Internal fistulas in diverticular disease

Woods, Rodney; Lavery, Ian C.; Fazio, Victor W.; Jagelman, David G.; Weakley, Frank L.

doi:10.1007/bf02556792

Cited by 243 publications

(143 citation statements)

References 24 publications

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“…[3][4][5][6] Colonoscopy and cytoscopy, including biopsy, are essential procedures for making differential diagnoses between malignancy and benignity but are of limited diagnostic value in showing fistulas. 2,5 Magnetic resonance imaging shows high tissue specificity and has proved highly sensitive for both detecting fistulas and investigating their morphologic characteristics. 7,8 Its expense and comparative difficulty of use are its greatest weaknesses as a first modality.…”

Section: Discussionmentioning

confidence: 99%

Vesicosigmoidal Fistula

Fujii

Moriguchi

Taniguchi

2010

Journal of Ultrasound in Medicine

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vesicosigmoidal fistula (VSF), a pathologic communication between the urinary bladder and the sigmoid colon, is a relatively rare condition with various causes, such as trauma, inflammation, and malignancy. Vesicosigmoidal fistulas account for about half of the fistulas resulting from diverticulitis. Most patients with a VSF present with urinary tract symptoms, including urinary urgency, dysuria, pneumaturia, and fecaluria. Recurrent urinary tract infections in an elderly man should increase suspicion. Despite the presence of obvious symptoms, the diagnosis of a VSF can be difficult to establish conclusively. To date, the diagnosis of a VSF remains a challenge without a reference standard. We encountered a case of a VSF due to sigmoid diverticulitis in which abdominal sonography helped us make a very early diagnosis. To the best of our knowledge, the sonographic findings of a VSF have not been reported in English previously. Case ReportA 60-year-old man with poorly controlled diabetes mellitus (hemoglobin A1c value of 9.5%) was admitted after having painful muscle cramps in the lower limbs. Heat cramps and a urinary tract infection were soon diagnosed. Although he had a remission of the muscle cramping for a few days, fecaluria and dysuria, which he had for a few months, persisted. He had no history of abdominal trauma or sigmoidal diverticulitis. Physical examination revealed slight tenderness in the center of the lower abdomen. No abdominal masses were palpable. In the laboratory tests, leukocytosis (10,000-20,000/µL), elevation of his C-reactive protein level (3.0-5.0 mg/dL), and leukocyturia were persistently found. A urine culture revealed more than 10 4 /mL of Escherichia coli. Although appropriate antibiotics for treating this bacterium were administered, both the leukocyturia and the urinary symptoms remained.

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Section: Discussionmentioning

confidence: 99%

Vesicosigmoidal Fistula

Fujii

Moriguchi

Taniguchi

2010

Journal of Ultrasound in Medicine

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“…1 The most common type of fistula is a colovescical fistula arising from the sigmoid colon. 2 Although rare, development of a colocolic fistula can occasionally occur. 2 We report on a rare case of a sigmoidocecal fistula leading to bacterial overgrowth with colonic pseudo-obstruction.…”

Section: Introductionmentioning

confidence: 99%

A Case of Colonic Pseudoobstruction Related to Bacterial Overgrowth Due to a Sigmoidocecal Fistula

Chung

Lim

Hong

et al. 2014

Korean J Gastroenterol

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Colocolic fistulas are usually a complication of an inflammatory or neoplastic process. Development of these abnormal bowel communications may lead to bacterial overgrowth. We report on a 71-year-old man with a one-year history of recurrent abdominal distension and irregular bowel habits. Abdominal X-rays and computed tomography showed multiple air-fluid levels and loops of distended bowel without evidence of mechanical obstruction or diverticulitis. Colonoscopy showed a fistulous tract between the sigmoid colon and cecum. Results of a lactulose breath test showed high fasting breath CH4 levels, which were thought to be the result of intestinal bacterial overgrowth. The patient was diagnosed with a colonic pseudo-obstruction associated with bacterial overgrowth due to a sigmoidocecal fistula. We recommended surgical correction of the sigmoidocecal fistula; however, the patient requested medical treatment. After antibiotic therapy, the patient still had mild symptoms but no acute exacerbations. (Korean J Gastroenterol 2014;63:125-128)

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“…In this report, we present a patient with colonic diverticular disease Type III according to Hinchey classification mimicking subcutaneous abscess and despite effective antiinflammatory therapy and drainage resulting colocutanous fistula. However, internal fistulas of diverticular diseases are well-defined in literature, colocutaneous fistulas well not documanted after percutane drainage of a cutanous abscess [1][2][3].…”

mentioning

confidence: 99%

Colocutanous fistula after percutanous drainage in a patient with diverticular disease

Yıldırım¹,

Yakan²

2017

Surg Rehabil

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We would like to draw readers attention to colocutanous fistulas,notable rare in this letter. In this report, we present a patient with colonic diverticular disease Type III according to Hinchey classification mimicking subcutaneous abscess and despite effective antiinflammatory therapy and drainage resulting colocutanous fistula. However, internal fistulas of diverticular diseases are well-defined in literature, colocutaneous fistulas well not documanted after percutane drainage of a cutanous abscess [1][2][3].A 63-year-old man with a faecal fistula in the left lower anterior abdominal region was admitted to our Department of Surgery. The patient's chief complaint is abdominal pain and low-output fecal purulent discharge from a fistula tract (Figure 1). Three days before presentation, the patient was felt colicky pain in the lower left abdominal quadrant. After the pain persisted and, on the following day, it intensified and was accompanied by a recorded fever of 38 º C. He has not noted any changes in his bowel movements. The patient has not taken any medication for the abdominal pain.His past medical history included diabetes mellitus, and no significant any disease. He had percutaneous drainage with the diagnosis of subcutanous abscess 28 days ago in an Invaziv Radiology Section of a different hospital. CT showed peridiverticular abscess formation sprawling into the rectus abdominis muscle and subcutanous planes.With these imaging findings in hand, we considered a colocutaneous fistula triggered by percutaneous drainage of an abscess originated perforated diverticular disease. As a result,we performed laparotomy which revealed a mass that sigmoid colon herniation originating from a inflamed diverticulitis through the posterior rectus sheath in the left lower abdominal wall and cutaneous fistula formation. We reduced the mass containing inflamed colon segment, and performed segmenter colon resection with end-to-end colocolic anastomosis. We curetted fistula tract, and sutured the posterior fascia of the rectus muscle. The patient was discharged on the 7 th postoperative day of the surgery. At followup examination after three months the patient was in good condition. Histologic examination of the speciman showed no malignancy.In our view,differential diagnosis is an important entity for abdominal skin abscess. We think that, surgical resection of fistulised segment is reserved for those Grade III diverticulitis. Drainage with imaging studies must be applied to prevent unwanted local and systemic complications.

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Internal fistulas in diverticular disease

Cited by 243 publications

References 24 publications

Vesicosigmoidal Fistula

Vesicosigmoidal Fistula

A Case of Colonic Pseudoobstruction Related to Bacterial Overgrowth Due to a Sigmoidocecal Fistula

Colocutanous fistula after percutanous drainage in a patient with diverticular disease

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