Management of colovesical fistulae caused by diverticulitis: 12 years of experience in one medical centre.

BACKGROUND: Diverticulitis can be complicated by a colovesical fistula (CVF). This phenomenon is relatively uncommon in surgical practice. The aim of this study was to evaluate diagnostic and surgical management of CVF at our medical centre. MATERIAL AND METHODS: In this retrospective study, details of 31 patients undergoing surgery for CVF between January 1998 and March 2010 were recorded. These patient records were analysed for presenting symptoms, diagnostic investigations and surgical procedures. RESULTS: The most common presenting symptoms were pneumaturia, urinary tract infections, abdominal pain, and fecaluria. CT identified CVF in 28 patients (92.2%), cystoscopy in 4 patients (23.5%), and barium enema in 3 patients (13.6%). Surgical management was resection of the diseased colon segment with primary anastomosis in 29 of 31 patients. The bladder fistulae were oversewn and an omental plasty was placed between bowel anastomosis and bladder. There was only one postoperative leak and one case of mortality (3.2%). CONCLUSIONS: CT is the most sensitive test in identifying CVF. Resection of the diseased colon segment and primary anastomosis seems to be an effective and safe surgical method for treating CVF. This surgical treatment has an acceptable risk for anastomotic leak and mortality.

Low morbidity and mortality after stenting for malignant bowel obstruction.

BACKGROUND: The difference in mortality between emergency and elective surgery for malignant colonic obstruction is more than 5% in healthy patients below the age of 65 and increases with age to around 20%. Emergency surgery can be avoided by endoscopic placement of a self-expandable metal stent (SEMS). AIM: To evaluate the effectiveness and safety of SEMS as 'bridge to surgery'. METHOD: Between January 2001 and July 2008, SEMS were placed for acute malignant colonic obstruction in 45 patients (median age 72 years, range 35-91). RESULTS: The procedure was technically successful in 43 patients (94%) with resolution of obstructive symptoms within 48 h in 87% of the patients. No perforations occurred during the procedure or while awaiting surgery. Two (4%) patients required a second endoscopic procedure. All patients underwent a single-stage surgical procedure. Postoperative mortality was 2.2% (n = 1). Histology showed advanced colorectal cancer (T3-4N1-2M0-1) in 75% of the patients. CONCLUSION: SEMS placement is a safe and effective procedure as bridge to surgery in patients presenting with colonic obstruction due to colorectal malignancy. This procedure carries a risk of serious complications well below that of the reported difference in mortality between emergency an elective surgery.