RESUMEN
A G4P4 woman in her 30s with a type II vesicouterine fistula, as defined by the Jozwik classification system, presented with symptoms of menouria, vaginal menses and urinary incontinence 8 years after caesarean delivery, the time of probable origination of the fistula tract. Transvaginal ultrasound identified a fistula tract communicating between the bladder and uterus, a rare finding that many years remote from caesarean delivery. Traditional surgical technique includes laparoscopic, abdominal and endoscopic methods of repair, sometimes using a transvesical approach. Transvesical repair can be associated with subsequent inpatient hospital stays and prolonged catheterisation. Our technique proposes a transvaginal surgical approach as an outpatient procedure with decreased operating time (40 min), postoperative pain and catheterisation requirement. It is the authors' belief that a transvaginal approach is less invasive and allows for better preservation of the uterus for future pregnancies and vaginal deliveries, as desired by the patient.
Asunto(s)
Fístula de la Vejiga Urinaria , Enfermedades Uterinas , Humanos , Femenino , Adulto , Fístula de la Vejiga Urinaria/cirugía , Fístula de la Vejiga Urinaria/etiología , Enfermedades Uterinas/cirugía , Cesárea/efectos adversos , Cesárea/métodos , Fístula/cirugía , Fístula/diagnóstico por imagen , Vagina/cirugía , Resultado del TratamientoRESUMEN
Withdrawal: Harkiran Narang, Surindra Maharaj, Unsuspected late presentation of post cesarean section vesico-peritoneal fistula, International Journal of Gynecology & Obstetrics, 17th April 2023, Volume 162, Issue 1, https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.14789. The above article, published online on 17th April 2023, on Wiley Online Library (https://doi.org/10.1002/ijgo.14789) and in Volume 162, Issue 1, has been withdrawn by agreement between the authors, Harkiran Narang and Surindra Maharaj, the Editor-in-Chief Michael Geary, the International Federation of Gynecology and Obstetrics, and John Wiley & Sons Ltd. The article has been withdrawn because the required consent for publication of a research's subject's case is missing.
Asunto(s)
Cesárea , Humanos , Femenino , Cesárea/efectos adversos , Embarazo , Enfermedades Peritoneales/etiología , Complicaciones Posoperatorias/etiología , Adulto , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/cirugíaRESUMEN
Enterovesical fistula (EVF) in Crohn's disease (CD) often does not improve with medical treatment and requires surgical treatment. The surgical treatment strategy for EVF in CD is definitive resection of the intestinal tract side, and performing a leak test using dye injection into the bladder after EVF dissection to determine the appropriate surgical procedure for the bladder side. This study aimed to evaluate the outcomes of surgical treatment for EVF in CD. Twenty-one patients who underwent surgery for EVF between 2006 and 2021 were included and retrospectively evaluated for clinical background, surgical procedures, and postoperative complications. The most common origin of EVF was the ileum (17 cases; 81%), and the most common site of EVF formation was the apex (12; 57%). Surgical approaches were laparotomy in 11 (52%) cases and laparoscopy in 10 (48%). Surgical procedures on the bladder side were fistula dissection in 13 (62%) cases and sutured closure of fistula in 8 (38%). A comparison of approaches revealed no significant difference in operative time, but the amount of blood loss was significantly less in the laparoscopy (p < 0.01). There was no significant difference in the occurrence of postoperative complications between approaches. Postoperative anti-TNF-α antibody agents were used in 17 (81%) cases, and there were no cases of recurrent EVF. In conclusion, definitive resection of the intestinal tract and minimal treatment on the bladder side were sufficient to achieve satisfactory outcomes for EVF in CD.
