Utilization of point-of-care ultrasound to evaluate for enterovesical fistula

Enterovesical fistula formation is a relatively rare disease process although a common complication for patients with inflammatory bowel disease (IBD), notably Crohn's disease. Enterovesical fistulas most commonly arise from diverticulitis (65-80%), cancer (10-20%), or Crohn's disease (5-7%). An increasing amount of evidence supports the use of ultrasonography as the primary imaging method for the monitoring of complications in individuals with a documented history of IBD. Our case report presents a 30-year-old female with a history of Crohn's disease who presented to the Emergency Department with concern for possible enterovesical fistula formation. Using bedside gray-scale ultrasonography, a fistulous tract clearly visualizing air bubbles and fecal matter actively moving from bowel to the bladder through the fistula was visualized confirming the diagnosis of an enterovesical fistula. While CT imaging is instrumental in identifying mural and extramural complications of IBD, performing ultrasonography in patients with IBD serves as an efficient, inexpensive, and noninvasive diagnostic aid for the diagnosis of enterovesical fistula.

Patient-reported urinary outcomes in adult males with congenital colorectal conditions

PURPOSE

Long-term urinary outcomes for patients born with Hirschsprung disease (HD) and anorectal malformations (ARM) may impact their health and wellbeing into adulthood. This study describes self-reported long-term urinary outcomes in males with HD and ARM.

METHODS

This was a prospective study of male patients in the Adult Colorectal Research Registry who completed surveys on urinary function between October 2019 and March 2022. Self-reported health and functional outcomes were summarized, and differences based on type of condition were compared.

RESULTS

Sixty-seven patients completed the questionnaire (response rate: 59.1%), of which 17.9% (12) had HD and 82.1% (55) had an ARM. Rates of urinary incontinence and stress urinary incontinence were 16.4% (11) and 4.5% (3), respectively. On sub-analysis of patients with ARM, patients with sacral ratio (SR) of 0.4-0.69 reported higher UTI rates compared to those with SR ≥ 0.7 (57.9 vs 25.8%, p = 0.023). Renal failure rates were highest among patients with recto-bladder neck fistulas (66.0%, p = 0.012).

CONCLUSION

Patients with HD and ARM report a variety of urological sequelae in adulthood. Outcomes appear to be more common in patients with ARM and may be impacted by both anatomy and sacral ratios. Transitional care to monitor and manage renal and urological function is imperative.

Colonic Visualization of 99mTc-DMSA Due to Enterovesical Fistula

A 60-year-old woman with recurrent urinary tract infection who had several operations for colorectal carcinoma underwent Tc-DMSA renal scintigraphy which showed an unexpected accumulation of radiotracer in the colon. When symptoms were reviewed, we noticed that she was suffering from pneumaturia and fecaluria which raised the suspicion of enterovesical fistula. Rectal contrast-enhanced computer tomography of pelvis demonstrated enterovesical and enterovaginal fistulas. Colonic radioactivity was considered to be related to retrograde peristalsis of Tc-DMSA from bladder activity via enterovesical fistula. In patients with pelvic surgeries and radiotherapy, radioactivity in the colon should raise the suspicion of enterovesical fistula.

[Complete androgen insensitivity syndrome associated with vesical fistula: a case report and literature review]

