Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Enterovesical Fistula

  • Author: Joseph Basler, MD, PhD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
 
Updated: Jan 21, 2015
 

Background

Vesicoenteric fistulae, also known as enterovesical or intestinovesical fistulae, occur between the bowel and the bladder. Normally, the urinary system is completely separated from the alimentary canal. Connections may result from any of the following:

  • Incomplete separation of the two systems during embryonic development (eg, failure of the urorectal septum to divide the common cloaca)
  • Infection
  • Inflammatory conditions
  • Cancer
  • Trauma or foreign body
  • Iatrogenic causes (presenting either postoperatively or as a treatment complication)

In the general practice of medicine, bowel disease that occurs adjacent to the bladder and erupts into it is the most common cause of misconnection of the two systems. Fistulae from the bowel to the ureter and the renal pelvis are also possible but uncommon in the absence of trauma, chronic infection, or surgical interventions. This article focuses on the more common causes, presentations, and treatments of enterovesical fistulae.[1]

For patient education information, see the Cancer Center, as well as Bladder Cancer and Bladder Control Problems

Next

History of the Procedure

As early as the second century AD, Rufus of Ephesus described fistulae between the bowel and the bladder. The common causes of acquired vesicoenteric fistulae have shifted from diseases of the past (eg, typhoid, amebiasis, syphilis, tuberculosis) to diverticulitis, malignancy, Crohn disease, and iatrogenic causes.

Treatments have also evolved. In 1888, some suggested that colovesical fistulae "might be cured by a course of Bristol water and ass's milk."[2] Although more invasive, certainly less colorful, and possibly more palatable, a single-stage surgical approach is more commonly used today.

Previous
Next

Problem

A fistula is an abnormal communication between two epithelialized surfaces. Vesicoenteric fistulae, also known as enterovesical or intestinovesical fistulae, occur between the bowel and the bladder. Vesicoenteric fistulae can be divided into four primary categories based on the bowel segment involved, as follows:

  • Colovesical
  • Rectovesical (including rectourethral)
  • Ileovesical
  • Appendicovesical

Colovesical fistula is the most common form of vesicointestinal fistula and is most often located between the sigmoid colon and the dome of the bladder. Rectourethral and rectovesical fistulae are observed in the postoperative setting, such as after prostatectomy, as a consequence of chronic infection or tissue destruction that accompanies massive decubiti, or in the setting of acute infections such as Fournier gangrene.

Previous
Next

Epidemiology

Frequency

Colovesical fistulae are the most common type of fistulous communication between the urinary bladder and the bowel. The relative frequency of colovesical fistulae is difficult to ascertain because of the numerous potential etiologies, including multiple disease processes and surgical procedures.[3]

The incidence of fistulae in patients with diverticular disease, the most common cause of colovesical fistula, is accepted to be 2%, although some referral centers have reported higher percentages. Only 0.6% of carcinomas of the colon lead to fistula formation.[4]

Colovesical fistulae are more common in males, with a male-to-female ratio of 3:1. The lower incidence in females is thought to be due to interposition of the uterus and adnexa between the bladder and the colon. In women, other types of fistulae (typically iatrogenic, such as enterovaginal, ureterovaginal, and vesicovaginal) are more common than colovesical fistulae.[4] Women who present with colovesical fistulae are commonly older and/or have a history of hysterectomy. Uterine atrophy or absence may be predisposing etiologies.

Previous
Next

Etiology

Fistula formation is believed to evolve from a localized perforation that has an adherent adjacent viscus. The pathologic process is almost always intestinal. Pathologic processes characteristic of particular intestinal segments cause those segments to adhere to the bladder. Therefore, the location of the segment can suggest intestinal pathology.

Previous
Next

Pathophysiology

Fistulae may be either congenital or acquired (eg, inflammatory, surgical, neoplastic). Congenital vesicoenteric fistulae are rare and are often associated with an imperforate anus.

