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Leng S, Ong WM, Mohd Rosli R, Fernando T, An V. Colovesical Fistula and Amyloidosis. Cureus 2025; 17:e80695. [PMID: 40242696 PMCID: PMC12000852 DOI: 10.7759/cureus.80695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2025] [Indexed: 04/18/2025] Open
Abstract
Systemic amyloidosis results from an abnormal deposition of toxic insoluble beta-sheet fibrillar protein in extracellular tissues, causing damage to multiple organ systems. Amyloid proteins (e.g., transthyretin, light chains, and serum amyloid A) may infiltrate the mucosa or vascular structures, resulting in gastrointestinal manifestations, including bleeding and diarrhoea. We discuss a case of a 71-year-old male with systemic immunoglobulin G kappa amyloid light chain amyloidosis who developed a colovesical fistula related to amyloid deposition.
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Affiliation(s)
| | - Wei Ming Ong
- Colorectal Surgery, Eastern Health, Melbourne, AUS
| | | | | | - Vinna An
- Colorectal Surgery, Eastern Health, Melbourne, AUS
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2
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Guha A, Gandhi S, Mynalli S, Baheti A, Haria P, Choudhari A, Desouza A, Saklani A, Shetty NS, Kulkarni S. A radiologist's guide to the galaxy of complications post total pelvic exenteration for rectal cancers. Clin Radiol 2025; 80:106719. [PMID: 39579393 DOI: 10.1016/j.crad.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 09/09/2024] [Accepted: 10/02/2024] [Indexed: 11/25/2024]
Abstract
Total pelvic exenteration (TPE) is a complicated morbid surgery with a patient having to cope with two permanent stomas lifelong. TPE is often the only option for potential cure that can be offered to patients with low/very low rectal cancers with multicompartment involvement. While the Clavien Dindo classification is used for clinically assessing the severity of complications, it does not guide making an imaging diagnosis (1). Radiologists are often unaware of the complications post-TPE surgery, what imaging modality to use, and how to diagnose these. The complications can be fatal if undiagnosed or misinterpreted and can be certainly managed with a good prognosis if promptly detected and treated (2). This article will focus on normal expected postoperative anatomy in the pelvis and perineum; with emphasis on recognition of signs that may aid in the diagnosis of complications in a bed of surgically altered anatomy. Systematic identification and evaluation of the various conduits and stomas; imaging appearances of normal and abnormal pelvic and perineal reconstruction techniques; and a patterned approach to the diagnosis of early and delayed complications post-TPE will be illustrated using a collection of cases.
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Affiliation(s)
- A Guha
- Department of Radio-diagnosis, Tata Memorial Hospital, Parel, Mumbai, 400012, India; Homi Bhabha National Institute, Anushakti Nagar, Trombay, 400094, India.
| | - S Gandhi
- Department of Radio-diagnosis, Tata Memorial Hospital, Parel, Mumbai, 400012, India; Homi Bhabha National Institute, Anushakti Nagar, Trombay, 400094, India
| | - S Mynalli
- Department of Radio-diagnosis, Tata Memorial Hospital, Parel, Mumbai, 400012, India; Homi Bhabha National Institute, Anushakti Nagar, Trombay, 400094, India
| | - A Baheti
- Department of Radio-diagnosis, Tata Memorial Hospital, Parel, Mumbai, 400012, India; Homi Bhabha National Institute, Anushakti Nagar, Trombay, 400094, India
| | - P Haria
- Department of Radio-diagnosis, Tata Memorial Hospital, Parel, Mumbai, 400012, India; Homi Bhabha National Institute, Anushakti Nagar, Trombay, 400094, India
| | - A Choudhari
- Department of Radio-diagnosis, Tata Memorial Hospital, Parel, Mumbai, 400012, India; Homi Bhabha National Institute, Anushakti Nagar, Trombay, 400094, India
| | - A Desouza
- Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India; Homi Bhabha National Institute, Anushakti Nagar, Trombay, 400094, India
| | - A Saklani
- Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India; Homi Bhabha National Institute, Anushakti Nagar, Trombay, 400094, India
| | - N S Shetty
- Department of Radio-diagnosis, Tata Memorial Hospital, Parel, Mumbai, 400012, India; Homi Bhabha National Institute, Anushakti Nagar, Trombay, 400094, India
| | - S Kulkarni
- Department of Radio-diagnosis, Tata Memorial Hospital, Parel, Mumbai, 400012, India; Homi Bhabha National Institute, Anushakti Nagar, Trombay, 400094, India
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Nigro N, Shahinyan G, Lin S, Bhalla RG, Flynn BJ. A comprehensive review of urinary tract fistulas: the evolution of etiologies, surgical techniques, and contemporary outcomes. Ther Adv Urol 2025; 17:17562872251317344. [PMID: 39936130 PMCID: PMC11811971 DOI: 10.1177/17562872251317344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 01/06/2025] [Indexed: 02/13/2025] Open
Abstract
Urinary tract fistulas (UTFs) are abnormal connections between the urinary tract and adjacent structures such as the bowel, vagina, or blood vessels. UTFs result in significant personal, social, and financial challenges to patients worldwide. This review investigates the various causes, risk factors, symptoms, and historical evolution of repair techniques of UTFs. This focuses on the shift from open surgery to minimally invasive techniques, particularly the growing utilization of robot-assisted laparoscopic (RAL) approaches. This review emphasizes the growing role of RAL surgery in treating UTFs, citing its advantages of reduced blood loss, low recurrence rates, and decreased postoperative complications while acknowledging challenges such as limited access to the RAL platform and longer surgical times. The study concludes with advocacy for more widespread access to the RAL platform as well as more research, including randomized controlled trials, to further refine the body of evidence and promote patient outcomes.
