Fístula colovesical de origen diverticular. Resolución laparoscópica con nuevo recurso técnico / Diverticular colovesical fistulae. Laparoscopic tip

Introducción: La enfermedad diverticular de colon es una patología de alta prevalencia en nuestro medio. Su presentación inicial como fístulas no complicadas no es frecuente sin antecedentes de episodios de diverticulitis previa. Objetivos: Presentar detalles técnicos de la cirugía de resección y tratamiento laparoscópico de una fistula colovesical de origen diverticular. Materiales y métodos: Se presenta el caso de un paciente varón de 63 años con dolor en hipogastrio sin alteraciones evacuatorias ni cirugías previas. Sin antecedentes de diverticulitis. Se realizó ecografía abdominal y tomografía computada donde se constata aire en vejiga. El urocultivo es positivo para escherichia coli y el colon por enema detecta pequeño trayecto fistuloso entre colon sigmoides y vejiga. Se decide resección laparoscópica. Resultados: Se realizó una colectomía sigmoidea laparoscópica con identificación de trayecto fistuloso a la vejiga que se aisló y seccionó entre clips de polímero. Se completó con anastomosis primara colorrectal y sondaje vesical prolongado que se retiró a los 15 días. Los parámetros postoperatorios fueron favorables con egreso a las 72 hs. Conclusión: La fístula colovesical es una complicación de la enfermedad diverticular de colon aunque es rara su debut como forma de presentación sin episodios de diverticulitis previa. Se destaca su identificación como trayecto único y no hemos encontrado mención al respecto en la bibliografía. Su resolución de ligadura entre clips es una opción terapéutica efectiva y rápida para su resolución definitiva. El abordaje laparoscópico electivo es de elección y su tratamiento mediante el procedimiento propuesto resultó efectivo y seguro.

Background: Diverticular disease is a high prevalent colonic pathology. Initial presentation as complicated disease includes fistulas, perforation and bleeding. Objetive: To present technical surgical aspects of surgical treatment of laporoscopic resection of colovesical fistula after diverticular disease. Methods: A 63 years old patient presented with low abdominal pain and no transit symptoms. There was no previous surgery and diverticulitis episode. Abdominal ultrasound and CT scan showed air in the bladder. Urine culture was positive to Escherichia coli. Colonic barium x-rays showed a colovesical fistula. Laparoscopic resection was decided as treatment of choice. Results: Laparoscopic sigmoid colectomy, aisolation of fistula tract and posterior clips ligation and section. Primary mecanic anastomosis and 15 days vesical catheter completed the treatment. Postoperative evolution was satisfactory. Conclusions: Colovesical fistula is a frequent complication of complicated diverticular disease, however its debut without previous episodes is rare. The colonic fistula presented as unique tract is unfrequent. Resolution by polimer clips and section associated with colonic resection by laparoscopic is a good option to avoid bladder sutures. This procedure resulted safe and effective.

Low diagnostic sensitivity of cystoscopy and cystography of surgically confirmed vesicoenteric fistulae.

PURPOSE: The objective of this study was to assess the accuracy of cystoscopy and cystography, as compared to other diagnostic studies, in identifying vesicoenteric fistulae (VEF) in a contemporary series of patients with surgically confirmed VEF. METHODS: With institutional review board approval, we performed a single-center retrospective review of surgically confirmed VEF between 2002 and 2018. Demographic data, comorbidities, symptoms, and diagnostic evaluation were reviewed. The sensitivity, specificity, and accuracy of cystoscopy in diagnosis of VEF were compared to cross-sectional imaging. RESULTS: The study cohort consisted of 51 patients with surgically confirmed VEF secondary to diverticular disease. Diagnostic evaluation included cross-sectional imaging with CT (94%), colonoscopy (82%), cystoscopy (75%), cystography (53%), and barium enema (26%). Cystoscopic evaluation definitively demonstrated evidence of VEF in 34% of patients, while 55% of patients had nonspecific urothelial changes on cystoscopy without definitively demonstrating VEF. Comparatively, the sensitivity of VEF was 25% for cystography and 84% for CT. CONCLUSIONS: In clinical practice, the diagnostic work-up of VEF is variable. In the modern era of managed care, inclusion of cystoscopy and cystography in the evaluation of VEF does not contribute a substantial additive benefit over standard cross-sectional imaging. Cystoscopy and cystography could potentially be eliminated from the diagnostic evaluation of VEF, in the absence of a concern for malignancy, in an effort to minimize unnecessary invasive testing as well as health care expenditures.