Inflammatory pathophysiology

Diverticulitis accounts for approximately 50%-70% of vesicoenteric fistulae, almost all of which are colovesical. A phlegmon or abscess is a risk factor for fistula formation.[5] This complication occurs in 2%-4% of cases of diverticulitis, although referral centers have reported a higher incidence.[6]

Crohn disease accounts for approximately 10% of vesicoenteric fistulae and is the most common cause of an ileovesical fistula. Ileovesical fistulae develop in 10% of patients with regional ileitis. The transmural nature of the inflammation characteristic of Crohn colitis often results in adherence to other organs. Subsequent erosion into adjacent organs can then give rise to a fistula. The mean duration of Crohn disease at the time of first symptoms of fistula formation is 10 years, and the average patient age is 30 years.[7]

Less-common inflammatory causes of colovesical fistulae include Meckel diverticulum,[8] genitourinary coccidioidomycosis,[9] and pelvic actinomycosis.[10] In addition, case reports have described appendicovesical fistulae as a complication of appendicitis.[11, 12, 13, 14] Enterovesical fistula formation due to lymphadenopathy associated with Fabry disease has been reported.[15]

Rarely, the bladder is the origin of the inflammatory process, as noted in a case report from Spain of bladder gangrene that caused a colovesical fistula in a patient with diabetes mellitus.[16] Additional case reports have demonstrated fistula formation in the setting of chronic outlet obstruction due to benign hypertrophy with the formation of a large bladder stone and recurrent infections.[17]

Malignant pathophysiology

Malignancy accounts for up to 20% of vesicoenteric fistulae and is the second most common cause of enterovesical fistula. Rectovesical fistula is the most common presentation, as rectal carcinoma is the most common colonic malignancy resulting in fistula formation.[18] Transmural carcinomas of the colon and rectum may adhere to adjacent organs and may eventually invade directly, causing development of a fistula. Transitional cell carcinoma of the bladder is the next most common malignancy-related pathology.[19] Occasionally, carcinomas of the cervix, prostate, and ovary are implicated, and incidents involving small-bowel lymphoma have been reported.[20]

Although malignancy is the second most common cause of enterovesical fistula formation, such an event is uncommon today because most carcinomas are diagnosed and treated prior to this advanced stage.

Iatrogenic pathophysiology

Iatrogenic fistulae are usually induced by surgical procedures, primary or adjunctive radiotherapy, and/or postprocedural infection. Surgical procedures, including prostatectomies, resections of benign or malignant rectal lesions, and laparoscopic inguinal hernia repair, are well-documented causes of rectovesical and rectourethral fistulae.[21, 22] Unrecognized rectal injury at the time of radical prostatectomy is an uncommon but well-documented etiology of rectourethral fistula.

External beam radiation or brachytherapy to bowel in the treatment field can eventually lead to fistula development. Radiation-associated fistulae usually develop years after radiation therapy for a gynecologic or urologic malignancy. The incidence of radiation-induced fistula associated with gynecological cancers (most commonly cervical cancer) is approximately 1%, many of which are rectovaginal or vesicovaginal.[23]

Fistulae develop spontaneously after perforation of the irradiated intestine, with the development of an abscess in the pelvis that subsequently drains into the adjacent bladder. Radiation-associated fistulae are usually complex and often involve more than one organ (eg, colon to bladder). Because of improvements in radiotherapy techniques, the incidence of this complication is decreasing. Although rare, fistulae due to cytotoxic therapy have been reported in a patient undergoing a CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) regimen for non-Hodgkin lymphoma.[24]

Traumatic pathophysiology

Urethral disruption caused by blunt trauma or a penetrating injury can result in fistulae, but these fistulae are typically rectourethral in nature. Penetrating abdominal or pelvic trauma, such as a gunshot wound, may result in fistula formation between both small and large bowel, including the rectum with the bladder. In a recent review of complications of penetrating rectal and bladder injuries, fistula formation occurred only in the presence of bowel and bladder injuries.[25] Foreign bodies in the bowel (eg, swallowed chicken bones or toothpicks) and peritoneum (eg, lost gallstone during laparoscopic cholecystectomy) have been reported as a cause of colovesical fistulae.[26, 27, 28, 29, 30]