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Affiliation(s)
- Noah Nigro
- University of Colorado School of Medicine, 13001 E 17th Pl., Aurora, CO 80045-2581, USA
| | - Gary Shahinyan
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Shujian Lin
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Rohan G. Bhalla
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brian J. Flynn
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, USA
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Chiang TW, Chang LW, Chiang FF, Li JR, Hung SC. Colon Cancer With Bladder Invasion: A Single Center Experience. In Vivo 2024; 38:2990-3001. [PMID: 39477384 PMCID: PMC11535905 DOI: 10.21873/invivo.13782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 11/07/2024]
Abstract
BACKGROUND/AIM The aim of our study was to investigate the outcome of colon cancer with bladder invasion after surgical intervention. PATIENTS AND METHODS Between 2011 and 2022, a total of 41 patients diagnosed with colon cancer and bladder invasion underwent surgical procedures at Taichung Veterans General Hospital. The impact of various risk factors on overall survival (OS) was assessed using Kaplan-Meier analyses and Cox proportional hazards models. RESULTS Among the enrolled patients, 21 underwent radical cystectomy, while 20 underwent partial cystectomy. Twelve had tumors located in the rectum, 19 in the sigmoid colon, and 10 in both the rectum and sigmoid colon. The median OS was 71.8 months in stage 2, 50.8 months in stage 3, and 11.2 months in stage 4 (p=0.061). Median OS was 71.8 months in patients with negative surgical margins and 10.5 months in those with positive surgical margins (p=0.003). In multivariate regression analysis, positive surgical margins [hazard ratio (HR)=3.64, 95% confidence interval (CI)=1.28-10.34, p=0.015] and emergency operations (HR=4.57, 95%CI=1.34-15.55, p=0.015) significantly impacted OS. CONCLUSION Complete resection of colon cancer with bladder invasion can yield excellent oncologic outcomes. The decision between partial and radical cystectomy should balance surgical margin clearance and the preservation of quality of life. Both surgical margin involvement and emergency operations are independent risk factors for OS.
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Affiliation(s)
- Tzu-Wei Chiang
- Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- Division of Colorectal Surgery, Department of Surgery, Chiayi Branch, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Li-Wen Chang
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, R.O.C
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C
| | - Feng-Fan Chiang
- Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Jian-Ri Li
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, R.O.C
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C
- Department of Medicine and Nursing, Hungkuang University, Taichung, Taiwan, R.O.C
| | - Sheng-Chun Hung
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, R.O.C
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C
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Karimi A, Xiong J, Kaur J. Colovesical Fistula Surgically Managed With Delayed Computed Tomography Detection. Cureus 2024; 16:e74277. [PMID: 39717290 PMCID: PMC11666304 DOI: 10.7759/cureus.74277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2024] [Indexed: 12/25/2024] Open
Abstract
Colovesical fistula is the result of a pathologic connection between the bladder and colon. It can be a deadly sequela of a variety of conditions. Diagnosis is usually confirmed by a computed tomography (CT) scan of the abdomen. We present a case of a patient who had multiple CT scans that did not show signs of fistula and was still successfully treated. Clinicians should follow clinical signs for colovesical fistula and pursue treatment regardless of CT scan findings.
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Affiliation(s)
- Abraham Karimi
- Medical School, St. Joseph's Medical Center, Stockton, USA
- Medical School, Touro College of Osteopathic Medicine, Vallejo, USA
| | - Jay Xiong
- Internal Medicine, St. Joseph's Medical Center, Stockton, USA
| | - Jasleen Kaur
- Internal Medicine, St. Joseph's Medical Center, Stockton, USA
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Singh A, Khanna T, Mahendru D, Kahlon J, Kumar V, Sohal A, Yang J. Insights into renal and urological complications of inflammatory bowel disease. World J Nephrol 2024; 13:96574. [PMID: 39351187 PMCID: PMC11439091 DOI: 10.5527/wjn.v13.i3.96574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/01/2024] [Accepted: 07/15/2024] [Indexed: 09/19/2024] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic condition characterized by immune-mediated inflammation in the gastrointestinal tract, which follows a relapsing and remitting course. Apart from affecting the gastrointestinal tract, IBD also has extra-intestinal manifestations (EIMs). While the etiology of extraintestinal manifestation remains unclear, it is theorized to be based on immunological responses influenced by genetic factors. Renal involvement is one of the EIMs observed in ulcerative colitis and Crohn's disease. The renal manifestations in IBD patients encompass a range of conditions including nephrolithiasis, amyloidosis, tubulointerstitial nephritis, glomerulonephritis (GN), obstructive pathologies, and chronic kidney disease (CKD). The incidence of CKD in IBD patients varies from 5%-15%. The decline in renal function can stem from various factors such as direct inflammatory damage to the kidneys leading to glomerular or tubular injury, or from complications like recurrent stones, amyloidosis, or GN. Additionally, nephrotoxic medications used in treating IBD, such as TNF-α inhibitors, calcineurin inhibitors, and aminosalicylates, can exacerbate the decline in renal function. Currently, there is a lack of consensus regarding these patients' screening and renal function monitoring. This review aims to assess the existing literature on the different renal complications among individuals with IBD, shedding light on their pathophysiology and management.
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Affiliation(s)
- Anmol Singh
- Department of Medicine, Tristar Centennial Medical Center, Nashville, TN 37203, United States
| | - Tejasvini Khanna
- Department of Medicine, Maulana Azad Medical College, New Delhi 110002, India
| | - Diksha Mahendru
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
| | - Jasraj Kahlon
- Department of Internal Medicine, Abrazo Medical Center, Phoenix, AZ 85015, United States
| | - Vikash Kumar
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY 11201, United States
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, WA 98105, United States
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX 77555, United States
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Medina LG, Lee RA, Celis V, Rodriguez V, Poncel J, Sayegh AS, Sotelo R. Robotic management of urinary fistula. Asian J Urol 2024; 11:357-365. [PMID: 39139533 PMCID: PMC11318412 DOI: 10.1016/j.ajur.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/13/2023] [Indexed: 08/15/2024] Open
Abstract
Objectives To highlight critical preoperative and intraoperative considerations in approaching fistula repair robotically. Methods A search of the literature was conducted to identify relevant articles pertaining to robotic management of urinary fistulae. Results Fistulae of the genitourinary tract can be a challenging dilemma for urologists, as definitive management may require surgical intervention. Pathogenesis of both enteric and non-enteric fistulae are multifactorial, and successful repair hinges on the meticulous perioperative evaluation, planning, and execution. Traditional open techniques can subject patients to increased morbidity and prolonged hospitalizations. Since its introduction, the robotic surgical platform has continued to expand its indications. Its three-dimensional visualization and tremor free wristed instrument movements have made the robotic platform an attractive option for genitourinary fistula reconstruction. Conclusion Robotic management of complex urinary fistulae is feasible in expert hands; more studies are needed to define its role in the treatment algorithm of this devastating conditions.