Recurrent symphysitis culminating in pelvic ring fracture after hyperextended transurethral prostate resection and vaporization with symphysis erosion: a case report.

BACKGROUND: Short-term and long-term complications of transurethral prostate resection can be different in nature. Capsule perforation and subsequent fistulation after resection and electrovaporization is seldom reported in the literature. CASE PRESENTATION: Here we report the case of a 79-year-old caucasian man with capsule perforation after transurethral prostate resection and electrovaporization resulting in a severe and recurrent symphysitis and subsequent pelvic ring fracture. The bladder-symphysis fistulation was surgically removed and additional orthopedic surgery could be avoided after definitely solving the urological problem. CONCLUSIONS: Urologists should be aware of rare complications after transurethral resection and electrovaporization of the prostate.

Tratamiento mínimamente invasivo de la fístula rectovesical: a propósito de un caso / Minimally invasive treatment of rectovesical fistula: a case report

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[Vesico-appendiceal fistula caused by appendiceal cancer: a case report].

A case of vesico-appendiceal fistula caused by appendiceal cancer is reported. A 37-year-old male was admitted with the chief complaint of suspended dust in the urine. Under cystoscopy, a tumor (1 cm diameter) was found in the right posterior wall of the bladder. Transurethral resection of the bladder tumor was performed. The pathological outcome was intestinal metaplasia without malignancy. Preoperative abdominal computed tomography suggested vesico-appendiceal fistula, retrospectively. Therefore, appendectomy with partial cystectomy was attempted. However, the appendix was adhered to the sigmoid mesocolon, therefore, appendectomy, partial cystectomy, and sigmoid colectomy were performed. We diagnosed the tumor as mucinous adenocarcinoma. The patient has been receiving adjuvant chemotherapy with tegafur-gimeracil-oteracil potassium for 17 months, because he refused right hemicolectomy. There was no evidence of recurrence after 58 months of follow-up. Vesico-appendiceal fistula caused by appendiceal cancer is very rare. Our case is the 21st case reported in Japan.

[Clinical study of enterovesical fistulas].

We conducted a retrospective review of 16 patients who were diagnosed with enterovesical fistula in our hospital between January 2000 and July 2013. The patient's median age was 74 years old and 4 were female. Most of the chief complaints were pneumaturia and fecaluria. There was a vesicosigmoidal fistula in 12 patients, an ileovesical fistula in 2, and a rectovesical fistula in 2. The main underlying cause was diverticulitis in 9 patients and a sigmoid colon carcinoma in 3. Diagnoses were made based on the findings of cystoscopy, barium enema, abdominal computed tomography and so on. Treatment varied in each case depending on the etiology and the patient's condition. The procedure was mostly open surgery, but laparoscopic sigmoidectomy was performed preserving the bladder in the two most recent cases.

[A case of sigmoid colon cancer with a sigmoidovesical fistula treated with preoperative XELOX+bevacizumab therapy and urinary bladder-conserving surgery].

