[Colovesical fistula as a complication of diverticular disease].

The results of research on the clinical picture, features of manifestation, diagnosis, and treatment of patients with diverticular disease complicated by sigmovesical fistula are presented. The study included 31 patients (19 [61.3%] men, 12 [38.7%] women), aged 32-83 (55.6 +/- 7.1) years. Diagnostic program included physical examination, laboratory blood and urine tests, endoscopic, radiological, ultrasound examinations. All patients underwent different interventions according to the severity and extent of the inflammatory process, the involvement of other organs of the abdominal cavity and the extent of diverticular lesions of the colon. Long-term results were assessed in all patients in a period of 5 months to 12 years, with a median follow-up 4.7 years. It is shown that the clinical manifestations of intestinovesical fistula did not match the severity of complications, and were subclinical. Timing for referral the patient to coloproctologist was 5 months after the occurrence of first clinical signs. In any case, conservative treatment has not led to spontaneous colovesical fistula closure. Average size of parafistulous infiltration on the wall of the bladder and perivesical tissue was 6.5 +/- 2.4 cm. All the patients underwent different types of colon resection. Postoperative complications did not requiring recurrent surgery were detected in 5 (16.1%) patients. None of these has experienced recurrence complications of diverticular disease. For the optimization the treatment strategy, physicians should follow multidisciplinary approach immediately after revealing the patient with persistent bacteriuria, pneumaturia and fecaluria. The surgery is the method of choice in the treatment of colovesical fistula as a complication of diverticular disease.

Colonic adenocarcinoma in a 13-year-old with cystic fibrosis.

The increase in longevity among patients with cystic fibrosis has brought to light comorbidities associated with the disease that are less acutely fatal than its pulmonary manifestations. Modern retrospective analysis has demonstrated an increased risk of gastrointestinal malignancy in patients with cystic fibrosis, with a marked elevation in malignancy rates among patients in their 20s and 30s. Here we report a case of colonic adenocarcinoma presenting as pneumaturia in a 13-year-old patient with cystic fibrosis.

Zinc deficiency as a problem in patients with Crohn's disease and fistula formation.

Zinc deficiency is common in patients with Crohn's disease (CD), especially in those with skin lesions and growth retardation. Patients with fistulas have been considered to be another group with zinc deficiency. We therefore determined serum zinc concentrations of 50 patients with CD. Zinc deficiency was diagnosed in 17 out of 50 patients (34%). Serum zinc concentrations of patients with fistulas were significantly lower than those of patients without fistulas, and zinc deficiency was found in 11/17 (65%) patients. Zinc deficiency may play a role in the formation and clinical course of fistulas. Therefore, in view of possible therapeutic implications, determination of serum zinc concentration in patients with CD and fistulas appears to be of value.

Isolated pneumaturia.

Sixteen patients with pneumaturia as their only urologic complaint were evaluated during a 38-year period. In three patients, a vesico-enteric fistula was documented. Five patients had an otherwise asymptomatic urinary tract infection. In eight patients, no pathologic process could be identified. These eight patients were women and had a benign course on follow-up. Urine culture gave positive results in all cases with a documented pathologic condition but gave negative results in all cases in which no explanation for pneumaturia could be found. Because of the difficulty in diagnosing a vesico-enteric fistula, all patients with isolated pneumaturia should have a thorough medical and urologic evaluation.

Detection of occult colovesical fistula by the Bourne test.

The value of different diagnostic tests in the detection of colovesical fistulas was studied in 28 surgically proven cases seen during the last 10 years at the University of Michigan, Ann Arbor. Etiologies were diverticulitis (19), Crohn disease (three), postradiation therapy (four), previous trauma (one), and bladder carcinoma (one). The fistulas were demonstrated by barium enema in 10 of 20 patients and by cystography in eight of 26. Cystoscopy was diagnostic in 11 of 25 patients and sigmoidoscopy in four of 24. Methylene blue test was positive in five of six patients, and in one patient given a charcoal enema the material appeared in the urine. The Bourne test, consisting of radiography of the centrifuged urine samples obtained immediately after a nondiagnostic barium enema, was positive in nine of 10 patients. In seven of these 10 patients, the Bourne test was the only positive evidence of an otherwise occult colovesical fistula later proven at surgery.