cultures collected from the patients and cystoscopy with fistula biopsy was found in 43.1% of cases, followed by fistula repair (29.3%) and urethral catheter drainage (15.5%). Hence, malignancy and rectosigmoid cancer become the most common etiology of EVF while cystoscopy with fistula biopsy is the most frequently performed procedure.

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).

Management of Left Staghorn Calculus With Colorenal Fistula

Fistula formation between the kidney and the colon is a rare occurrence. Colorenal fistulas have been reported after renal cryoablation, calculous pyonephrosis, and renal cell carcinoma. Fistula formation is reported in as many as 35% of patients with Crohn's disease. Crohn's-related urinary fistulas may include enterovesical, enteroureteral, rectourethral, urethrocutaneous, and entero-urachal fistulas. Here, we report a rare case of a patient who was found to have a left colorenal fistula in the setting of a left staghorn calculus and recurrent urinary tract infections with a question about the eventual definitive management of the patient.

Review article: investigation and management of internal fistulae in Crohn’s disease

Crohn's disease is an inflammatory, penetrating intestinal disease associated with fistula formation. Fistulae in Crohn's disease can be classified into external and internal fistulae. Internal fistulae form between the gastrointestinal tract and another internal organ and include enteroenteric, enterocolic, enterovesical and rectovaginal fistulae. They are associated with significant morbidity and a decreased quality of life. To review the classification, diagnosis, medical and surgical management of internal fistulae in Crohn's disease, and propose a treatment algorithm. A literature review on internal fistulae in Crohn's disease in the adult population was undertaken, synthesised and summarised. Internal fistulae occur in up to 15% of patients with Crohn's disease. Multi-modal assessment including a combination of endoscopy and cross-sectional imaging, usually magnetic resonance, is required to diagnose fistulae and determine extent of disease. Determining optimal treatment strategies for these complex fistulae remains a challenge due to limited and generally low-quality data. Most studies to date have focussed on luminal disease, with (usually post hoc) outcomes more often reported for external fistulae, particularly perianal fistulae, than internal fistulae. Anti-tumour necrosis factor therapies have emerged as the mainstay of medical therapy, with particularly promising data for enterovesical fistulae, but many patients will still require surgical intervention. The indications and optimal timing of surgery vs medical therapy remains uncertain; thus multi-disciplinary input when making such decisions is important. Internal fistulae result in significantly increased morbidity in Crohn's disease, and further studies to determine optimal multi-modality management strategies incorporating medical and surgical therapy are required.

Enterovesical Fistula and Bladder Calculus caused by a Migrated Intrauterine Device: A Case Report

Enterovesical Fistula and Bladder Calculus caused by a Migrated Intrauterine Device: A Case Report