A 64-year-old man presented with abdominal pain, diarrhea, urinary pain, and frequent urination.He was diagnosed with locally advanced sigmoid colon cancer accompanied by a sigmoidovesical fistula, which was determined to require total cystectomy for curative resection.Expecting tumor shrinkage and conservation of the urinary bladder, we performed loop ileostomy followed by preoperative mFOLFOX6+bevacizumab therapy.After 1 course of administration, the implanted port became infected.Therefore, the regimen was changed to 4 courses of XELOX+bevacizumab therapy.After the treatment, there was no longer any evidence of sigmoidovesical fistula.We performed a urinary bladder-conserving sigmoidectomy and finally achieved pathological curative resection.After adjuvant chemotherapy, no findings suggestive of recurrence were noted during 10 postoperative months.Preoperative XELOX+bevacizumab therapy may be worth considering as a therapeutic option for conserving the urinary bladder in cases of locally advanced colon cancer.

Fístula colovesical de origen diverticular / Results of surgical treatment of colovesical fistulas of diverticular origin

Background: The main causes of colovesical fistulas are diverticular disease of the colon and colon carcinoma. Aim: To analyze the results of the surgical treatment of colovesical fistulas of diverticular origin. Material and Methods: Retrospective analysis of all patients operated for a colovesical fistula of diverticular origin. Results: From 141 patients subjected to a colon excision for diverticular disease, 18 had a colovesical fistula. The latter, compared to patients without fistulas were male in a higher proportion, were younger and had more concomitant diseases. Pneumaturia was reported in 83 percent and urine fecal soiling in 56 percent. In two thirds of patients, the fistula appeared in the absence of a diverticular crisis. Abdominal CAT sean demonstrated the fistula in 80 percent of cases. It was complemented with barium enema and cystoscopy. Excision with immediate anastomosis was the surgical procedure used in 94 percent of patients, without sequelae or relapse, after a mean follow up of 74 months. No patient died during the procedure or required a new intervention. Conclusions: Colovesical fistulas are most common in young men with associated diseases and their treatment of choice, with good long-term results, is primary excision.

Antecedentes: El objetivo de este estudio es analizar los resultados del tratamiento quirúrgico de la Fístula Coló Vesical (FCV) de origen diverticular, los que se comparan con la enfermedad diverticular no fistulizada. Pacientes y Método: Análisis retrospectivo de todos los pacientes intervenidos por una FCV de origen diverticular en forma consecutiva. Resultados: De un total de 141 pacientes resecados por una enfermedad diverticular del colon sigmoides, la indicación quirúrgica en 27 (19,3 por ciento) fue la presencia de una fístula, de las cuales 18 corresponden a una FCV. El grupo con FCV tiene predominio de hombres (p = 0,0001), más joven (p = 0,027) y con mayor incidencia de enfermedades asociadas (p = 0,0001). La neumaturia se presentó en el 83 por ciento y la fecaluria en el 56 por ciento. En dos tercios de los casos la FCV se estableció en ausencia de una crisis diverticular previa. El estudio más relevante para demostrar la presencia de una FCV fue la tomografía computada (80 por ciento), que se complementa con el enema balitado y la cistoscopia. La resección con anastomosis inmediata, más simple sutura de la vejiga fue el procedimiento empleado en el 94 por ciento de los pacientes, sin secuelas ni casos de recidiva, con un seguimiento global promedio de 74,2 meses (extremos 12-158). No hubo reoperaciones ni mortalidad operatoria. Conclusiones: la FCV de origen diverticular es una condición patológica poco frecuente que afecta a pacientes varones en la séptima década de la vida, con múltiples enfermedades asociadas y que frecuentemente se instala en forma silenciosa. La resección primaria es el tratamiento de elección con buenos resultados a largo plazo.

Fístulas colovesicales: análisis de 7 casos / Colovesical fistula: report of 7 cases