Androgen insensitivity syndrome (AIS) is a very uncommon genetic disorder that results from the resistance of androgen receptor (AR) to androgen, which influences the formation of the male genitalia and in turn presents with female phenotype. Surgical resection of undesceaded testicle and different kinds of genitoplasty are crucial methods to correct the deformity of reproductive system, as well as hormone replacement therapy, which is an essential therapy for postoperational rehabilitation in AIS patients. A 43-year-old patient, who was socially female, was first admitted to gastroenterology department due to recurrent ascites and occasional abdominal pain with unknown origin. Taking physical examination, ultrasonography, karyotype analysis and sex hormone levels into consideration, the overall manifestations revealed the typical clinical features of complete androgen insensitivity syndrome. After that she was transferred to urology department for laparoscopic gonadectomy. During the surgery, doctors found that there was a vesical fistula on the upper wall near the conjunction between the bladder and ligamenta umbilicale medium, which explained the recurrent ascites for more than 4 years. After resecting the testicles and the tissues around the vesical fistula for histopathology, the result suggested Sertoli cell adenoma, hyperplastic Leydig cells and urothelium atypical hyperplasia. Hormone replacement therapy was given right after discharge. The hormone levels of follicle-stimulating hormone, luteinizing hormone, estradiol and progesterone were modulated by the dysfunction of androgen production after gonadectomy and hormone replacement therapy together with psychotherapy could stabilize her hormone levels and improve the quality of her life. The patient was suspicious of AIS family history and the pedigree was made to analyze her family which was possibly X-linked recessive pattern. We propose three possible hypotheses of the fistula, which are direct surgical injury, recurrence of bladder cancer and congenital urachal anomalies. But whether it is relevant between urachal anomalies and AIS is yet to be discovered.

Multiple Lymphomatous Diverticulosis and Comorbid Chronic Lymphocytic Leukemia: Novel Manifestations of Ileocolic Mantle Cell Lymphoma

Mantle cell lymphoma (MCL) has tropism for the gastrointestinal tract (GIT) identifiable as multiple polyps and mass lesions throughout the GIT. We describe 2 novel manifestations of MCL. A 60-year-old woman with known chronic lymphocytic leukemia (CLL) had an exophytic mass of the appendiceal orifice. Multiple polypoid masses of the distal ileum were identified in the right hemicolectomy specimen (multiple lymphomatous polyposis). Ancillary studies confirmed the coexistence of the 2 independent lymphoproliferative disorders. A 69-year-old man had recurrent urinary tract infections and pneumatouria caused by a colovesicular fistula complicating diverticulosis coli. Segmental resections of the sigmoid and ileocecum confirmed diverticulosis of the left and right colon. Histology identified infiltrates of MCL confined to the penetrating aspects of colonic diverticula. MCL has not been documented to coexist with CLL. An invaginating morphology of lymphoma, multiple lymphomatous diverticulosis is also a novel presentation. These 2 scenarios expand MCL's known manifestations within the GIT.

Laparoscopic surgery of benign entero-vesical or entero-vaginal fistulae

PURPOSE

Entero-vesical or entero-vaginal fistulae (EVF) are an uncommon septic complication mainly of diverticular disease. The fistulae are usually situated within extensive and dense inflammatory masses occluding the entrance of the pelvis. There are still some controversies regarding laparoscopic feasibility and treatment modalities of this disorder.

METHODS

A retrospective chart review of all patients with EVF operated at our department since 2008. Patients were identified by use of the computerized hospital information system.

RESULTS

In nineteen patients (ten males), median age 68 years, 13 patients had entero-vesical fistulae, and 6 patients had entero-vaginal fistulae. The fistulae were caused by complicated diverticular disease in 16 patients (84 %), Crohn's disease (two patients), and ulcerative colitis (one patient). All cases were attempted laparoscopically. Operative treatment involved separation of the inflammatory mass and resection of the affected colorectal segment. There were three conversions (16 %), all three requiring bladder repair considered too extensive for laparoscopic means. In two further patients small bladder defects were sutured laparoscopically, the remaining patients required no bladder repair. The inferior mesentric artery (IMA) was preserved in all cases. Median operative time was 180 min. Two patients received a protective ileostomy: one converted patient and one cachectic patient with Crohn's disease under immune-modulating therapy. Both ileostomies were closed. Altogether, there were five complications in five patients (26 %), four of them were minor (Clavien grade I and II). The cachectic patient with Crohn's disease suffered a major (grade IIIb) complication (stoma prolapse, treated by early closure of the ileostomy). There was no anastomotic leakage and no mortality. Median hospital stay was 12 days.

CONCLUSIONS

The laparoscopic approach is a safe option for the treatment of EVF of benign inflammatory origin. In most cases it offers all the advantages pertaining to minimally invasive surgery. For a definite and causal approach, the disorder belongs primarily within the therapeutic domain of the visceral surgeon. Following the separation of the inflammatory colon, most of the bladder lesions caused by EVF will heal without further surgical measures.