Asunto(s)
Enfermedad de Crohn , Fístula Intestinal , Fístula de la Vejiga Urinaria , Humanos , Enfermedad de Crohn/cirugía , Enfermedad de Crohn/complicaciones , Masculino , Femenino , Adulto , Fístula Intestinal/cirugía , Fístula Intestinal/etiología , Persona de Mediana Edad , Estudios Retrospectivos , Fístula de la Vejiga Urinaria/cirugía , Fístula de la Vejiga Urinaria/etiología , Resultado del Tratamiento , Complicaciones Posoperatorias , Adulto Joven , Laparoscopía/métodos , Adolescente , Laparotomía/métodos , Laparotomía/efectos adversos , AncianoRESUMEN
BACKGROUND: Ileoanal pouch is a demanding procedure with many potential technical complications including bladder or ureteral injury, while inflammation or stricture of the anastomosis or anal transition zone may lead to the formation of strictures and fistulae, including to the adjacent urethra. Pouch urinary tract fistulae are rare. We aimed to describe the presentation, diagnostic workup, and management of patients with pouch urinary at our center. METHODS: Our prospectively maintained pouch registry was queried using diagnostic codes and natural language processing free-text searches to identify ileoanal pouch patients diagnosed with any pouch-urinary tract fistula from 1997 to 2022. Descriptive statistics and pouch survival using Kaplan-Meier curves are presented. Numbers represent frequency (proportion) or median (range). RESULTS: Over 25 years, urinary fistulae were observed 27 pouch patients; of these, 16 of the index pouches were performed at our institution [rate 0.3% (16/5236)]. Overall median age was 42 (27-62) years, and 92.3% of the patients were male. Fistula locations included pouch-urethra in 13 patients (48.1%), pouch-bladder in 12 patients (44.4%), and anal-urethra in 2 (7.4%). The median time from pouch to fistula was 7.0 (0.3-38) years. Pouch excision and end ileostomy were performed in 12 patients (bladder fistula, n = 3; urethral fistula, n = 9), while redo ileal pouch-anal anastomosis (IPAA) was performed in 5 patients (bladder fistula, n = 3; urethral fistula, n = 2). The 5-year overall pouch survival after fistula to the bladder was 58.3% vs. 33.3% with urethral fistulae (p = 0.25). CONCLUSION: Pouch-urinary tract fistulae are a rare, morbid, and difficult to treat complication of ileoanal pouch that requires a multidisciplinary, often staged, surgical approach. In the long term, pouches with bladder fistulae were more likely to be salvaged than pouches with urethral fistulae.
Asunto(s)
Reservorios Cólicos , Complicaciones Posoperatorias , Fístula Urinaria , Humanos , Masculino , Adulto , Femenino , Persona de Mediana Edad , Reservorios Cólicos/efectos adversos , Fístula Urinaria/etiología , Fístula Urinaria/cirugía , Complicaciones Posoperatorias/etiología , Factores de Tiempo , Sistema de Registros , Estudios Prospectivos , Proctocolectomía Restauradora/efectos adversos , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/cirugía , Estimación de Kaplan-MeierRESUMEN
Appendicovesical fistula is a rare complication associated with appendicitis, Crohn's disease, or appendiceal tumors, posing significant diagnostic challenges. We reported a pediatric case of appendicovesical fistula that remained undiagnosed by non-contrast computed tomography, fluoroscopic voiding cystourethrography (VCUG). Although identified during cystoscopy, its connection to the fistula site could not be determined. However, the transvesical contrast-enhanced ultrasound clearly demonstrated the presence of fistula. Subsequently, laparoscopic appendectomy and bladder repair were performed successfully, leading to complete recovery in the patient. To our knowledge, this is the first reported diagnosis of appendicovesical fistula in children using contrast-enhanced ultrasound.
Asunto(s)
Medios de Contraste , Ultrasonografía , Fístula de la Vejiga Urinaria , Humanos , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/diagnóstico por imagen , Fístula de la Vejiga Urinaria/cirugía , Ultrasonografía/métodos , Masculino , Apéndice/diagnóstico por imagen , Enfermedades del Ciego/diagnóstico por imagen , Enfermedades del Ciego/etiología , Enfermedades del Ciego/cirugía , Niño , Apendicectomía/efectos adversos , Apendicitis/diagnóstico por imagen , Apendicitis/cirugíaRESUMEN
Bladder stones represent approximately 5% of all cases of urolithiasis and are typically identified and managed long before causing irreversible renal injury. We present a case of a man in his 40s with a prior history of a gunshot wound to the abdomen who presented with leakage from a previously healed suprapubic tube tract and was found to have a giant bladder stone with a resulting renal injury. He subsequently underwent a combined open cystolithotomy and vesicocutaneous fistulotomy during his hospitalisation, which helped to improve his renal function. In addition to there being few reported cases of bladder stones >10 cm, this represents the first report in the literature of an associated decompressive 'pop-off' mechanism through a fistulised tract.
