Diagnostic lessons learnt from a series of enterovesical fistulae

Abstract

We recommend cystoscopy and urine cytology for faecal material as the first-line investigations in all patients with a suspected enterovesical fistulae. CT scanning and barium enema should not be first line investigations but may be performed subsequently to help determine the aetiology and planning of surgery.

Enterovesical Fistula Complicating Myomectomy: A Case Report

“…Majority of cases of colovesical fistula are from diverticular disease [6]. Other causes include colon cancer, crohn's disease, surgeries and actinomycosis [5] [6] [7] [8].…”

“…Pneumaturia, fecaluria and recurrent urinary tract infections are common methods of presentation in enterovesical fistula [5] [6]. Diagnosis of this disease is sometimes challenging and patients may be monitored for months before recognition of this disease [3].…”

A Rare Cause of Entero-Vesical Fistula Caused by a Skewer, Multidisciplinary Management and Minimally-Invasive Surgical Correction

“…Cystoscopy has the capability to identify potential but nonspecific lesions, such as erythema, oedema, and congestion. Even though cystoscopy can fail to detect EVf in 54-65 % of cases, its use is essential for the entire investigation process [4,6,28,29] . Considering that 10%-15% of colovesical fistulae are secondary to neoplasms, colonoscopy should be part of the diagnostic work-up of EVf in order to determine the bowel pathology responsible for the fistula formation [4,5,29] Cystography can demostrate the presence of contrast outside the bladder but may not a fistula [29] its detection rate for EVf ranges between 20% and 30% [30] .…”

“…EVf can be caused by embriological abnormalities, infections, inflammatory bowel diseases, tumours, trauma and iatrogenic lesions [3]. The most frequent cause is the diverticular disease (Dd), 2/3 of total cases [4][5][6][7] and about 2-4% of patient with Dd have an EVf [5][6][7][8][9][10] ,after surgical treatment this percentage increases to 20% [9]. In neoplasia EVf can be caused by the primitive tumour usually from the bowel tract and rarely from the urinary tract or can be caused after radiotherapy [11][12][13] .…”

“…At least there are FBs in the lower gastrointestinal tract like chicken bones and fish bones or Foley's catheter in the bladder. The clinical presentation of EVf is characterized by pneumaturia, fecaluria and, recurrent urinary tract infections [2,4,22,23]. Other symptoms are abdominal pain that occurs in the 40 % of patients and fever related with infections or inflammation [2,24,25].…”