Surgical protocol and outcome for sigmoidovesical fistula secondary to diverticular disease of the left colon: A retrospective cohort study

Abstract

Adequately performed CT followed by colonoscopy is the mainstay for diagnosis. Type 1 SVF should be treated in a single stage by complete resection and immediate anastomosis without a stoma. Type 2 cases are best managed in two stages while those with type 3 SVF are emergently managed by three stage procedure. Treatment of type 4 should be individualized.

Entero-vesical fistula revealed by recurrent urinary tract infection

“…However, limits of this method are the absence of characterization of the fistula. 6,7 Computed tomography is a satisfactory and reliable diagnosis study representing the modality of choice for diagnosis of enterovesical fistula, providing essential information about the adjacent anatomical structures and the underlying pathology causing the fistula thus guiding the therapeutic strategy. 2,7 Endoscopic procedures (cystoscopy and colonoscopy) are very helpful in entero-vesical fistula diagnosis and determination of the underlying pathology by providing the possibility obtain a tissue biopsy to rule out malignancy and should be part of entero-vesical fistula workup.…”

“…6,7 Computed tomography is a satisfactory and reliable diagnosis study representing the modality of choice for diagnosis of enterovesical fistula, providing essential information about the adjacent anatomical structures and the underlying pathology causing the fistula thus guiding the therapeutic strategy. 2,7 Endoscopic procedures (cystoscopy and colonoscopy) are very helpful in entero-vesical fistula diagnosis and determination of the underlying pathology by providing the possibility obtain a tissue biopsy to rule out malignancy and should be part of entero-vesical fistula workup. 1,2,7 Usually, Because of high pressure in the intestine, the fistula works from the intestine to the bladder except when there is an obstacle on the lower urinary tract, as was the case of our patient resulting in opacification of the intestine during cystography thus permitting diagnosis of entro-vesical fistula.…”

“…2,7 Endoscopic procedures (cystoscopy and colonoscopy) are very helpful in entero-vesical fistula diagnosis and determination of the underlying pathology by providing the possibility obtain a tissue biopsy to rule out malignancy and should be part of entero-vesical fistula workup. 1,2,7 Usually, Because of high pressure in the intestine, the fistula works from the intestine to the bladder except when there is an obstacle on the lower urinary tract, as was the case of our patient resulting in opacification of the intestine during cystography thus permitting diagnosis of entro-vesical fistula.…”

“…Surgical management became the preferred line of treatment with possibility of conservative approach in selected cases. 7 Means of Conservative approach include a trial of medical therapy as bowel rest, total parenteral nutrition, antibiotics, steroids, immunomodulatory drugs, and urethral catheter drainage. 2 Single stage surgery is actually the treatment of choice.…”

“…This entails resection of the diseased bowel segment, a partial cystectomy, primary bowel anastomosis and bladder wall repair followed by use of a Foley catheter for 1 week. 2,3,6,7 The old Staged procedure that entails initial colostomy, surgical repair and restoration of gastrointestinal continuity may be needed in cases with larges abscess or underlying malignancy. 2,3,7 As our case expose and as reported in previous series outcome of entero-vesical fistulae management is, in the majority of cases, excellent.…”