Asunto(s)
Fístula Cutánea , Cálculos de la Vejiga Urinaria , Heridas por Arma de Fuego , Humanos , Masculino , Cálculos de la Vejiga Urinaria/diagnóstico , Cálculos de la Vejiga Urinaria/cirugía , Cálculos de la Vejiga Urinaria/diagnóstico por imagen , Fístula Cutánea/etiología , Fístula Cutánea/cirugía , Fístula Cutánea/diagnóstico , Adulto , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/cirugía , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/diagnóstico , Fístula de la Vejiga Urinaria/cirugíaRESUMEN
Successful surgical management of a chronic complex abdominal fistula requires thoughtful pre-operative evaluation and planning and often benefits from a multi-disciplinary approach. Initially, attention is focused on controlling sepsis and ensuring adequate hydration and electrolyte replacement. Next, efforts to optimize nutrition and engage the patient in prehabilitation are prioritized. Simultaneously, imaging is used to gain detailed assessment of anatomy. We present a challenging case involving a Jackson-Pratt (JP) drain from prior surgery causing a complex intra-abdominal fistula. The JP drain traversed multiple small bowel loops and the sigmoid colon before terminating in the bladder. Management required multi-disciplinary coordination involving colorectal surgery and urology. The patient's definitive surgery included anterior resection, colostomy takedown, right colectomy, three small bowel resections, and bladder repair. The use of JP drains after abdominal surgery is not without risk. Clinicians should have standardized indications for placement of JP drains and consistent protocols regarding timing of removal.
Asunto(s)
Fístula Intestinal , Humanos , Fístula Intestinal/cirugía , Fístula Intestinal/etiología , Pared Abdominal/cirugía , Masculino , Intestino Delgado/cirugía , Fístula de la Vejiga Urinaria/cirugía , Fístula de la Vejiga Urinaria/etiología , Persona de Mediana Edad , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Drenaje/métodos , Colectomía/métodosRESUMEN
BACKGROUND: Ileal pouch-anal anastomosis (IPAA) is considered the preferred restorative surgical procedure for patients with ulcerative colitis and familial adenomatous polyposis requiring proctocolectomy. Unfortunately, postoperative leaks remain a complication with potentially significant ramifications. This study aimed to provide a comprehensive description of the evaluation, management, and outcomes of leaks after primary IPAA procedures. METHODS: Between 1995 and 2022, a total of 4058 primary IPAA procedures were performed at Cleveland Clinic. From a prospectively maintained pouch registry, we retrospectively reviewed the data of 237 patients who presented to the pouch center for management. Of these, 114 (3%) had undergone the index IPAA procedure at our clinic (de novo cases), whereas 123 patients had their index IPAA performed elsewhere. Data were missing for 43 patients, resulting in a final cohort of 194 patients. RESULTS: Our cohort had an average age of 41 years (range, 16-76) at the time of leak diagnosis. Overall, 55.2% were males, average body mass index was 24.4 kg/m2, and pain was the most prevalent presenting symptom (61.8%), followed by fever (34%). Leaks were confirmed through diagnostic testing in 141 cases, whereas 27.3% were detected intraoperatively. The most common initial diagnoses were pelvic abscess (47.4%) and enteric fistulas (26.8%), including cutaneous (9.8%), vaginal (7.2%), and bladder fistulas (3.1%). By location, leaks occurred at the tip of the "J" (52.6%), at the pouch-anal anastomotic site (35%), and in the body of the pouch (12.4%). A nonoperative management approach was initially attempted in 49.5% of cases, including antibiotic therapy, drainage, endoclip, and endo-sponge, with a success rate of 18.5%. Surgery was eventually required in 81.4% of patients, including (1) sutured or stapled pouch repair (52.5%), with diversion performed in 87.9% of these cases either before or during the salvage surgery; (2) pouch excision with neo-IPAA (22.7%), including 9 patients from the first group; and (3) pouch disconnection, repair, and reanastomosis (9.3%). Pouch failure occurred in 8.4%, with either pouch excision (11.1%) or permanent diversion (4.5%). Ultimately, 12.4% of patients (24 of 194) required permanent diversion, with all necessitating pouch excision. In the 30-day follow-up after salvage surgery, short-term complications arose in 38.7% of patients. The most common complications observed were ileus, pelvic abscess/sepsis, and fever. CONCLUSION: Leaks after primary IPAA procedures represent an infrequent, yet challenging, complication. Despite attempts at nonoperative management, the success rate is limited. Salvage surgery is associated with a high pouch retention rate, underscoring its importance in the management of post-IPAA leaks.