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Affiliation(s)
- Luis G. Medina
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Randall A. Lee
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Valeria Celis
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Veronica Rodriguez
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jaime Poncel
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aref S. Sayegh
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rene Sotelo
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Hattori N, Nakayama G, Umeda S, Nakamura M, Yamamura T, Sawada T, Nakanishi K, Shimizu D, Kanda M, Hayashi M, Tanaka C, Kodera Y. Outcomes of surgical treatment for enterovesical fistula in Crohn's disease. NAGOYA JOURNAL OF MEDICAL SCIENCE 2024; 86:280-291. [PMID: 38962416 PMCID: PMC11219233 DOI: 10.18999/nagjms.86.2.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/05/2023] [Indexed: 07/05/2024]
Abstract
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.
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Affiliation(s)
- Norifumi Hattori
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Goro Nakayama
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinichi Umeda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsunaki Sawada
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koki Nakanishi
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Dai Shimizu
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masamichi Hayashi
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chie Tanaka
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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VanFleet AX, Kinkead Z, Daniel J, Derr C. Utilization of point-of-care ultrasound to evaluate for enterovesical fistula. Emerg Radiol 2024; 31:113-115. [PMID: 38030949 DOI: 10.1007/s10140-023-02192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
Enterovesical fistula formation is a relatively rare disease process although a common complication for patients with inflammatory bowel disease (IBD), notably Crohn's disease. Enterovesical fistulas most commonly arise from diverticulitis (65-80%), cancer (10-20%), or Crohn's disease (5-7%). An increasing amount of evidence supports the use of ultrasonography as the primary imaging method for the monitoring of complications in individuals with a documented history of IBD. Our case report presents a 30-year-old female with a history of Crohn's disease who presented to the Emergency Department with concern for possible enterovesical fistula formation. Using bedside gray-scale ultrasonography, a fistulous tract clearly visualizing air bubbles and fecal matter actively moving from bowel to the bladder through the fistula was visualized confirming the diagnosis of an enterovesical fistula. While CT imaging is instrumental in identifying mural and extramural complications of IBD, performing ultrasonography in patients with IBD serves as an efficient, inexpensive, and noninvasive diagnostic aid for the diagnosis of enterovesical fistula.
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Affiliation(s)
| | - Zoe Kinkead
- University of South Florida Emergency Medicine, Tampa, FL, USA
| | - Jeannez Daniel
- University of South Florida College of Medicine, Tampa, FL, USA
| | - Charlotte Derr
- University of South Florida Emergency Medicine, Tampa, FL, USA
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10
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Diamantidis D, Papatheodorou N, Kostoglou P, Tsakaldimis G, Botaitis S. Management of vesicoenteric fistulas arising from perforated Meckel's diverticulum: a report of a case and review of the literature. Oxf Med Case Reports 2024; 2024:omad155. [PMID: 38370499 PMCID: PMC10873693 DOI: 10.1093/omcr/omad155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 02/20/2024] Open
Abstract
Vesicoenteric fistulas are rare, with an incidence of 0.1%-0.2% in the general population, and Meckel's diverticulum is a rare cause, accounting for less than 5% of cases with challenging diagnosis due to atypical symptoms at the admission. This article presents a case of a vesicoenteric fistula formation between Meckel's diverticulum perforated by a foreign body and urinary bladder in a 38-years-old Caucasian male admitted to emergency department due to colicky abdominal pain located in the lower abdomen. An extensive review of the literature was conducted referring all the cases of vesicoenteric fistula incorporating Meckel's diverticulum to elucidate the clinical characteristics, explore the diagnostic yield, and to summarize the therapeutic approach.
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Affiliation(s)
- Dimitrios Diamantidis
- Department of Urology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Papatheodorou
- 1st General Surgery Department, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Panagiotis Kostoglou
- 1st General Surgery Department, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Tsakaldimis
- Department of Urology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Sotirios Botaitis
- 1st General Surgery Department, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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11
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Tang S, Li X, Guo D, Zhuo F. Positive outcomes with neoadjuvant chemotherapy in the management of colovesical fistula in cancer: a case report and literature review. Front Pharmacol 2024; 14:1284316. [PMID: 38298269 PMCID: PMC10828894 DOI: 10.3389/fphar.2023.1284316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/08/2023] [Indexed: 02/02/2024] Open
Abstract
Colovesical fistula (CVF) is usually developed from colonic diverticulitis, followed by tumor. Traditional surgery is usually completed in one or more stages. For complex cancerous CVF, radical resection is more difficult. We report a 62-year-old male patient diagnosed with sigmoid colon cancer combined with sigmoid vesical fistula. In the course of treatment, in addition to conventional surgery, neoadjuvant chemotherapy (NAC) was innovatively used. The sigmoid tumor and fistula were significantly shrunken. Radical surgery achieved negative margins.
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Affiliation(s)
- Song Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Xinjun Li
- Department of Oncological Surgery, Guangzhou Royallee Cancer Center, Guangzhou, Guangdong, China
| | - Donghua Guo
- Medical Imaging Unit, Guangzhou Royallee Cancer Center, Guangzhou, Guangdong, China
| | - Fan Zhuo
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
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12
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Yadav DK, Adhikari MB, Maharjan B, Mishra P, Shrestha PP. Jejunovesical Fistula Diagnosis After Normal Vaginal Delivery: A Case Report. JNMA J Nepal Med Assoc 2024; 62:58-61. [PMID: 38410006 PMCID: PMC10924501 DOI: 10.31729/jnma.8407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Indexed: 02/28/2024] Open
Abstract
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.
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Affiliation(s)
- Deepak Kumar Yadav
- Department of Urology and Kidney Transplant, Nepal Mediciti Hospital, Nakhkhu Patan, Karyabinayak, Lalitpur, Nepal
| | - Mahesh Bahadur Adhikari
- Department of Urology and Kidney Transplant, Nepal Mediciti Hospital, Nakhkhu Patan, Karyabinayak, Lalitpur, Nepal
| | - Bipin Maharjan
- Department of Urology and Kidney Transplant, Nepal Mediciti Hospital, Nakhkhu Patan, Karyabinayak, Lalitpur, Nepal
| | - Prashant Mishra
- Department of Urology and Kidney Transplant, Nepal Mediciti Hospital, Nakhkhu Patan, Karyabinayak, Lalitpur, Nepal
| | - Pramesh Prasad Shrestha
- Department of Urology and Kidney Transplant, Nepal Mediciti Hospital, Nakhkhu Patan, Karyabinayak, Lalitpur, Nepal
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13
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Dagnesses Fonseca JO, Teja García G, Luengo Batres P, Calvo Espino P. Iatrogenic enterovesical fistula secondary to a permanent urinary catheter. BMJ Case Rep 2023; 16:e257476. [PMID: 38056931 PMCID: PMC10711913 DOI: 10.1136/bcr-2023-257476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
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.