[Vesicoappendiceal Fistula: A Case Report]

A 65-year-old man had been aware of pieces of food occasionally in the urine since February 2008. In November 2010, he came to an outpatient clinic with high fever and cloudy urine and was diagnosed with urinary tract infection. Because he had fecaluria, interconnection between urinary bladder and digestive tract was suspected. Although excretory urography showed no remarkable findings, an outflow of contrast media into the appendix was demonstrated in the cystography. By cystoscopy, the fistula hole was confirmed on the posterior wall of the bladder and inflow of feces from the hole was noticed. Operation was performed under the diagnosis of vesicoappendiceal fistula. The appendix was adhesive to the ileum, the right side of the bladder and the upper side of the rectum, and an en bloc resection was performed. Because the fecalith existed near the fistula, appendicitis appeared to induce inflammatory change and abscess formation around the appendix, and the abscess might have perforate into the bladder.

[Fistula as cause of cyclic haematuria in a woman]

We report a case of a 32-year-old female with a vesicouterine fistula (Youssef's syndrome). She had had a low segment caesarean section and subsequently developed cyclic haematuria and menorrhoea. There was a significant delay in diagnosis of the fistula because of problems with visualising the fistula. In this case the fistula was lastly diagnosed with magnetic resonance imaging (MRI), the patient was treated with hysterectomy (patient's wish) and the fistula tract was repaired succesfully. If investigation with ultrasonography, cystoscopy and computerised tomography at a highly specialised department is negative, we recommend that MRI should be performed.

[Recurrent urinary tract infection due to enterovesical fistula secondary to colon diverticular disease: a case report]

INTRODUCTION

Enterovesical fistula are pathological connections between the bladder and pelvic intestinal segments. It consists of a rare complication of neoplastic and inflammatory pelvic disorders, in addition to iatrogenic or traumatic injuries, and correlates with both high morbidity and mortality indexes.

CASE REPORT

Male patient, 61 years old, admitted at the hospital clinics featuring abdominal pain and distension, vomiting and fecal retention. Patient's pathological precedents include high blood pressure, diabetes mellitus, vesical dysfunction and recurrent urinary tract infection on the past three years. Magnetic resonance imaging of abdomen and pelvis revealed enterovesical fistula in association with colon diverticular disease of the sigmoid. Management of choice consisted of partial colectomy with bowel lowering and partial cystectomy with surgical double-J stent insertion.

DISCUSSION

Although consisting of a gastrointestinal primary affection, patients with enterovesical fistula usually search for medical help charging urinary tract features. In this particular case, our patient was admitted with gastrointestinal symptoms, reasoned by diagnostic delay, as the patient had already attended at multiple centers with urinary symptoms.

CONCLUSION

Despite being an unusual affection, recurrent urinary tract infection associated with colon diverticular disease must always be considered at differential diagnosis of recurrent urinary tract infection as it concurs with high morbidity and mortality.

Retained pill camera at an entero-uracho-vesical fistula site in a patient with Crohn's disease

An 18-year-old female patient with Crohn's disease had abdominal pain secondary to a retained pill camera. After several weeks of medical management, the camera spontaneously passed. However, the patient also had an intra-abdominal abscess that worsened, despite medical therapy. Surgical therapy was recommended and a 5cm infected urachal cyst with entero-urachal and vesico-urachal fistulas was discovered. An en-bloc resection of the entire area was performed to include the urachal cyst, the adherent portion of the dome of the bladder, and 15cm of associated ileum. The bladder was repaired, a suprapubic catheter was placed, and an ileo-ileal anastamosis was performed. Microscopic findings were consistent with active Crohn's disease and fistula formation. The entero-uracho-vesical fistula site was likely the site of the retained pill camera. The patient did well postoperatively and was discharged on postoperative day six without complications.

Laparoscopic-assisted PSARP - the advantages of combining both techniques for the treatment of anorectal malformations with recto-bladderneck or high prostatic fistulas

AIM

The aim of this study was to present an alternative way to use both the posterior sagittal approach combined with laparoscopy for the repair of select cases of anorectal malformation (ARM).