Asunto(s)
Fuga Anastomótica , Colitis Ulcerosa , Reservorios Cólicos , Proctocolectomía Restauradora , Humanos , Femenino , Masculino , Adulto , Proctocolectomía Restauradora/efectos adversos , Proctocolectomía Restauradora/métodos , Persona de Mediana Edad , Fuga Anastomótica/etiología , Fuga Anastomótica/cirugía , Fuga Anastomótica/diagnóstico , Fuga Anastomótica/terapia , Estudios Retrospectivos , Reservorios Cólicos/efectos adversos , Adulto Joven , Adolescente , Colitis Ulcerosa/cirugía , Anciano , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Reoperación/estadística & datos numéricos , Reoperación/métodos , Poliposis Adenomatosa del Colon/cirugía , Fístula de la Vejiga Urinaria/cirugía , Fístula de la Vejiga Urinaria/etiología , Fístula Vaginal/cirugía , Fístula Vaginal/etiología , Fístula Urinaria/etiología , Fístula Urinaria/cirugía , Fiebre/etiologíaRESUMEN
Enterovesical fistula represents an abnormal communication between the intestine and bladder. The causes are diverticulitis (56.3%), malignant tumours, which are located mainly in the intestine (20.1%), and Crohn's disease (9.1%). Other causes include iatrogenic injury (3.2%); trauma; foreign bodies in the intestinal tract; radiotherapy; chronic appendicitis; tuberculosis; and syphilis. Normal vaginal delivery as a cause for enterovesical fistula has not been reported in many publications yet. We report a case of a 30-year-old female, who developed an jejunovesical fistula after normal vaginal delivery. It was diagnosed after diagnostic cystoscopy and computed tomography of the abdomen and pelvis. There was jejuno-vesical fistula. Resection of the segment of the jejunum with side-to-side anastomosis with bladder repair was done. A follow-up cystogram was done which showed no contrast extravasation into the peritoneum. The patient was followed up for 9 months after surgery. Keywords: case reports; fistula; jejunum; urinary bladder.
Asunto(s)
Enfermedad de Crohn , Fístula Intestinal , Fístula de la Vejiga Urinaria , Femenino , Humanos , Adulto , Embarazo , Fístula de la Vejiga Urinaria/diagnóstico , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/cirugía , Fístula Intestinal/diagnóstico , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Enfermedad de Crohn/complicaciones , Parto ObstétricoRESUMEN
AIM: Aim of the study to summarize the current information on diagnostic and treatment options for uterovesical fistula as a consequence of iatrogenic complication. Methods: Literature review of available information on surgical treatment options for uterovesical fistula resulting from previous caesarean section and comparison with our own experience in the developing world. Conclusion: Uterovesical fistula is an abnormal communication between the bladder and uterus. The cause of this pathology in most cases is an iatrogenic complication, most commonly arising after a caesarean section. The incidence of this pathology varies significantly geographically. In developed countries, these fistulas are rather rare. On the other hand, in developing countries, uterovesical fistulas are more common with a significant impact on the subsequent life of the patient due to generally inaccessible health care.