Previous
Next

Presentation

The presenting symptoms and signs of enterovesical fistulae occur primarily in the urinary tract. Symptoms include suprapubic pain, irritative voiding symptoms, and symptoms associated with chronic urinary tract infection (UTI). The hallmark of enterovesical fistulae may be described as Gouverneur syndrome, namely, suprapubic pain, frequency, dysuria, and tenesmus. Other signs include abnormal urinalysis findings, malodorous urine, pneumaturia, debris in the urine, hematuria, and UTIs.[31]

The severity of the presentation also varies. Chronic UTI symptoms are common, and patients with enterovesical fistula frequently report numerous courses of antibiotics prior to referral to a urologist for evaluation. Urosepsis may be present and can be exacerbated in the setting of obstruction. It has been demonstrated in dog models that surgically created colovesical fistulae are tolerated well in the absence of obstruction.[32]

Pneumaturia and fecaluria may be intermittent and must be carefully sought in the history. Pneumaturia occurs in approximately 50%-60% of patients with enterovesical fistula but alone is nondiagnostic, as it can be caused by gas-producing organisms (eg, Clostridium species, yeast) in the bladder, particularly in patients with diabetes mellitus (ie, fermentation of diabetic urine) or in those undergoing urinary tract instrumentation. Pneumaturia is more likely to occur in patients with diverticulitis or Crohn disease than in those with cancer. Fecaluria is pathognomonic of a fistula and occurs in approximately 40% of cases. Patients may describe passing vegetable matter in the urine. The flow through the fistula predominantly occurs from the bowel to the bladder. Patients very rarely pass urine from the rectum.[18]

Symptoms of the underlying disease causing the fistula may be present. Abdominal pain is more common in patients with Crohn disease, but an abdominal mass is discovered in fewer than 30% of patients. In patients with Crohn disease who have a fistula, abdominal mass and abscess are more common.[18]

Previous
Next

Indications

The documented presence of a fistula that is causing symptoms or adversely affecting quality of life is an indication for surgical intervention in patients with enterovesical fistulae. Fistulae should be repaired in patients with abdominal pain, dysuria, malodorous urine, incontinence, urinary outlet obstruction, recurrent UTIs, bouts of sepsis, and/or pyelonephritis. Patients at high surgical risk may be treated with medical therapy and catheter drainage but may ultimately require at least diverting surgery if symptoms persist. Patients with terminal cancer are often better treated conservatively or with simple diversions.

Previous
Next

Relevant Anatomy

Fistula formation is believed to evolve from a localized perforation to which an adjacent viscus adheres. The pathologic process is almost always intestinal and characteristic to particular intestinal segments that adhere to the bladder. The segments most commonly in proximity to the bladder include the rectum, sigmoid colon, ileum, jejunum, and appendix. Furthermore, the segment of bowel that is involved can suggest the intestinal pathology.

Colovesical fistulae primarily result from sigmoid diverticular disease. Ileovesical fistulae are most likely associated with Crohn disease. Rectovesical fistulae are more commonly due to trauma, surgery, or malignancy. Appendicovesical fistulae tend to be associated with a history of appendicitis.

Previous
Next

Contraindications

Poor overall general health, inability to tolerate general or regional anesthesia, and terminal cancer are contraindications to aggressive management to cure a fistula. Patients with these contraindications may be served better with medical therapy or less-invasive diversions (eg, colostomy, ureterostomy, percutaneous drainage).

Previous
 
 
Contributor Information and Disclosures
Author

Joseph Basler, MD, PhD Thomas P Ball Residency Education Professor, Urology Residency Program Director, Department of Urology, University of Texas Health Science Center at San Antonio; Chief, Section of Urology, Audie Murphy Veterans Affairs Hospital

Joseph Basler, MD, PhD is a member of the following medical societies: American Urological Association, Society of University Urologists, SWOG, Texas Medical Association, Society for Basic Urologic Research, Society of Urologic Oncology

Disclosure: Nothing to disclose.

Coauthor(s)

Eminajulo Adekoya, MD Resident Physician, Department of Urology, University of Texas Health Science Center at San Antonio School of Medicine

Eminajulo Adekoya, MD is a member of the following medical societies: American Medical Association, American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.