METHODS

The laparoscopic approach was used for rectal dissection, ligation of the fistula, and division of vessels to pull the rectum down in cases of ARM with recto-bladderneck or high prostatic fistula. The posterior sagittal incision we believe made the perineal portion safer, allowing for rectal tapering when necessary, and for accurate placement of the rectum, anchored in the center of the sphincter.

RESULTS

There were 15 children (recto-bladderneck fistula, n=13 and recto-prostatic fistula, n =2) in this series. There were no urethral injuries, posterior urethral diverticula, or rectal strictures. A laparotomy was needed in two children in order to mobilize a very high rectum. Follow-up ranged from 3 months to 10 years. Clinical results were consistent with our published series for male patients with these types of defects: 5 are fecally incontinent (3 are clean with a bowel management program), 1 is fecally continent, and 9 are too young to assess. Four children suffered rectal mucosal prolapse.

CONCLUSION

The combination of laparoscopy and PSARP represents a useful technical alternative that allows for a safe reconstruction in cases of ARM with recto-bladderneck and in selected high prostatic fistulas.

Intractable metabolic acidosis in a patient with colovesical fistula

A 58-year-old female presented with urosepsis and faecaluria secondary to a colovesical fistula of diverticular aetiology. A plan was made for surgical repair of the fistula. Preoperatively the patient developed a hyperchloraemic metabolic acidosis, with hyperkalaemia and hyponatraemia. Renal function was normal, and a short synachten test ruled out Addison's disease. Postoperatively her acid-base physiology normalised in the absence of medical management, demonstrating that surgical intervention was responsible for resolution of the patient's metabolic acidosis. The mechanisms by which colovesical pathophysiology causes hyperchloraemic metabolic acidosis are discussed. Although diverticular disease is the most common cause of colovesical fistulae, this is the first report of such fistulae causing metabolic acidosis.

15-year history of spontaneous appendico-vesical fistula (case report)

Appendicovesical (AVF) fistula is rare complication in the modern era. Only a few cases of AVF were described in the literature of the last decade. AVF is meanly associated with a history of appendicitis. The guiding symptoms are coprosuria and pneumaturia, with recurrent infection of the urinary tract. The accurate pre-operative diagnosis is difficult to make. It usually took at least one year from the onset of symptom to confirm diagnosis. It has been reported a few cases of 15 year history of undiagnosed AVF. We represent a case of EVF, spontaneously developed after treated acute appendicular colic presenting an unusual long - 15 years undiagnosed history, without presenting of typical symptoms. The analyses of disease history after cystoscopy lead to correct pre-operative diagnosis. AVF can develop as a complication not only after untreated appendicitis, but also after "successfully" treated with antibiotics appendicular colic may indicate the presence of an AVF and needs to assessing patient's history and applying cystoscopy and modern examination methods in complex diagnosis issues.

[A case of total pelvic exenteration and reconstruction of perianal skin defect using a VY advancement of bilateral gluteus maximus musculocutaneous flaps for anal canal cancer associated with anal fistula]

A 53-year-old man, who was diagnosed as having an anal canal cancer associated with anal fistula, was introduced to our hospital. By CT and MRI examination, fluid collections were detected in the perirectal space and fistula was connected to bladder. Total pelvic exenteration was performed under the consideration of keeping the margin for the large skin defect. We reconstructed the perianal skin defect using a VY advancement of bilateral gluteus maximus musculocutaneous flaps. After the surgery, no sign of recurrence has been observed in 1 year and 4 months. This constructive technique was effective for anal defects.

[A man with pain in the lower abdominal]

A 38-year-old man presented with abdominal pain, dysuria, pneumaturia and pyuria, due to an enterovesical fistula in Crohn's disease.

Non perianal fistulas in Crohn's disease and short bowel syndrome: what we can do?