Introducción: La fístula colovesical es una comunicación anormal entre vejiga e intestino grueso. Generalmente es secundaria a una enfermedad inflamatoria o neoplásica representando un desafío tanto diagnóstico como terapéutico. Material y método: Se revisaron en forma retrospectiva los pacientes intervenidos con el diagnóstico de fístula colovesical entre agosto de 1991 y mayo de 2006, registrando su distribución por sexo, edad, etiología, sintomatología, exámenes complementarios y tratamiento quirúrgico. Todos los pacientes se estudiaron mediante tomografía axial computada (TAC), cistoscopia y enema baritado. Resultados: Se revisaron 7 pacientes, hombre/mujer 4/3, con edad promedio de 60 años (rango 42-82). En 5 pacientes (71,5 por ciento) la fístula fue secundaria a una enfermedad diverticular complicada y en 2 casos (28,5 por ciento) a neoplasia de colon. La fecaluria y la neumaturia fueron los principales motivos de consulta. En 2 casos (28,5 por ciento) el motivo de consulta fue dolor pélvico, y 2 pacientes (28,5 por ciento) consultaron por infecciones urinarias. La cistoscopia mostró el orificio fistuloso en 4 de 7 pacientes (57,1 por ciento). El enema baritado mostró la fístula en 4 de7 casos (57,1 por ciento). La TAC fue diagnosticada en 5 de 7 casos(71,4 por ciento). En los 7 casos se efectuó una hemicolectomía izquierda más cistectomía parcial. El promedio de días de hospitalización fue de 9,7 días (rango 7-12) y no se registraron complicaciones posoperatorias ni mortalidad. Conclusiones: La fístula colovesical es una patología poco frecuente. Su principal etiología es la enfermedad diverticular complicada. Fecaluria y neumaturia son signos patognomónicos. La TAC es el examen diagnóstico de elección. El tratamiento es quirúrgico, y en la actualidad se recomienda la reparación en un tiempo operatorio.

Introduction: Colovesical fistula is an abnormal comunication between the bladder and the colon. Usually it is associated with inflammatory or neoplasic disease and its management remains a challenge Material and methods: Patients with colovesical fistula that underwent repair between 1991 and 2006 were analyzed. Age, sex, etiology, clinical and imaging findings were reviewed. All patients underwent CT scan with rectal contrast. Results: Out of 7 patients (4 male) with a mean age of 60 years (range 42-82), fistula was secondary to complicated colonic diverticula and colonic tumour in 5 (71.5 percent) and 2 (28.5 percent) respectively. Fecaluria and pneumaturia were the main complains. Two patients were seen for pelvis pain and another two for urinary infections. Cystoscopy allowed for fistula identification in 4 out of 7 patients (57.1 percent). Retrograde colonography was positive in 4 out of 7 cases. CT scan showed fistula in 5 of the 7 patients (71.4 percent). All patients underwent left colectomy and partial cystectomy. Mean hospital stay was 9.7 days (range 7 to 12) there were no postoperatory complications. Conclusion: Colovesical fistula is a rare occurrence. Its main etiology is colonic diverticular disease. Fecaluria and pneumaturia are pathognomonic. CT scan is the image modality of choice. Surgical treatment is always warranted and one time repair is currently advocated.

Laparoscopic repair of rectourethral fistulas after prostate surgery.

OBJECTIVES: To present our experience with laparoscopic rectourinary fistula (RUF) repair. RUF is a rare entity that can develop after ablative or extirpative prostate surgery. Successful management often requires an aggressive approach. Several techniques have been described for surgical correction. METHODS: From October 2004 to October 2005, 3 patients were treated for RUF. The mean age was 63 years (range 58 to 68). RUF developed after open simple prostatectomy, open radical prostatectomy, and transurethral prostate resection. The operative steps were dependent on the location of the fistulous tract (bladder-prostate-urethra). When the fistula involved the prostatic capsule, the technique included capsulectomy and urethrovesical anastomosis. When the bladder was involved, a transvesical approach was used, involving dissection of the fistulous tract, closure of the rectum, tissue interposition, and bladder closure. RESULTS: The mean operative time was 247 minutes (range 230 to 270). The mean hospital stay was 2.6 days (range 2 to 3). No complications occurred. At a mean follow-up of 12 months (range 7 to 19), all patients were free of fistula recurrence. CONCLUSIONS: Laparoscopic repair of RUF is feasible and represents an attractive alternative to the standard approaches. The laparoscopic technique facilitates concomitant colostomy and tissue interposition without the need for patient repositioning or an additional incision.