Additional Contributors

Erik T Goluboff, MD Professor, Department of Urology, College of Physicians and Surgeons, Columbia University College of Physicians and Surgeons; Director of Urology, Allen Pavilion, New York Presbyterian Hospital

Erik T Goluboff, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Medical Society of the State of New York, New York Academy of Medicine, Phi Beta Kappa, Society for Basic Urologic Research

Disclosure: Nothing to disclose.

Acknowledgements

Christopher H Cantrill, MD Resident Physician, Department of Urology, University of Texas Health Sciences Center at San Antonio

Christopher H Cantrill, MD is a member of the following medical societies: American Association of Clinical Urologists, American Urological Association, and Endourological Society

Disclosure: Nothing to disclose.

Ann S Fenton, MD, MPH Chief, Urology Flight Surgical Services/SGOSU, 1st Fighter Wing Hospital, Langley Air Force Base; Consulting Staff, Department of Urology, Naval Medical Center Portsmouth; Assistant Professor, Eastern Virginia Medical School

Ann S Fenton, MD, MPH is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Angela Kamerer Schang, MD Attending Urologist, McKay Urology

Angela Kamerer Schang, MD is a member of the following medical societies: American Medical Association and American Urological Association

Disclosure: Nothing to disclose.

References
  1. Scozzari G, Arezzo A, Morino M. Enterovesical fistulas: diagnosis and management. Tech Coloproctol. 2010 Dec. 14(4):293-300. [Medline].

  2. Cripps WH. The passage of air and faeces per urethra. Lancet. 1888. 2:619.

  3. Garcea G, Majid I, Sutton CD, Pattenden CJ, Thomas WM. Diagnosis and management of colovesical fistulae; six-year experience of 90 consecutive cases. Colorectal Dis. 2006 May. 8(4):347-52. [Medline].

  4. Karamchandani MC, West CF Jr. Vesicoenteric fistulas. Am J Surg. 1984 May. 147(5):681-3. [Medline].

  5. Balsara KP, Dubash C. Complicated sigmoid diverticulosis. Indian J Gastroenterol. 1998 Apr. 17(2):46-7. [Medline].

  6. Corman ML. Colovesical fistula complicating diverticulitis in brothers. Dis Colon Rectum. 1999 Nov. 42(11):1511. [Medline].

  7. Charúa-Guindic L, Jiménez-Bobadilla B, Reveles-González A, Avendaño-Espinosa O, Charúa-Levy E. [Incidence, diagnosis and treatment of colovesical fistula]. Cir Cir. 2007 Sep-Oct. 75(5):343-9. [Medline].

  8. Dearden C, Humphreys WG. Meckel's diverticulum: a vesico-diverticular fistula. Ulster Med J. 1983. 52(1):73-4. [Medline].

  9. Kuntze JR, Herman MH, Evans SG. Genitourinary coccidioidomycosis. J Urol. 1988 Aug. 140(2):370-4. [Medline].

  10. Piper JV, Stoner BA, Mitra SK, Talerman A. Ileo-vesical fistula associated with pelvic actinomycosis. Br J Clin Pract. 1969 Aug. 23(8):341-3. [Medline].

  11. Cakmak MA, Aaronson IA. Appendicovesical fistula in a girl with cystic fibrosis. J Pediatr Surg. 1997 Dec. 32(12):1793-4. [Medline].

  12. Cockell A, McQuillan T, Doyle TN, Reid DJ. Colovesical fistula caused by appendicitis. Br J Clin Pract. 1990 Dec. 44(12):682-3. [Medline].

  13. Yamamoto H, Yoshida M, Sera Y, et al. Laparoscopic diagnosis of appendicovesical fistula in a pediatric patient. Surg Laparosc Endosc. 1997 Jun. 7(3):266-7. [Medline].

  14. Athanassopoulos A, Speakman MJ. Appendicovesical fistula. Int Urol Nephrol. 1995. 27(6):705-8. [Medline].

  15. Carter D, Choi HY, Telford G, Otterson M, Chitapalli K, Pintar K. Lymphadenopathy and entero-vesical fistula in Fabry's disease. Am J Clin Pathol. 1988 Dec. 90(6):726-31. [Medline].

  16. Téllez Martinez-Fornés M, Fernandez A, Burgos F, et al. Colovesical fistula secondary to vesical gangrene in a diabetic patient. J Urol. 1991 Oct. 146(4):1115-7. [Medline].