Crohn's disease (CD) is a lifelong disease arising from an interaction between genetic and environmental factors, but seen predominantly in the developed countries of the world. The precise etiology is unknown and therefore a causal treatment is not yet available. Fistulating Crohn's disease includes fistulas arising in the perianal area, together with those communicating between the intestine and other organs or the abdominal wall. Non perianal fistulas include fistulas communicating with other viscera (urinary bladder, vagina), loops of intestine (enteroenteral fistulas) or the abdominal wall (enterocutaneus fistulas). The diagnostic approach is a crucial aspect in the management of fistulating CD as the findings influence the therapeutic strategy. Short bowel syndrome caused by extensive bowel resection should be initially treated with nutritional support and can caused serious treatment and reevaluating problems. We review this uncommon manifestation in a high risk patient after multiple operations and severely shortened bowel and also with non perianal fistulating CD.

A case of split notochord syndrome with congenital ileal atresia, the total absence of a colon, and a dorsal enteric cyst communicating to the retroperitoneal isolated ceca with a vesical fistula

Split notochord syndrome (SNS) is an extremely rare anomaly. This report presents the case of a male infant with SNS associated with congenital ileal atresia and a dorsal enteric cyst communicating to the retroperitoneal isolated ceca with a vesical fistula. Dorsal fistulography and vesicography were useful and essential for the detailed study of the topology in this patient. The embryological mechanism and etiologic theories are discussed with a review of 19 cases reported in the literature.

Severe metabolic acidosis and hypokalemia in a patient with enterovesical fistula

We report a case of a 59-year-old woman who had severe metabolic acidosis and hypokalemia due to an enterovesical fistula. The patient came to our hospital complaining of systemic weakness and numbness of the fingers. She was found to have hyperchloremic metabolic acidosis (arterial bicarbonate, 2.8 mEq/l) and hypokalemia (serum potassium, 1.9 mEq/l) and was admitted for treatment. Following the correction of metabolic acidosis and hypokalemia, the patient was examined for the underlying cause of these electrolyte and acid-base disorders. She had a history of total hysterectomy followed by radiotherapy due to uterine cancer 30 years previously. After the surgery, she had suffered postoperative neurogenic bladder dysfunction, necessitating intermittent self-catheterization. Two years before admission, she had begun to experience watery diarrhea. A radiographic study after recovery from the acid-base and electrolyte disorders revealed the presence of an enterovesical fistula. The fistula was surgically resected and the metabolic acidosis completely cleared. Unexplained hyperchloremic metabolic acidosis with hypokalemia may suggest the presence of an enterovesical fistula in patients with a surgical history of malignant pelvic tumor and neurogenic bladder dysfunction.

Unusual complication of suprapubic cystostomy in a male patient with tetraplegia: traction on Foley catheter leading to extrusion of Foley balloon from urinary bladder and suprapubic urinary fistula--importance of securely anchoring suprapubic catheter with adhesive tape or BioDerm tube holder

Suprapubic cystostomy is recommended to patients with neuropathic bladder to prevent complications of long-term urethral catheter drainage. We present a 50-year-old male patient with tetraplegia who had long-term urethral catheter drainage. Following flexible cystoscopy, he developed a urine leak from the right side of the scrotum. Suprapubic cystostomy was performed. After suprapubic cystostomy, the urinary fistula healed completely. A follow-up cystourethrogram confirmed an intact urethra with no leak of contrast. Six weeks later, this patient presented with a hole below the suprapubic cystostomy through which a small amount of urine was leaking. A keyhole dressing had been applied around the suprapubic catheter and the catheter was hanging loosely, thus permitting traction on the catheter, especially when the urine bag was full. Computerised tomography of the pelvis showed extrusion of the Foley balloon from the urinary bladder, but the tip of the catheter was still located within the bladder. The extruded catheter was removed and a Foley catheter was inserted, ensuring that the balloon was inflated within the urinary bladder. The suprapubic catheter was secured firmly to the anterior abdominal wall with a BioDerm Tube Holder, thus preventing any traction on the catheter or Foley balloon. The urine leak through the hole below the suprapubic cystostomy stopped and the sinus healed. This case illustrates the need to anchor the suprapubic catheter securely to the anterior abdominal wall with adhesive tape or BioDerm Tube Holder to prevent traction and consequent displacement of the catheter or Foley balloon.