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Kwon AG, Brinzevich D, Borovik A, Bhalla R. Ileal conduit to small intestine fistula following extensive abdominopelvic resection and radiation for metastatic colon cancer. BMJ Case Rep 2023; 16:e254170. [PMID: 38056922 PMCID: PMC10711872 DOI: 10.1136/bcr-2022-254170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
A woman in her mid-60s presented with decreased output from urostomy, which was an opening from the neobladder (ileal conduit). Presentation was preceded by a 6-month history of alternating faecaluria and increased colostomy output. Laboratory studies were notable for normal anion gap metabolic acidosis. Creatinine level of the colostomy output was 17.7 mg/dL, a finding indicative of the presence of urine in the sample. CT enterography and X-ray loopogram confirmed neobladder to small intestine fistula.Neobladder creation is commonly performed in patients with bladder cancer requiring resection. Fistulas between the neobladder and intestine are observed in fewer than 2.7% of cases. The patient's history of extensive abdominopelvic resection, colostomy creation and radiation likely contributed to fistula development. We highlight the need for a high index of suspicion for a fistula in a patient with a neobladder experiencing recurrent urinary tract infections or a high colostomy output concurrently with low neobladder output.
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Affiliation(s)
- Alvin G Kwon
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Daria Brinzevich
- Hematology/Oncology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexander Borovik
- Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rakesh Bhalla
- Internal Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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15
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Chen Y, Cao L, Qiu J, Li Z, Guo Z, Zhu Z, Xu Y, Qian W, Zhu W, Li Y. Surgical Management and Outcome of Entero-Urinary Fistula Complicating Crohn's Disease: A Single Center Study. World J Surg 2023; 47:3365-3372. [PMID: 37775571 DOI: 10.1007/s00268-023-07196-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/01/2023]
Abstract
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.
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Affiliation(s)
- Yusheng Chen
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, NO. 305 East Zhongshan Road, Nanjing, 210002, People's Republic of China
| | - Lei Cao
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, NO. 305 East Zhongshan Road, Nanjing, 210002, People's Republic of China
| | - Jiayin Qiu
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Zhun Li
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, NO. 305 East Zhongshan Road, Nanjing, 210002, People's Republic of China
| | - Zhen Guo
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, NO. 305 East Zhongshan Road, Nanjing, 210002, People's Republic of China
| | - Zhenxing Zhu
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, NO. 305 East Zhongshan Road, Nanjing, 210002, People's Republic of China
| | - Yihan Xu
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, NO. 305 East Zhongshan Road, Nanjing, 210002, People's Republic of China
| | - Wenwei Qian
- Department of General Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, People's Republic of China
| | - Weiming Zhu
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, NO. 305 East Zhongshan Road, Nanjing, 210002, People's Republic of China.
| | - Yi Li
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, NO. 305 East Zhongshan Road, Nanjing, 210002, People's Republic of China.
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16
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Silva MM, Costa AB, Baptista CE. A Rare Case of Recurrent Cystitis in a Primary Care Setting. Cureus 2023; 15:e48914. [PMID: 38106770 PMCID: PMC10725319 DOI: 10.7759/cureus.48914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Uncomplicated cystitis is common in women and typically presents with symptoms such as increased urinary frequency, dysuria, suprapubic pain, and urgency. Escherichia coli is the most frequently identified pathogen in these cases. Colovesical fistulas constitute an uncommon etiology of recurrent urinary tract infections, and they are even rarer in women due to the protective barrier provided by the uterus. Faecaluria and pneumaturia are the pathognomonic symptoms of these types of fistulas that help differentiate them from recurrent cystitis. While the gold standard imaging is the abdominopelvic CT scan, in some instances, MRI may be necessary to identify fistulous tracts. This case report describes a scenario of recurrent urinary tract infection caused by a colovesical fistula, in a woman with a history of diverticular disease. In contrast to uncomplicated recurrent cystitis, the treatment of the fistula is surgical. The aim of this article is to raise awareness of this potential and rare cause of recurrent urinary tract infection encountered in a primary healthcare setting, in order to prevent the prescription of multiple cycles of ineffective antibiotic therapy in these patients and the consequent development of antimicrobial resistance, a global public health issue. Our intention is to alert general practitioners about the diagnosis of a rare cause of recurrent cystitis, the treatment of which is surgical and warrants referral to secondary care.
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Affiliation(s)
- Mariana M Silva
- Unidade de Saúde Familiar Cynthia, Regional Health Administration of Lisbon and Tagus Valley, Lisbon, PRT
| | - Ana B Costa
- Unidade de Saúde Familiar Cynthia, Regional Health Administration of Lisbon and Tagus Valley, Lisbon, PRT
| | - Carlos E Baptista
- Unidade de Saúde Familiar Cynthia, Regional Health Administration of Lisbon and Tagus Valley, Lisbon, PRT
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17
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Ponsiglione A, Campo I, Sachs C, Sofia C, Álvarez-Hornia Pérez E, Ciabattoni R, Sharaf DE, Causa-Andrieu P, Stanzione A, Cuocolo R, Zawaideh J, Brembilla G. Extraprostatic incidental findings on prostate mpMRI: A pictorial review from the ESUR junior network. Eur J Radiol 2023; 166:110984. [PMID: 37480649 DOI: 10.1016/j.ejrad.2023.110984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
The role of multiparametric MRI (mpMRI) in prostate cancer setting is increasingly consolidated and, as a result, its usage in clinical practice is in exponential growth. However, beyond the prostate gland, several key structures are included in the field of view of mpMRI scans. Consequently, various extra-prostatic incidental findings (IFs) belonging to different anatomical systems can be accidentally recognized. Therefore, it is mandatory for a radiologist to be familiar with the wide range of pathologies potentially encountered, to guide management and avoid patient anxiety and costs due to additional work-up prompted by clinically insignificant extra-prostatic findings. With this pictorial review, we aim to illustrate a wide range of IFs that can be detected when performing mpMRI of the prostate, focusing on their imaging characteristics, differential diagnosis, and clinical relevance. Additionally, we propose the CheckDEEP, the Checklist for DEtection of ExtraProstatic findings, to be used for a thorough evaluation of target areas within each anatomical system.