  17. Abbas F, Memon A. Colovesical fistula: an unusual complication of prostatomegaly. J Urol. 1994 Aug. 152(2 Pt 1):479-81. [Medline].

  18. Pontari MA, McMillen MA, Garvey RH, Ballantyne GH. Diagnosis and treatment of enterovesical fistulae. Am Surg. 1992 Apr. 58(4):258-63. [Medline].

  19. Dawam D, Patel S, Kouriefs C, Masood S, Khan O, Sheriff MK. A "urological" enterovesical fistula. J Urol. 2004 Sep. 172(3):943-4. [Medline].

  20. Paul AB, Thomas JS. Enterovesical fistula caused by small bowel lymphoma. Br J Urol. 1993 Jan. 71(1):101-2. [Medline].

  21. Miller B, Morris M, Gershenson DM, et al. Intestinal fistulae formation following pelvic exenteration: a review of the University of Texas M. D. Anderson Cancer Center experience, 1957-1990. Gynecol Oncol. 1995 Feb. 56(2):207-10. [Medline].

  22. Gray MR, Curtis JM, Elkington JS. Colovesical fistula after laparoscopic inguinal hernia repair. Br J Surg. 1994 Aug. 81(8):1213-4. [Medline].

  23. Levenback C, Gershenson DM, McGehee R, et al. Enterovesical fistula following radiotherapy for gynecologic cancer. Gynecol Oncol. 1994 Mar. 52(3):296-300. [Medline].

  24. Ansari MS, Nabi G, Singh I, et al. Colovesical fistula an unusual complication of cytotoxic therapy in a case of non-Hodgkin's lymphoma. Int Urol Nephrol. 2001. 33(2):373-4. [Medline].

  25. Crispen PL, Kansas BT, Pieri PG, Fisher C, Gaughan JP, Pathak AS, et al. Immediate postoperative complications of combined penetrating rectal and bladder injuries. J Trauma. 2007 Feb. 62(2):325-9. [Medline].

  26. Nelson AM, Frank HD, Taubin HL. Colovesical fistula secondary to foreign-body perforation of the sigmoid colon. Dis Colon Rectum. 1979 Nov-Dec. 22(8):559-60. [Medline].

  27. Potter D, Smith D, Shorthouse AJ. Colovesical fistula following ingestion of a foreign body. Br J Urol. 1998 Mar. 81(3):499-500. [Medline].

  28. Andrews NJ, Hall CN, Taylor TV. Colovesical fistula caused by a chicken bone. Br J Urol. 1988 Dec. 62(6):617. [Medline].

  29. Daoud F, Awwad ZM, Masad J. Colovesical fistula due to a lost gallstone following laparoscopic cholecystectomy: report of a case. Surg Today. 2001. 31(3):255-7. [Medline].

  30. Khan MS, Bryson C, O'Brien A, Mackle EJ. Colovesical fistula caused by chronic chicken bone perforation. Ir J Med Sci. 1996 Jan-Mar. 165(1):51-2. [Medline].

  31. Driver CP, Anderson DN, Findlay K, et al. Vesico-colic fistulae in the Grampian region: presentation, assessment, management and outcome. J R Coll Surg Edinb. 1997 Jun. 42(3):182-5. [Medline].

  32. Krco MJ, Jacobs SC, Malangoni MA, Lawson RK. Colovesical fistulas. Urology. 1984 Apr. 23(4):340-2. [Medline].

  33. Corman ML. Colovesical Fistula. Colon and Rectal Surgery. Philadelphia, Pa: JB Lippincott; 1984. 505.

  34. Golabek T, Szymanska A, Szopinski T, Bukowczan J, Furmanek M, Powroznik J, et al. Enterovesical fistulae: aetiology, imaging, and management. Gastroenterol Res Pract. 2013. 2013:617967. [Medline]. [Full Text].

  35. Shinojima T, Nakajima F, Koizumi J. Efficacy of 3-D computed tomographic reconstruction in evaluating anatomical relationships of colovesical fistula. Int J Urol. 2002 Apr. 9(4):230-2. [Medline].

