Enterovesical Fistulae: Aetiology, Imaging, and Management

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Abstract

Background and Study Objectives. Enterovesical fistula (EVF) is a devastating complication of a variety of inflammatory and neoplastic diseases. Radiological imaging plays a vital role in the diagnosis of EVF and is indispensable to gastroenterologists and surgeons for choosing the correct therapeutic option. This paper provides an overview of the diagnosis of enterovesical fistulae. The treatment of fistulae is also briefly discussed. Material and Methods. We performed a literature review by searching the Medline database for articles published from its inception until September 2013 based on clinical relevance. Electronic searches were limited to the keywords: “enterovesical fistula,” “colovesical fistula” (CVF), “pelvic fistula”, and “urinary fistula”. Results. EVF is a rare pathology. Diverticulitis is the commonest aetiology. Over two-thirds of affected patients describe pathognomonic features of pneumaturia, fecaluria, and recurrent urinary tract infections. Computed tomography is the modality of choice for the diagnosis of enterovesical fistulae as not only does it detect a fistula, but it also provides information about the surrounding anatomical structures. Conclusions. In the vast majority of cases, this condition is diagnosed because of unremitting urinary symptoms after gastroenterologist follow-up procedures for a diverticulitis or bowel inflammatory disease. Computed tomography is the most sensitive test for enterovesical fistula.

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Most cited references 70

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

Brian C Sutton, Zulqarnain I. Majid, Clare Pattenden … (2006)

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. 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. 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. 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.

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Enterovesical fistulas: diagnosis and management.

G Scozzari, A Arezzo, M Morino (2010)

Enterovesical fistula (EVF) is an abnormal communication between the intestine and the bladder. It represents a rare complication of inflammatory or neoplastic disease, and traumatic or iatrogenic injuries. The most common aetiologies are diverticular disease and colorectal carcinoma. Over 75% of affected patients describe pathognomonic features of pneumaturia, faecaluria and recurrent urinary tract infections. The diagnosis of EVF can be challenging, and frequently patients are monitored for months before the condition is recognised and treated effectively. Diagnostic tools include laboratory tests, imaging studies and endoscopic procedures. Although conservative management can be attempted in selected patients, in most cases, the treatment is mainly based on surgical interventions. Recently, the laparoscopic approach to EVF has been shown to be safe and effective. Although it is a rare condition in a general surgery setting, EVF is a challenging condition leading to high morbidity and mortality rates.

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Diagnosis and surgical management of colovesical fistulas due to sigmoid diverticulitis.

Sebastian Melchior, Dragan Cudovic, Jon Jones … (2009)

Diverticular disease of the colon is the most frequent cause of colovesical fistulas. In this study we evaluated the accuracy of different diagnostic procedures for the detection of colovesical fistula and the clinical outcome in a series of 49 patients who underwent surgery for colovesical fistula due to sigmoid diverticulitis. Between 1982 and 2007, 42 men and 7 women underwent surgery for colovesical fistula due to sigmoid diverticulitis. Preoperative diagnostic procedures included the poppy seed test, abdominopelvic computerized tomography, magnetic resonance tomography of the abdomen, cystogram, retrograde colonic enema, urethrocystoscopy and colonoscopy. All patients had urinary tract infections and dysuria. Pneumaturia and fecaluria, which are pathognomonic symptoms of colovesical fistula, were present in 71.4% and 51.0% of the patients (35 and 25 of 49), respectively. Colovesical fistula was correctly diagnosed by the poppy seed test in 94.6% (35 of 37 examined patients) compared to abdominopelvic computerized tomography in 61.0% (25 of 41), magnetic resonance tomography in 60.0% (3 of 5), cystogram in 16.7% (5 of 30), retrograde colonic enema in 35.7% (15 of 42), cystoscopy in 10.2% (5 of 49) and colonoscopy in 8.5% (4 of 47). Patients underwent resection of the fistulized bowel, single stage bowel anastomosis without protective colostomy and closure of the bladder defect. Postoperative morbidity was 8.2% (4 of 49) and mortality was 0%. During a median followup of 68 months there were no recurrent fistulas. In our series the poppy seed test had the highest sensitivity to detect colovesical fistulas. However, abdominopelvic computerized tomography, colonoscopy and cystoscopy are essential diagnostic procedures because the presence of colon or bladder cancer as an underlying cause of colovesical fistula will determine further therapy.

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Author and article information

Journal

Journal ID (nlm-ta): Gastroenterol Res Pract

Journal ID (iso-abbrev): Gastroenterol Res Pract

Journal ID (publisher-id): GRP

Title: Gastroenterology Research and Practice

Publisher: Hindawi Publishing Corporation

ISSN (Print): 1687-6121

ISSN (Electronic): 1687-630X

Publication date (Print): 2013

Publication date (Electronic): 21 November 2013

Volume: 2013

Electronic Location Identifier: 617967

Affiliations

¹Department of Urology, Collegium Medicum of the Jagiellonian University, Ulica Grzegorzecka 18, 31-531 Cracow, Poland

²Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Ulica Jaczewskiego 8, 20-954 Lublin, Poland

³Department of Endocrinology and Diabetes, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK

⁴Department of Radiology, Central Clinical Hospital Ministry of Interior in Warsaw, ul. Wolowska 137, 02-507 Warsaw, Poland

⁵The 1st Department of Urology, Postgraduate Medical Education Centre, European Health Centre in Otwock, ul. Borowa 14/18, 05-400 Otwock, Poland

Author notes

*Tomasz Golabek: elementare@ 123456op.pl

Academic Editor: Iwona Sudoł-Szopinska

Article

DOI: 10.1155/2013/617967

PMC ID: 3857900

PubMed ID: 24348538

SO-VID: 03f3be43-7d5a-4087-81d7-0d9553a1ccfb

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 3 September 2013

Date accepted : 29 October 2013

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