Adjustable continence therapy for the treatment of urinary incontinence after radical cystectomy and orthotopic neobladder in women

The management of urinary incontinence after radical cystectomy and orthotopic neobladder reconstruction is a very challenging situation. We report on a patient that developed a neobladder-urethro-vaginal fistula successfully treated but resulting in severe urinary incontinence that was cured after the periurethral insertion of adjustable silicone balloons.

Abberant sex habits leading to acute limb ischemia and hematuria

We report a case of a 42 year-old man suffering from an acute limb ischemia. Upon urokinase treatment he developed gross hematuria. Finally, CT scanning revealed a self-inserted foreign body not only causing thrombosis of the external iliac artery, but also forming an arteriovesical fistula. This case emphasises the importance of detailed history taking and thorough further investigation in recurrent macroscopic hematuria in a patient. Massive bleeding from the bladder should alert the doctor for a rare, but life-threatening arteriovesical fistula.

Are perineal and luminal fistulas associated in Crohn's disease? A population-based study

BACKGROUND & AIMS

We aimed to determine the frequency of fistulizing Crohn's disease (CD) and the relationship between perineal and luminal fistulas.

METHODS

A population-based retrospective study was conducted by using the University of Manitoba Inflammatory Bowel Disease Research Registry. In 2003 there were 3192 IBD patients, 1595 had (CD), and 398 patients reported stricturing or fistulizing disease. Patients were interviewed and medical records were reviewed for phenotype assessment. Perineal fistulas were defined as those exiting in the perineum or fistulizing to sexual organs. Luminal fistulas were defined as arising from the bowel to organs other than the perineum.

RESULTS

The prevalence of fistulizing CD was at most 22.1%. Of the 398 patients, 280 CD patients were eligible for full phenotype verification. Of these, 50 patients had both perineal and luminal fistulas, 151 had only perineal fistulas, and 79 had only luminal fistulas. Odds ratio (OR) for likelihood of having luminal fistula disease if perineal disease was present was 5.02 (95% confidence interval [CI], 3.40-7.42; P < .0001). Fistula patients were more likely to be diagnosed younger; 20-29 years (OR, 1.37; 95% CI, 1.02-1.85; P = .048). Compared with luminal fistulas, perineal fistulas had a higher likelihood to have colonic (OR, 3.32; 95% CI, 1.59-6.90; P = .002) rather than isolated ileal involvement (OR, 0.39; 95% CI, 0.21-0.72; P = .004). The comparison of fistulizing CD to non-fistulizing disease revealed a predisposition to colonic (OR, 1.41; 95% CI, 1.04-1.90; P = .032), ileocolonic (OR, 2.49; 95% CI, 1.91-3.26; P < .001), and upper gastrointestinal (OR, 3.87; 95% CI, 1.93-7.74; P < .0001) disease versus isolated ileal involvement (OR, 0.25; 95% CI, 0.19-0.34; P < .0001).

CONCLUSIONS

There is a lower prevalence of fistulizing CD in this population than previously published. Perineal and luminal fistula diseases are highly related to one another but typically have distinct clinical associations.

Appendicovesical fistula associated with Hirschsprung's disease

Appendicovesical fistulae are rare. Only 112 cases in all ages have been reported previously in the world literature. Our case is that of a 1-year-old boy who presented during the neonatal period with missed appendiceal perforation associated with a long segment Hirschsprung's disease. The case is discussed.

[Ascites and renal failure caused by a bladder fistula: report of one case]

Bladder fistula to open peritoneum is an uncommon cause of ascites. We report a 50 year-old woman with a history of pain in the lower abdomen and slight weight loss. The patient had a history of a repaired bladder perforation 12 years before, during a labor with forceps. The patient had microscopic hematuria and an abdominal CAT scan showed ascites. Serum creatinine was 2.2 mg/dl. An abdominal Doppler ultrasound showed normal portal and suprahepatic veins. Due to the suspicion that ascites accumulation could be urine, a sample was obtained and urea nitrogen and creatinine were measured. Since both levels were high in the ascitic fluid the patients was subjected to a cystoscopy that disclosed a fistula between the bladder and peritoneum. The patient was operated and the fistula excised. The postoperative period was uneventful, and the serum creatinine normalized.