Diagnosis and management of colovesical fistulae; six-year experience of 90 consecutive cases.

INTRODUCTION: Colovesical fistulae are well-recognized but relatively uncommon presentation to colorectal surgery. As a result, few centres have sufficient experience in the investigation and surgical treatment of colovesical fistulae to develop clear protocols in its management. METHODS: This study examines the diagnostic and treatment pathways of 90 consecutive patients with colovesical fistulae presenting to a single surgeon, over a six-year period. Using the findings from this study and previously published data, the authors suggest tentative guidelines for the diagnosis and management of such patients. RESULTS: Pneumaturia and faecaluria were present in 90.1% of all cases. The diagnosis of colovesical fistula is predominately a clinical one, however, cystoscopy was the most accurate test to detect fistulae (46.2%) followed by barium enema (20.1%). Barium enema was the most sensitive test to detect stricture formation (70.6%). Colonic endoscopy was the most reliable means of excluding a colonic malignancy. The most common pathology was diverticular disease (72.2%), colonic carcinoma (15.3%) and Crohn's disease (9.7%). Left sided colonic resections were undertaken in 73.6% of patients, right hemicolectomy in 4.2% and defunctioning loop colostomies in 18.5%. Of the left sided resections, primary anastomosis was achieved in 92% of cases (n = 48) with one postoperative leak and no mortality. DISCUSSION: Resection and primary anastomosis should be the treatment of choice for colovesical fistulae, with an acceptable risk of anastomotic leak and mortality. Barium enema, colonic endoscopy and CT should be routine in the investigation of colovesical fistulae.

The spectrum of colovesical fistula and diagnostic paradigm.

BACKGROUND: Our experience with colovesical fistula (CVF) over a 12-year period was reviewed to clarify its clinical presentation and diagnostic confirmation. METHODS: Twelve patients with CVF were identified. Presenting symptoms, etiologic factors, diagnostic investigations, and subsequent treatment were reviewed. RESULTS: Underlying etiologies were diverticular disease (75%), colon cancer (16%), and bladder cancer (8%). Pneumaturia (77%) was the most common presentation, followed by urinary tract infections, dysuria and frequency (45%), fecaluria (36%), hematuria (22%), and orchitis (10%). The ability of various preoperative investigations to identify a CVF were: computed tomography (CT) (90%), barium enema (BE) (20%), and cystography (11%), whereas cystoscopy, intravenous pyelogram (IVP), and colonoscopy were nondiagnostic. All patients underwent single- or multiple-staged repair of the fistula. CONCLUSIONS: In patients with a suspected CVF, we recommend CT followed by a colonoscopy as a first-line investigation to rule out malignancy as a cause of CVF. Other modalities should only be used if the diagnosis is in doubt or additional information is needed to plan operative management.

Vesico-ileosigmoidal fistula caused by diverticulitis: report of a case and literature review in Japan.

Enterovesical fistula is a relatively uncommon complication of colorectal and pelvic malignancies, diverticulitis, inflammatory bowel disease, radiotherapy, and trauma in Asian countries. A case of vesico-ileosigmoidal fistula and a literature review of this disease in Japan are presented. A 70-yr-old male was referred with complaints of urinary pain and pneumaturia. On admission, urinary tract infection and pneumaturia were presented. A barium enema demonstrated multiple diverticulum in his sigmoid colon and the passage of contrast medium into the bladder and ileum. Under the diagnosis of vesico-ileosigmoidal fistula due to suspected diverticulitis of the sigmoid colon, sigmoidectomy and partial resection of the ileum with partial cystectomy were performed. The histopathology revealed diverticulosis of the sigmoid colon with diverticulitis and development of a vesico-ileosigmoidal fistula. No malignant findings were observed. Until the year 2000, a total of 173 cases of vesico-sigmoidal fistula caused by diverticulitis had been reported in Japan. Pneumaturia and fecaluria are the most common types, presenting symptoms in 63% of the cases. Computed tomography, with a sensitivity of 40% to 100%, is the most commonly used diagnostic study. For patients with vesico-sigmoidal fistula, resection of the diseased sigmoid colon and partial cystectomy with primary anastomosis are the safest and most acceptable procedures, leading to the best results.