Asunto(s)
Fístula , Fístula de la Vejiga Urinaria , Enfermedades Uterinas , Embarazo , Humanos , Femenino , Cesárea/efectos adversos , Fístula de la Vejiga Urinaria/diagnóstico , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/cirugía , Fístula/diagnóstico , Fístula/etiología , Fístula/cirugía , Enfermedades Uterinas/diagnóstico , Enfermedades Uterinas/cirugía , África del Sur del Sahara/epidemiología , Enfermedad IatrogénicaAsunto(s)
Músculo Grácil , Fístula Rectal , Procedimientos Quirúrgicos Robotizados , Fístula de la Vejiga Urinaria , Fístula Urinaria , Masculino , Humanos , Músculo Grácil/cirugía , Fístula Rectal/etiología , Fístula Rectal/cirugía , Colgajos Quirúrgicos , Prostatectomía/efectos adversos , Fístula de la Vejiga Urinaria/cirugía , Fístula Urinaria/cirugíaRESUMEN
An enterovesical fistula is a rare entity resulting from inflammatory, neoplastic and iatrogenic processes. It can manifest clinically as pneumaturia and recurrent urinary tract infections. Its diagnosis is supported by imaging examinations and its treatment is primarily surgical.
Asunto(s)
Fístula Intestinal , Fístula de la Vejiga Urinaria , Infecciones Urinarias , Humanos , Catéteres Urinarios/efectos adversos , Infecciones Urinarias/complicaciones , Catéteres de Permanencia/efectos adversos , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Fístula de la Vejiga Urinaria/diagnóstico por imagen , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/cirugía , Enfermedad IatrogénicaRESUMEN
BACKGROUND: Entero-urinary fistulas (EUF) are a rare complication of Crohn's disease (CD), observed in 1.6 to 7.7%. The management of EUF complicating CD is challenging. We aimed to report the outcome and surgical management of EUF in CD. METHODS: A retrospective chart review was performed in all CD patients with EUF who underwent surgery in our center between January 2012 and December 2021. Patient demographics, preoperative optimization, surgical management, postoperative complications, and follow-up information were collected from a prospectively maintained database. RESULTS: A total of 74 eligible patients were identified. The median interval between CD diagnosis and EUF diagnosis was 2 (0.08-6.29) years. Patients with EUF presented with pneumaturia (75.68%), urinary tract infections (72.97%), fecaluria (66.22%), and hematuria (6.76%). Fistulae originated most commonly from the ileum (63.51%), followed by the colon (14.86%), the rectum (9.46%), the cecum (2.70%), and multiple sites (9.46%). The EUF symptoms, weight, nutritional status, laboratory results were significantly improved after preoperative optimization. The absence of EUF symptoms was observed in 42 patients after the optimization and only 9 of which required bladder repair. However, 19 of 32 patients whose symptoms did not resolve required bladder repair (P = 0.001). Only 1 patient developed a bladder leakage in the early postoperative period and 3 patients experienced recurrent bladder fistula. CONCLUSIONS: Surgical management of EUF complicating CD is effective and safe, with a low rate of postoperative complication and EUF recurrence. Preoperative optimization, which is associated with the resolution of urinary symptoms and improved surgical outcomes, should be recommended.
Asunto(s)
Enfermedad de Crohn , Fístula Intestinal , Fístula de la Vejiga Urinaria , Fístula Urinaria , Humanos , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/cirugía , Estudios Retrospectivos , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Fístula Urinaria/cirugía , Fístula Urinaria/complicaciones , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/cirugía , Fístula de la Vejiga Urinaria/diagnóstico , Complicaciones Posoperatorias/etiologíaRESUMEN
Colovesical fistula is commonly suspected in cases of diverticular disease, malignancy, trauma, iatrogenic injury or radiotherapy. In a case of allogenic live related transplant, this is rarely expected, especially after 20 years. The presence of gas in the bladder in the absence of history of instrumentation of urinary tract should prompt us to evaluate for colovesical fistula. Pneumaturia, faecaluria and recurrent urinary tract infection are tell-tale features of colovesical fistula, and when patients who are renal allograft recipient present with them, it should prompt a proper workup and swift surgical management, since the outcome is uniformly favourable. From our knowledge in this realm, we know that these are immunocompromised patients and have a high tendency to develop risk factors like malignancy and/or diverticular disease and eventually form colovesical fistula. An expected time period could be from 2 months to 6 years. But in our case, fistula formation occurred long after peak corticosteroid action, in the absence of conventional aetiologies.