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Affiliation(s)
- Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Irene Campo
- Radiology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Camilla Sachs
- Department of Radiology, Ospedale Ca' Foncello, 31100, Treviso, Italy
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | | | - Riccardo Ciabattoni
- Department of Radiology, Ospedale San Salvatore di Pesaro, Azienda Sanitaria Territoriale Pesaro Urbino, Pesaro, Italy
| | - Doaa E Sharaf
- Department of Radiology, Urology & Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Jeries Zawaideh
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgio Brembilla
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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18
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Helberg T, Jackson BS, Brown K. Man With Suprapubic Catheter and Decreased Urine Output. Ann Emerg Med 2023; 82:e71-e72. [PMID: 37479414 DOI: 10.1016/j.annemergmed.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Travis Helberg
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Bradley S Jackson
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Kyle Brown
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS
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19
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Kunitsky KD, Cavayero C. Uretero-Colonic Fistula at a Previous Colon Anastomosis Site: A Case Report. Cureus 2023; 15:e40154. [PMID: 37431328 PMCID: PMC10329561 DOI: 10.7759/cureus.40154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/12/2023] Open
Abstract
Uretero-colonic fistulae are a rare disease resulting from pathologic connection between the ureter and colon, which can be difficult to diagnose. This case report reviews the case of an 83-year-old female with a history of ovarian cancer treated with surgery, radiation, and chemotherapy, who developed a uretero-colonic fistula at a previous colon anastomosis site, which was later diagnosed by ureteroscopy. She was treated with stent placement followed by loop colostomy and was discovered to have metastatic ovarian cancer. She received palliative care consultation and was advised to follow up as an outpatient with the oncology and urology services. Although uretero-colonic fistulae are treatable, treatment depends on patients' overall clinical picture.
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20
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Hsu MW, Chen WC, Wei TN, Huang CP. Management of Enterovesical Fistula in a Patient with Crohn's Disease: A Case Report and Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13091527. [PMID: 37174919 PMCID: PMC10177369 DOI: 10.3390/diagnostics13091527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Enterovesical fistula (EVF) is a rare complication of Crohn's disease (CD), characterized by recurrent urinary tract infections, fecaluria, and pneumaturia. However, most diagnostic tools have low sensitivity for EVF. Management consists of conservative and surgical approaches. Conservative treatment is usually adopted first. However, the appropriate time to consider surgery remains controversial. Herein, we report on the case of a 34-year-old male who presented with diffuse abdominal pain with fullness for one day. Enteroscopy and biopsy confirmed the diagnosis of Crohn's disease. Contrast-enhanced computed tomography (CT) suggested a fistula between the ileum and urinary bladder; however, cystoscopy did not find an obvious tract. The patient initially received medical treatment, but the symptoms persisted with recurrent urinary tract infections and subsequent bilateral hydronephrosis. He then underwent successful fistulectomy, partial cystectomy, and two segmental resections of the small bowel with end-to-end primary sutures. No complications or symptomatic urinary tract infections were noted during 30 months of follow-up after surgery, suggesting no recurrence of EVF. Surgical intervention is warranted when medical treatment fails or complications occur. Clinical symptoms and laboratory data are often less informative for the diagnosis of EVF, and CT is the most helpful diagnostic modality. Our management strategy provides an option for such patients.
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Affiliation(s)
- Ming-Wei Hsu
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
| | - Wen-Chi Chen
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404328, Taiwan
| | - Ting-Na Wei
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
- School of Medicine, China Medical University, Taichung 404328, Taiwan
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21
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Ho SM, Rajaguru K, Ng JY, Seow CS. Case report on a rare complication after transanal total mesorectal excision (TaTME) for rectal malignancy vesicorectal fistula. Int J Surg Case Rep 2023; 105:108009. [PMID: 36989629 PMCID: PMC10074581 DOI: 10.1016/j.ijscr.2023.108009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Transanal Total Mesorectal Excision (TaTME) represents the latest surgical approach in rectal cancer management. We present a rare case of vesicorectal fistula (VRF) following a complication of TaTME surgery. CASE PRESENTATION A 67-year-old male underwent a Hartmann's procedure for perforated rectosigmoid cancer in 2019. He was lost to follow-up and re-presented in 2021 with synchronous cancer of the transverse colon and rectum. A two-team surgical approach was utilized: open subtotal colectomy (transabdominal approach) with concurrent excision of rectal stump (TaTME approach). Intraoperatively, an inadvertent bladder injury was identified and repaired. 8 months later, he re-presented with the passage of urine per rectum. Imaging and endoscopy revealed a VRF with cancer recurrence at the rectal stump. CLINICAL DISCUSSION VRF is an uncommon complication of TaTME that carries a significant physical and psychological impact on the patient. While shown to be a safe and useful technique, the long-term oncological outcomes of TaTME are still awaited. Unique complications have been reported with TaTME, including gas embolism and injuries to the genitourinary structures, in which the latter caused the eventual VRF formation in our patient. CONCLUSION Revisional surgery for recurrent disease is challenging and can result in rare complications, especially in patients with distorted anatomy and when new surgical techniques are utilized. Radiotherapy further causes unpredictable tissue healing quality. The challenge remains for proper patient selection with individualization of surgical approaches, while keeping a close eye on the oncological outcomes of the patient.
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Affiliation(s)
- Sapphire Melody Ho
- Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Kishore Rajaguru
- Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore.
| | - Jing Yu Ng
- Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Choon Sheong Seow
- Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore
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22
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Dong C, Pan X, Wei L, Man X, Zhou Z, Huang Y, Wang X, Qi L, Xue F, Li Y. Colon cancer with colovesical fistula: A report of four cases and a literature review. Oncol Lett 2023; 25:158. [PMID: 36936024 PMCID: PMC10020892 DOI: 10.3892/ol.2023.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/10/2023] [Indexed: 03/21/2023] Open
Abstract
Colon cancer with colovesical fistula (CVF) is a rare complication of colon cancer that possesses an extremely poor prognosis. Surgical treatment can improve the prognosis. The current study presents four cases of CVF, in which the first two cases were treated conservatively and the other two were treated surgically. The first case presented with intestinal obstruction for 3 days, and computed tomography (CT) was performed. The patient refused surgery and still exhibited lower abdominal pain 11 months later. The second case presented with urinary frequency and urgency that lasted for 2 days, and CT was performed. The patient refused surgery and died 2 months later. The third case presented with fecaluria that lasted for 1 month, and CT, endoscopy and one-stage palliative surgery were performed. The patient was lost to follow-up 5 months later. The fourth case presented with acute urinary tract symptoms for 4 months, and CT, endoscopy and one-stage radical surgery were performed. The patient remained disease-free 10 months later. The four cases reported in the present study not only represent excellent examples of the disease spectrum, but also act as a reminder of the possibility of detecting CVF at an early stage of the disease. The present study discusses the epidemiology of CVF, and presents the pattern of CVF in terms of signs, symptoms and imaging examinations, including CT, cystoscopy and colonoscopy, as well as treatment in the early stage of the disease.