  36. Jarrett TW, Vaughan ED. Accuracy of computerized tomography in the diagnosis of colovesical fistula secondary to diverticular disease. J Urol. 1995 Jan. 153(1):44-6. [Medline].

  37. Labs JD, Sarr MG, Fishman EK, et al. Complications of acute diverticulitis of the colon: improved early diagnosis with computerized tomography. Am J Surg. 1988 Feb. 155(2):331-6. [Medline].

  38. Narumi Y, Sato T, Kuriyama K, Fujita M, Mitani T, Kameyama M. Computed tomographic diagnosis of enterovesical fistulae: barium evacuation method. Gastrointest Radiol. 1988 Jul. 13(3):233-6. [Medline].

  39. Caoili EM, Cohan RH, Korobkin M, et al. Urinary tract abnormalities: initial experience with multi-detector row CT urography. Radiology. 2002 Feb. 222(2):353-60. [Medline].

  40. Ing A, Lienert A, Frizelle F. Medical image. CT colonography for colovesical fistula. N Z Med J. 2008 Aug 8. 121(1279):105-8. [Medline].

  41. Woods RJ, Lavery IC, Fazio VW, et al. Internal fistulas in diverticular disease. Dis Colon Rectum. 1988 Aug. 31(8):591-6. [Medline].

  42. Amendola MA, Agha FP, Dent TL, et al. Detection of occult colovesical fistula by the Bourne test. AJR Am J Roentgenol. 1984 Apr. 142(4):715-8. [Medline].

  43. Kaisary AV, Grant RW. "Beehive on the bladder": an indication of colovesical disease. Br J Urol. 1984 Feb. 56(1):35-7. [Medline].

  44. Long MA, Boultbee JE. Case report: the transabdominal ultrasound appearances of a colovesical fistula. Br J Radiol. 1993 May. 66(785):465-7. [Medline].

  45. Chen SS, Chou YH, Tiu CM, Chang T. Sonographic features of colovesical fistula. J Clin Ultrasound. 1990 Sep. 18(7):589-91. [Medline].

  46. Haggett PJ, Moore NR, Shearman JD, Travis SP, Jewell DP, Mortensen NJ. Pelvic and perineal complications of Crohn's disease: assessment using magnetic resonance imaging. Gut. 1995 Mar. 36(3):407-10. [Medline].

  47. Koelbel G, Schmiedl U, Majer MC, et al. Diagnosis of fistulae and sinus tracts in patients with Crohn disease: value of MR imaging. AJR Am J Roentgenol. 1989 May. 152(5):999-1003. [Medline].

  48. Ravichandran S, Ahmed HU, Matanhelia SS, Dobson M. Is there a role for magnetic resonance imaging in diagnosing colovesical fistulas?. Urology. 2008 Oct. 72(4):832-7. [Medline].

  49. Lavery IC. Colonic fistulas. Surg Clin North Am. 1996 Oct. 76(5):1183-90. [Medline].

  50. Kwon EO, Armenakas NA, Scharf SC, Panagopoulos G, Fracchia JA. The poppy seed test for colovesical fistula: big bang, little bucks!. J Urol. 2008 Apr. 179(4):1425-7. [Medline].

  51. Rames RA, Bissada N, Adams DB. Extent of bladder and ureteric involvement and urologic management in patients with enterovesical fistulas. Urology. 1991 Dec. 38(6):523-5. [Medline].

  52. Najjar SF, Jamal MK, Savas JF, Miller TA. The spectrum of colovesical fistula and diagnostic paradigm. Am J Surg. 2004 Nov. 188(5):617-21. [Medline].

  53. Amin M, Nallinger R, Polk HC Jr. Conservative treatment of selected patients with colovesical fistula due to diverticulitis. Surg Gynecol Obstet. 1984 Nov. 159(5):442-4. [Medline].

  54. Solkar MH, Forshaw MJ, Sankararajah D, Stewart M, Parker MC. Colovesical fistula--is a surgical approach always justified?. Colorectal Dis. 2005 Sep. 7(5):467-71. [Medline].

  55. Fiocchi C. Closing fistulas in Crohn's disease--should the accent be on maintenance or safety?. N Engl J Med. 2004 Feb 26. 350(9):934-6. [Medline].