Diagnosis and management of enterovesical fistulas in patients with Crohn's disease.

The objective of this study was to investigate the clinical manifestations and diagnostic studies used to evaluate Crohn's patients with enterovesical fistulas (EVFs) and to assess outcome after surgical intervention. This is a ten year multi-institutional retrospective chart review of patients with Crohn's disease. Of 400 patients identified with Crohn's disease eight (2%) were diagnosed with EVF. The mean age at diagnosis was 27 years. No patients had prior surgeries for Crohn's. Duration of symptoms ranged from 6 months to 15 years. There were seven ileovesical and one colovesical fistula identified. One patient had associated perianal disease. Three had concomitant enteroenteral fistulae. Clinical features included pneumaturia in seven patients (88%), fecaluria in three (38%), hematuria in five (63%), and urinary tract infection symptoms in seven (88%). Diagnostic studies included CT scan in six, barium or gastrografin enema in four, and cystoscopy in four. Surgical therapy involved resection of the affected bowel. The bladder defect was closed primarily in two layers in all patients using absorbable suture, with omental patch in four. Two patients underwent ileostomy and one underwent colostomy, all taken down within 6 months. There were no bladder leaks and no anastamotic leaks. There were no perioperative deaths. The mean postoperative stay was nine days. The mean follow-up was 39 months. We conclude that pneumaturia is a strong clinical indicator of EVF. CT has been valuable in identifying gas within the bladder in these patients. Cystoscopy has proven useful in identifying the fistulous tract and in evaluation of the ureters. The presence of an EVF should heighten suspicion as to the presence of concomitant enteroenteral fistulae. Barium or gastrografin studies are useful in this capacity. Surgical treatment of EVFs should include resection of affected bowel. The bladder defect can safely be closed using absorbable suture.

[Dermoid cyst with thyroid follicle perforated into bladder and ileum: a case report].

A 64-year-old woman was admitted to our hospital on August 19, 1996 with the chief complaint of microscopichematuria. A solid mass was found in her lower abdomen. An abdominal CT scan suggested a large intrapelvic cystic mass and the existence of a fistulous connection between the mass and the small intestine. The existence of a fistula was confirmed by a preoperative barium enema and a cystscopic study. On September 25, 1996, a suprapubic partial cystectomy and total hysterectomy were performed since an intrapelvic abscess was suspected. The cystic mass was observed to adhere to the hollow viscus (uterus, rectum, appendix, ileum and bladder). As a result a part of the ileum and bladder were also removed with the mass. The contents of the cyst included a foul smelling gas and white-green pus. Using a probe, we found two fistulous openings to the ileum and bladder. The histopathological findings indicated a dermoid cyst of the left ovary with thyroid follicles, which are known as "Struma ovarii".

Appendico-ileo-vesical fistula.

Appendico-vesical fistula is a rare condition. In total, 109 cases, most secondary to appendicitis, have been reported in the English-language literature. We report the first case, to our knowledge, of appendico-ileo-vesical fistula secondary to appendiceal diverticulitis. An enterovesical fistula was diagnosed by urine culture, cystoscopy, and computed tomography. The locations of enteric opening sites were demonstrated by barium enema and colonoscopy. Ileocecal resection and fistulectomy with primary reconstruction were performed. We believe that accurate pre- and intra-operative diagnosis is essential for cure. This case demonstrates the importance of barium enema and colonoscopic examinations in the diagnosis and treatment of complicated enterovesical fistula.