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Affiliation(s)
- Changming Dong
- Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
- Department of Urology, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Xiang Pan
- Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Lifu Wei
- Department of General Surgery, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Xiaojun Man
- Department of Urology, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Zhengxi Zhou
- Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Yanping Huang
- Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Xiaoxiang Wang
- Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Lezhong Qi
- Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Feng Xue
- Department of General Surgery, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
- Professor Feng Xue, Department of General Surgery, Affiliated Hospital of Yangzhou University, Yangzhou University, 155 Nanjing North Road, Yangzhou, Jiangsu 225000, P.R. China, E-mail:
| | - Yifan Li
- Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
- Correspondence to: Professor Yifan Li, Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hangjiang Middle Road, Yangzhou, Jiangsu 225000, P.R. China, E-mail:
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23
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Ladke P, Mitra K, Dhok A, Dhawan S, Potdukhe P. Colo-Vesical Fistula: Relevance of Conventional Radiology in the Modern Era. Cureus 2023; 15:e36037. [PMID: 37056544 PMCID: PMC10089645 DOI: 10.7759/cureus.36037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2023] [Indexed: 03/14/2023] Open
Abstract
Colo-vesical fistula (CVF) is usually encountered in severe inflammatory and malignant conditions. Radiological imaging is crucial to the diagnosis of a colo-vesical fistula and helps gastroenterologists and surgeons select the best treatment option. This disorder is typically identified during follow-up of treatments for diverticulitis or chronic inflammatory bowel disease. The patients present with symptoms of pneumaturia and fecaluria. The most accurate imaging modality for diagnosing CVF is CT with rectal contrast. In this case report, we present a case of a 58-year-old male patient with complaints of fecaluria and pneumaturia for three months. Ultrasonography and barium enema revealed a clear fistulous tract between the sigmoid colon and the urinary bladder. Subsequently, the patient underwent exploratory laparotomy and the specimen was sent for histopathological evaluation to rule out malignancy. The diagnosis on imaging was consistent with post-operative findings of a CVF. This case report will add to the knowledge of radiologists about the imaging features of CVFs and their identification on imaging.
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24
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Sidhu K, Seyfi D, Byrne C. Right-Sided Epididymo-Orchitis as a Presentation of Diverticular Colovesical Fistula. Cureus 2023; 15:e35376. [PMID: 36987474 PMCID: PMC10039812 DOI: 10.7759/cureus.35376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 02/25/2023] Open
Abstract
A colovesical fistula is a recognized complication of diverticulitis. Although the underlying pathology is usually of colonic origin, the majority of patients present with urological symptoms, classically pneumaturia, and urinary tract infection. Epididymo-orchitis is a rare presentation. It is important to identify elderly males who present with recurrent urosepsis and/or epididymo-orchitis refractory to medical treatment as they may have an underlying benign or malignant etiology. The diagnostic challenge in these cases is to confirm the presence of a fistula, exclude malignancy, and determine the underlying pathology. We present a case of diverticular colovesical fistula in an elderly male who presented with symptoms of epididymo-orchitis on a background of recurrent urinary tract infections. The presence of intravesical gas within the left posterolateral bladder wall and soft tissue thickening continuous with the mid-sigmoid colon was consistent with a colovesical fistula. This patient underwent elective laparoscopic anterior resection and repair of colovesical fistula.
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25
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Hsu JT, Chen KH, Chang HC, Tan JS. Laparoscopic bladder-sparing surgical technique for the recurrent enterovesical fistula. Asian J Surg 2023; 46:1155-1156. [PMID: 35999104 DOI: 10.1016/j.asjsur.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Jen-Ting Hsu
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuo-Hsin Chen
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsiao-Chun Chang
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jiun-Siang Tan
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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26
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An Y, Cao Q, Liu Y, Lei L, Wang D, Yang Y, Kong W, An D, Liu D. Sigmoido-vesical fistula secondary to sigmoid colon cancer presenting as urinary tract infection with Lactococcus lactis: A case report. Front Oncol 2023; 13:1054978. [PMID: 36937404 PMCID: PMC10016092 DOI: 10.3389/fonc.2023.1054978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
A colovesical fistula is a pathological communication between the colon and bladder. The symptoms include pneumaturia, fecaluria, and a lower urinary tract infection. The diagnosis is based on clinical symptoms, but the symptoms are not specific. Therefore, confirming the diagnosis is challenging. Urine cultures performed in patients with colovesical fistulas usually show growth of Escherichia coli or mixed growth of bowel organisms. Urinary tract infections caused by Lactococcus lactis are very rare, as it is rarely considered pathogenic in humans. We report the case of a 70-year-old woman who presented with symptoms of a recurrent urinary tract infection. Urine cultures were positive for L. lactis. Abdominopelvic computed tomography (CT) revealed focal thickening of the bladder wall and gas in the bladder. Cystoscopic examination and colonoscopy revealed sigmoid colon cancer and a sigmoido-vesical fistula. Laparoscopic surgical treatment was done. The patient recovered and was discharged 3 weeks later without chemoradiotherapy. On follow-up after 6 months, the patient was asymptomatic and stable. To our knowledge, this is the second reported case of L. lactis infection of the urinary tract and the first reported case in adults. L. lactis infection usually indicates the presence of serious underlying diseases such as malignancies, uncontrolled diabetes, and organ failure.