Asunto(s)
Enfermedades Diverticulares , Fístula Intestinal , Trasplante de Riñón , Fístula de la Vejiga Urinaria , Humanos , Trasplante de Riñón/efectos adversos , Riñón , Fístula de la Vejiga Urinaria/diagnóstico por imagen , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/cirugía , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Enfermedades Diverticulares/complicaciones , AloinjertosRESUMEN
BACKGROUND: Blunt trauma to the urinary bladder is common with penetrating injury being a rare occasion. Most common entry pint for penetrating injuries includes buttock, abdomen and perineum with thigh being rare. There are a number of complications that may develop as a result of penetrating injury with vesicocutanous fistula being a rare occurrence that usually presents with typical sign and symptoms. CASE PRESENTATION: We present a rare case of penetrating bladder injury through medial upper thigh as an entry point that had complicated into vesicocutaneous fistula with atypical presentation of long-standing pus discharge that had been managed by incision and drainage several times with no success. MRI demonstrated a presence of fistula tract and a foreign body (piece of wood) in-situ confirmed the diagnosis. CONCLUSION: Fistulas are a rare complication of bladder injuries and can cause negative impact on the quality of life of patients. Delayed urinary tract fistulations and secondary thigh abscesses are uncommon therefore a high index of suspicion is needed for early diagnosis. This case emphasizes the importance of radiological tests in aiding the diagnosis and ultimately proper management.
Asunto(s)
Fístula Cutánea , Enfermedades de la Vejiga Urinaria , Fístula de la Vejiga Urinaria , Heridas Penetrantes , Humanos , Vejiga Urinaria/diagnóstico por imagen , Vejiga Urinaria/lesiones , Calidad de Vida , Fístula de la Vejiga Urinaria/diagnóstico por imagen , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/cirugía , Enfermedades de la Vejiga Urinaria/complicaciones , Pelvis/lesiones , Fístula Cutánea/diagnóstico por imagen , Fístula Cutánea/etiología , Fístula Cutánea/cirugía , Heridas Penetrantes/complicaciones , Heridas Penetrantes/diagnóstico por imagen , Heridas Penetrantes/cirugíaRESUMEN
Exstrophy variants are uncommon developmental anomalies of the bladder; the variants involving only the bladder neck are extremely rare. There are only three case reports of inferior vesical fissure (IVF) to date, and usually it's uncommonly associated with other malformations. A combination of inferior vesical fistula (IVF) as an exstrophy variant with urethral atresia and anorectal malformation has not been described previously. We report a case of IVF in a 4-year-old male previously operated for anorectal malformation who was managed with fistula closure with bladder neck reconstruction of lay open of stenosed urethra. Recognition of the exstrophy variant is important because the treatment and prognosis are very different.
Asunto(s)
Malformaciones Anorrectales , Extrofia de la Vejiga , Anomalías del Sistema Digestivo , Fístula de la Vejiga Urinaria , Masculino , Humanos , Preescolar , Vejiga Urinaria/cirugía , Vejiga Urinaria/anomalías , Extrofia de la Vejiga/cirugía , Extrofia de la Vejiga/complicaciones , Malformaciones Anorrectales/complicaciones , Fístula de la Vejiga Urinaria/cirugía , Uretra/cirugíaAsunto(s)
Fístula , Fístula de la Vejiga Urinaria , Enfermedades Uterinas , Embarazo , Humanos , Femenino , Cesárea/efectos adversos , Fístula de la Vejiga Urinaria/diagnóstico por imagen , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/cirugía , Fístula/etiología , Fístula/cirugía , PeritoneoRESUMEN
Enterovesical fistula in Crohn's disease that require surgery may be managed safely laparoscopically with similar morbidity to open repair and a shorter length of stay. Preoperative biologic exposure does not affect surgical morbidity.