  56. Zhang W, Zhu W, Li Y, Zuo L, Wang H, Li N, et al. The respective role of medical and surgical therapy for enterovesical fistula in Crohn's disease. J Clin Gastroenterol. 2014 Sep. 48(8):708-11. [Medline].

  57. Ferguson GG, Lee EW, Hunt SR, Ridley CH, Brandes SB. Management of the bladder during surgical treatment of enterovesical fistulas from benign bowel disease. J Am Coll Surg. 2008 Oct. 207(4):569-72. [Medline].

  58. Kirsh GM, Hampel N, Shuck JM, Resnick MI. Diagnosis and management of vesicoenteric fistulas. Surg Gynecol Obstet. 1991 Aug. 173(2):91-7. [Medline].

  59. Van Thillo EL, Delaere KP. Endoscopic treatment of colovesical fistula. An endoscopical approach. Acta Urol Belg. 1992. 60(2):151-2. [Medline].

  60. Puente I, Sosa JL, Desai U, et al. Laparoscopic treatment of colovesical fistulas: technique and report of two cases. Surg Laparosc Endosc. 1994 Apr. 4(2):157-60. [Medline].

  61. Joo JS, Agachan F, Wexner SD. Laparoscopic surgery for lower gastrointestinal fistulas. Surg Endosc. 1997 Feb. 11(2):116-8. [Medline].

  62. Petropoulos P, Nassiopoulos K, Chanson C. [Laparoscopic therapy of diverticulitis]. Zentralbl Chir. 1998. 123(12):1390-3. [Medline].

  63. Perniceni T, Burdy G, Gayet B, et al. [Results of elective segmental colectomy done with laparoscopy for complicated diverticulosis]. Gastroenterol Clin Biol. 2000 Feb. 24(2):189-92. [Medline].

  64. Siriser F. Laparoscopic-assisted colectomy for diverticular sigmoiditis. A single-surgeon prospective study of 65 patients. Surg Endosc. 1999 Aug. 13(8):811-3. [Medline].

  65. Moesgaard F, Hoffmann S, Nielsen R. Successful fibrin seal closure of a contaminated fistula. Case report. Acta Chir Scand. 1989 Aug. 155(8):427-8. [Medline].

  66. McBeath RB, Schiff M, Allen V, et al. A 12-year experience with enterovesical fistulas. Urology. 1994 Nov. 44(5):661-5. [Medline].

 
Previous
Next
 
CT scan showing the adherence of the sigmoid colon to the lateral edge of the bladder.
A lower cut of the CT scan from the related image. Note the sigmoid colon in direct proximity to the fistula and the air in the bladder.
A CT scan one cut further inferiorly from the related images, showing the typical air pattern in the bladder and more obvious inflammatory changes at the site of the vesicoenteric fistula.
An endoscopic view of colovesical fistula (upper right). Note the prominent edema and erythema characteristic of the fistula (ie, herald patch). Occasionally, a whitish discharge with the consistency of toothpaste can be observed emanating from the orifice. The presentation of a vesicoenteric fistula includes the presence of air, fecal material, and polymicrobial recurrent urinary tract infection.
A white mucinous exudate is observed emanating from the site of a colovesical fistula in a patient with both a sigmoid diverticular abscess and colon cancer.
After a bladder wash-out, the fistula appears as a raised, edematous, sessile lesion in the bladder. The air bubble is observed at the top of the photo, and some remnant mucus threads are adherent at the bottom.
The edema surrounding the fistula often extends for a considerable distance around the bladder wall. A cobblestone appearance is typical when chronic inflammation is present.
Colovesical fistula identified on CT scan in a patient with diverticular disease and fecaluria. Arrow – fistula, B – bladder, C – sigmoid colon with diverticula.
Colovesical fistula visualization on sagittal MRI. Arrow – fistula, B – bladder, C – sigmoid colon.
Operative view from superior and anterior showing the bladder (B) and colon (C) with area of erythema at the site surrounding the fistula.
Cystoscopic view of an anastomotic urethrorectal fistula that developed after radical prostatectomy. The patient remains asymptomatic with occasional pneumaturia. This is an uncommon complication of radical prostatectomy.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.