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Affiliation(s)
- Yanhua An
- Department of General Practice, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiumei Cao
- Department of General Practice, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Qiumei Cao,
| | - Yixin Liu
- Emergency Department, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Luping Lei
- Department of General Practice, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dawei Wang
- Department of General Practice, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yanjie Yang
- Emergency Department, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Weijie Kong
- Department of General Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dali An
- Department of General Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dan Liu
- Department of Urologic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Arora G, Badhe PV. Role of Multidetector Computed Tomography in Diagnosis of Acquired Gastrointestinal Fistulas. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1758124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Abstract
Introduction Fistulas are abnormal communication between two epithelialized surfaces. Gastrointestinal fistulas are communication between the gut and another epithelialized surface. Fistulas are classified according to anatomic (internal or external), physiologic (output volume), and etiologic characteristics. In the case of clinical suspicion of a fistula, a multidisciplinary approach helps in diagnosing and management. Multidetector computed tomography (MDCT) has an advantage over other imaging modalities due to its ability to reconstruct high-resolution images in seconds, which limits motion or peristalsis artifacts, and is ideal for patients who are uncooperative or who are seriously ill.
Aim Evaluation of MDCT as an initial tool in the diagnosis and characterization of gastrointestinal fistulas.
Methods During this prospective observational study, MDCT was used to assess patients with clinical suspicion of gastrointestinal fistulas. When necessary, contrast agents were used to identify the enteric fistulous tract. The etiology and characterization of the fistulas were determined. Further, the gastrointestinal fistulas were confirmed via endoscopy, cystoscopy, or surgery.
Results The most common type of gastrointestinal fistula is enterocutaneous fistula (ECF) (39%) and the most common cause of gastrointestinal fistulas is postoperative (47%). ECFs were classified according to their etiology, anatomy, and favorable characteristics (85% favorable) along with complexity (64% complex) to aid in the management process. In addition to pancreaticopleural fistulas (22%), biliary (11%), esophageal (8%), and pelvic fistulas (19%) were also observed. There were 19% of fistulas (esophageal and biliary) that were asymptomatic. Endoscopy confirmed such asymptomatic fistulas that were not convincingly detected on CT.
Conclusion In this study, we concluded that with the appropriate clinical history, MDCT can accurately depict enteric fistulas. In addition to characterizing fistulas, MDCT is equally useful for detecting secondary complications like inflammation, obstruction, or abscesses.
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Affiliation(s)
- Gitanjali Arora
- Department of Radio-Diagnosis, King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Padma V Badhe
- Department of Radio-Diagnosis, King Edward Memorial Hospital, Mumbai, Maharashtra, India
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A case report of small bowel bladder fistula after rectal cancer operation. Asian J Surg 2022; 46:1792-1793. [PMID: 36581544 DOI: 10.1016/j.asjsur.2022.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/13/2022] [Indexed: 12/28/2022] Open
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Mbaeri TU, Nwadi UV, Onu OA. Iatrogenic Vesicojejunal Fistula Six Years Following Subtotal Hysterectomy: Diagnostic Challenges and Management. Niger Med J 2022; 63:432-437. [PMID: 38867754 PMCID: PMC11165328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
Enterovesical fistula represents an abnormal communication between the urinary bladder and the gastrointestinal tract. It can result spontaneously from different disease processes, but can also complicate a surgical procedure. While most involve the large bowel, few involve the small bowel and these present with more clinical problems, as well as challenges in diagnosis and management. The patient is a 50-year-old P8 +0, woman who presented to our facility with a 6 months' history of faecaluria. There was associated history of urinary frequency, urgency, pneumaturia and dysuria. She had subtotal hysterectomy 6 years prior to presentation. Cystography, Abdominal computed tomography scan, and cystoscopy done revealed a small bowel fistula with the bladder. She had exploratory laparotomy which revealed the fistula and extensive intra-abdominal nylon suturing of bladder and jejunum. She was treated and did well postoperatively. Enterovesical fistula can follow wrong suture use in surgical procedures even many years after the procedure. A high index of suspicion and imaging modalities are needed for early diagnosis and prompt management.
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Affiliation(s)
- Timothy Uzoma Mbaeri
- Division of Urology, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Uchenna Victor Nwadi
- Division of Urology, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Onyekachi Amos Onu
- Division of Urology, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
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Kumar S, Pollok R, Goldsmith D. Renal and Urological Disorders Associated With Inflammatory Bowel Disease. Inflamm Bowel Dis 2022:6658535. [PMID: 35942657 PMCID: PMC10393213 DOI: 10.1093/ibd/izac140] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Indexed: 12/15/2022]
Abstract
Renal and urinary tract complications related to inflammatory bowel disease (IBD) have been relatively understudied in the literature compared with other extraintestinal manifestations. Presentation of these renal manifestations can be subtle, and their detection is complicated by a lack of clarity regarding the optimal screening and routine monitoring of renal function in IBD patients. Urolithiasis is the most common manifestation. Penetrating Crohn's disease involving the genitourinary system as an extraintestinal complication is rare but associated with considerable morbidity. Some biologic agents used to treat IBD have been implicated in progressive renal impairment, although differentiating between drug-related side effects and deteriorating kidney function due to extraintestinal manifestations can be challenging. The most common findings on renal biopsy of IBD patients with renal injury are tubulointerstitial nephritis and IgA nephropathy, the former also being associated with drug-induced nephrotoxicity related to IBD medication. Amyloidosis, albeit rare, must be diagnosed early to reduce the chance of progression to renal failure. In this review, we evaluate the key literature relating to renal and urological involvement in IBD and emphasize the high index of suspicion required for the prompt diagnosis and treatment of these manifestations and complications, considering the potential severity and implications of acute or chronic loss of renal function. We also provide suggestions for future research priorities.