Diagnóstico y manejo de las fistulas vesicocolonicas / Diagnosis and management of vesicocolonic fistulae

En el período que va desde enero de 1993 a diciembre de 1996, se estudian 10 pacientes con fístula vesicocolónica secundaria a diverculitis ( 5 casos), cáncer de colon ( 2 casos), iatrogenia ( 2 casos) y dudoso ( 1 caso). Los síntomas de presentación fueron neumaturia, fecaluria, disuria e infección urinaria. Los exámenes complementarios para el diagnóstico fueron: cultivos de orina, cistografía, colon por enema , urograma exctretor, cistoscopia , fibrocolonoscopia, rectosigmoidescospia y TAC (tomogtafía axial computada). Entre ellos, los más concluyentes y efectivos para el diagnóstico de fístula vesicocolónica resultaron el cultivo fde orina, la cistografía y el colon por enema. El tratamiento en todos los casos fue la cirugía en todos los casos fue la cirugía en un tiempo con resección de la fístula y del segmento de colon afectado, la anastomosis terminoterminal del colon y el cierre simple de la pared de la vejiga. No se registraron recidivas de las fístulas durante el tiempo de observación del estudio

Diagnóstico y manejo de las fistulas vesicocolonicas / Diagnosis and management of vesicocolonic fistulae

En el período que va desde enero de 1993 a diciembre de 1996, se estudian 10 pacientes con fístula vesicocolónica secundaria a diverculitis ( 5 casos), cáncer de colon ( 2 casos), iatrogenia ( 2 casos) y dudoso ( 1 caso). Los síntomas de presentación fueron neumaturia, fecaluria, disuria e infección urinaria. Los exámenes complementarios para el diagnóstico fueron: cultivos de orina, cistografía, colon por enema , urograma exctretor, cistoscopia , fibrocolonoscopia, rectosigmoidescospia y TAC (tomogtafía axial computada). Entre ellos, los más concluyentes y efectivos para el diagnóstico de fístula vesicocolónica resultaron el cultivo fde orina, la cistografía y el colon por enema. El tratamiento en todos los casos fue la cirugía en todos los casos fue la cirugía en un tiempo con resección de la fístula y del segmento de colon afectado, la anastomosis terminoterminal del colon y el cierre simple de la pared de la vejiga. No se registraron recidivas de las fístulas durante el tiempo de observación del estudio(AU)

Vesico-colic fistulae in the Grampian region: presentation, assessment, management and outcome.

Over a 12-year period, 67 patients presented with a vesico-colic fistula. The mean age was 69 years (range 19-96 years), with symptoms predominantly referred to the urinary tract. Cystoscopy and barium enema confirmed the presence of a fistula in 60 and 44% of patients respectively. A computerized tomography (CT) scan, used in only seven patients, revealed the fistula in each case. The underlying pathology included diverticular disease (62%), carcinoma (27%) and inflammatory bowel disease (6%). Fifty-one patients proceeded to surgery, of whom 32 (63%) had a sigmoid/recto sigmoid resection with primary anastomosis, and 13 (25%) a Hartmann's procedure. A diverting colostomy alone was employed to palliate cases of widespread carcinoma. No patient subsequently had the Hartmann's reversed. In addition to colonic resection, 48 (92%) patients had a simultaneous bladder procedure, varying from simple oversew in 32 (70%) patients to cystectomy and ileal conduit in three (6%). Wedge excision with primary bladder closure was practised in 12 (24%). Fistula recurrence occurred in seven (14%) patients, and the 30-day mortality was 10%. Surgery for vesico-colic fistula has an appreciable morbidity and mortality, yet if offers the only hope of achieving permanent symptomatic control.

Laparoscopic diagnosis of appendicovesical fistula in a pediatric patient.

Appendicovesical fistula is a rare complication of acute appendicitis in children that is difficult to diagnose preoperatively. A 21-month-old boy with signs and symptoms of recurrent urinary tract infections underwent abdominal ultrasonography, computed tomography (CT), barium enema examination, and cystography, none of which was sufficient to establish a diagnosis; an appendicovesical fistula was demonstrated by laparoscopy. The patient underwent open appendectomy, with resection of the fistula through a small incision, and has recovered without complications.