Giant prostatic urethral calculus associated with urethrocutaneous fistula

Urethral stones in men are rare clinical entity and most of them migrate from the urinary bladder. Urethral stones are rarely formed primarily in the urethra and are usually associated with urethral strictures or diverticula. We report a 41-year-old man with giant prostatic urethral stone (5.9x3.2x2.8 cm) associated with a urethrocutaneous fistula. The etiological factors, pathogenesis, clinical presentation, complications and management of giant urethral calculi are reviewed.

[Treatment by stent of a benign stricture of the colon complicated by a fistula]

We report on a case of a 69-year-old man with a benign stricture of the sigmoid colon due to diverticulosis, complicated by a colovesicular fistula. Due to severe co-morbidity, surgical excision of the fistula and resection of the sigmoid colon were not indicated. Instead, the stricture and the fistula were managed via the insertion of a self-expanding, uncoated metallic stent (SEMS). The clinical symptoms disappeared after insertion of the SEMS. We conclude that SEMS may be a possible therapeutic tool in selected cases of benign stricture of the colon, with or without fistula.

Colovesical fistula complicating diverticular disease: one-stage resection

Colonic diverticular disease is common in developed countries, and its prevalence increases with age. Most affected individuals remain asymptomatic throughout their lives, and relatively few patients require surgical intervention for obstructive or inflammatory complications. Colovesical fistula is the most common type (65%) of fistula associated with colonic diverticular disease. Primary resection of sigmoid colon with colorectal anastomosis performed as a one-stage procedure is its definitive treatment and can be performed safely--as simple closure, using an omental flap, or through resection and closure of bladder defect--in 90% of the patients. We report our experience with four patients suffering from colovesical fistula who were treated with primary resection of sigmoid colon and colorectal anastomosis performed as a one-step procedure. In our experience, diverting colostomy or Hartmann intervention is not recommended because of the lack of fistula definitive resolution and the possibility of additional complications.

[Sigmoido-vesical fistula as a cause of recurrent urinary tract infections]

The authors describe a case of sigmoido-vesical fistula in 64 years old woman. The fistula probably developed as a result of complications of sigmoidal diverticulitis. The main clinical manifestation were symptoms of recurrent urinary tract infections and pneumaturia. For the diagnosis of the fistula different methods such as urography, cystography, ultrasonographic examination, colonoscopy, bacteriological urine analysis and laboratory investigations were used. The patient was qualified to surgical treatment. One-stage operation performed appeared successful.

Vesicocervical fistula: an unusual complication of vesicovaginal [corrected] fistula repair

A rare case of vesicocervical fistula following repair of a vesicovaginal fistula is presented. The patient complained of cyclical menouria since the first repair done 15 years ago and gradually worsening urinary incontinence. A laparoscopic assisted repair of the fistula was performed and the patient is fully continent at 12-months follow up.

[Pneumaturia as a sequela of asymptomatic diverticulitis]

Pneumaturia is sometimes the first symptom of colovesical fistula. Colovesical fistula presents a difficult problem with complicated diagnosis and therapy. Most common are fistulas between the colon (sigmoid) and bladder, which results from sigmoiditis and diverticulitis. The paper reports the case of a 61-year-old man with diagnosis of diverticulitis and symptom of pneumaturia in duration of 3 months. The operation was successfully performed in cooperation with a surgeon and an urologist.

Youssef's syndrome--report of 7 cases and review of literature

Seven patients in their thirties presented with cyclical haematuria, apparent amenorrhoea and urinary continence following lower segment caesarean section. Investigations confirmed the diagnosis of Youssef's syndrome. Four patients who had 2 children each opted for hysterectomy. The remaining 3 patients had excision of the fistula with repair of uterus and bladder. In this group, at 6 years follow-up, in spite of conceiving, 2 patients aborted with no further pregnancy reported.