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Affiliation(s)
- Shankar Kumar
- Centre for Medical Imaging, University College London, London, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - David Goldsmith
- Renal and Transplantation Department, Guys and St Thomas' Hospitals NHS Foundation Trust, Great Maze Pond, London, UK
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31
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Radiation Therapy and Malignant Fistulae of Anorectal Cancers. Pract Radiat Oncol 2022; 12:e517-e521. [PMID: 35718072 DOI: 10.1016/j.prro.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Though fistulization is a well-studied late toxicity of radiation therapy (RT), anorectal cancers (ARC) can present with malignant fistulae (MF) and negatively impact quality of life. The effect of RT, often combined with concurrent chemotherapy (CHT), on MF, needs systematic analysis, as practitioners are concerned that RT may exacerbate MF. We reviewed our institutional series evaluating the hypothesis that RT worsens MF. METHODS AND MATERIALS A single-institutional retrospective analysis of ARC patients receiving RT from 2006-2019 was performed. These patients were screened for MF. MF resected prior to RT and RT not directed at the site of MF were excluded. Effect was assessed by review of available follow-up documentation and imaging. RESULTS Six-hundred-and-thirty-nine patients with ARC were reviewed, and 47 had MF (7.4%). With a median follow-up of 22 months (range 2-133 months), RT improved MF in 17/29 (59%) of evaluable patients, with 9/29 (31.0%) having resolution. Median time to improvement was 50 days (range 25-117 days); median duration of improvement was 161 days (range 0-1,941 days). MF persisted in 12/29 (41%), with persistent local disease in all cases; in two cases, MF worsened concomitant with local progression. CONCLUSIONS Seven-point-four percent of ARC patients presented with MF. RT led to improvement or resolution in more than half of evaluable patients. Persistence or worsening of MF was only observed in patients with refractory or progressive local disease. Based on our findings, MF is not a contraindication to RT, and may be considered as an independent indication for palliative RT.
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Widia F, Firman M, Irdam GA, Syaiful RA. A six years' experience with 41 cases of enterovesical fistula in a Tertiary National Hospital in Indonesia: A retrospective study. Ann Med Surg (Lond) 2022; 73:103102. [PMID: 35028134 PMCID: PMC8715043 DOI: 10.1016/j.amsu.2021.103102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The incidence of Enterovesical Fistula (EVF) is relatively low. Currently, there is no agreement about the best methods for EVF management. This study was performed to investigate the characteristics of EVF to find the optimal diagnostic and management pattern. METHODS Data were collected retrospectively from the medical record at Cipto Mangunkusumo Hospital. Patients diagnosed with EVF between January 2014 and April 2019 were included. They were evaluated for demographics, characteristics, diagnostic modalities, and treatment modalities. RESULTS From 41 patients, 26 (63.3%) are male, and 15 (36.6%) are female. Peak incidence was 51-60 years old. The most common symptoms are fecaluria found in 32 (78%) patients. The common etiology is gastrointestinal cancer found in 17 (41.5%) patients, followed by gynecologic cancer and diverticulitis found in both 9 (22%) patients. The rectovesical fistula was seen in 25 (61%) patients with an advanced stage rectosigmoid cancer, followed by colovesical in 14 (34.1%) of patients with sigmoid diverticulitis (p 0.038). The common diagnostic modalities performed are cystoscopy in 32 (78%), followed by colonoscopy in 11 (26.8%) patients. The preferred modalities that were used in most cases were surgery in 35 (85.4%) patients. A two-stage surgical approach was used in 28 (68.3%) patients. CONCLUSION The incidence of EVF is uncommon. Malignancy was the leading cause of EVF in this study. Combined diagnostic modalities are recommended in EVF cases. The two-stage surgical approach was the preferred modality. Further prospective studies are mandatory to analyze this condition.
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Affiliation(s)
- Fina Widia
- Department of Urology, Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Salemba, Jakarta Pusat, DKI Jakarta, 10430, Jakarta, Indonesia
| | - Muhammad Firman
- Department of Urology, Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Salemba, Jakarta Pusat, DKI Jakarta, 10430, Jakarta, Indonesia
| | - Gampo Alam Irdam
- Department of Urology, Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Salemba, Jakarta Pusat, DKI Jakarta, 10430, Jakarta, Indonesia
| | - Ridho Ardhi Syaiful
- Department of Surgery, Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Salemba, Jakarta Pusat, DKI Jakarta, 10430, Jakarta, Indonesia
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Rajan YRD, Priyanka C. A Case of Rectovesical Fistula Following Blunt Trauma in a Child. Cureus 2021; 13:e18931. [PMID: 34812315 PMCID: PMC8604205 DOI: 10.7759/cureus.18931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Rectovesical fistulae (RVF) are uncommon entities and usually occur after surgery for prostate, radiation, and sometimes due to penetrating trauma. However, RVF occurrence after blunt trauma to the abdomen or perineum is very rare. The management of RVF is challenging, and treatment options should be considered according to the individual. Here we present a case of a 10-year-old boy who presented with fecaluria, pneumaturia, the passage of urine per rectum, and burning micturition for four days after incurring a blunt injury to the perineum. Cystography revealed leakage of contrast material into the rectum and an MRI of the pelvis was done for confirmation, which revealed a 1.3 cm thick fistulous tract of 2.7 cm length with openings at the posterior bladder wall and anterior rectal wall. After conservative management for 14 days failed to show any improvement, primary repair of the fistulous tract along with fecal diversion and urinary diversion were done. The suprapubic catheter was removed after four weeks, and at the two-month follow-up, colostomy closure was done. No recurrence was found in the six-month follow-up period. In cases of small traumatic RVF where conservative management fails, fecal and urinary diversion can be considered, as it is associated with successful outcomes and less recurrence.
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Zizzo M, Tumiati D, Bassi MC, Zanelli M, Sanguedolce F, Porpiglia F, Fiori C, Campobasso D, Castro Ruiz C, Bergamaschi FA, Maestroni UV, Carrieri G, Cormio L, Biolchini F, Palicelli A, Soriano A, Sassatelli R, Ascani S, Annessi V, Giunta A. Management of colovesical fistula: a systematic review. Minerva Urol Nephrol 2021; 74:400-408. [PMID: 34791866 DOI: 10.23736/s2724-6051.21.04750-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Colovesical fistulas (CVFs) account for approximately 95% enterovesical fistulas (EVFs). About 2/3 CVF cases are diverticular in origin. It mainly presents with urological signs such as pneumaturia and fecaluria. Diagnostic investigations aim at confirming the presence of a fistula. Although conservative management can be chosen for selected individuals, most patients are mainly treated through surgical interventions. CVF represents a challenging condition, which records high rates of morbidity and mortality. Our systematic review aimed at achieving deeper knowledge of both indications, in addition to short- and long-term outcomes related to CVF management. EVIDENCE ACQUISITION We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Pubmed/MEDLINE, Embase, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. EVIDENCE SYNTHESIS The 22 included articles covered an approximately 37 years-study period (1982-2019), with a total 1,365 patient population. CVF etiology was colonic diverticulitis in most cases (87.9%). Pneumaturia (50.1%), fecaluria (40.9%) and urinary tract infections (46.6%) were the most common symptoms. Abdomen computed tomography (CT) scan (80.5%), colonoscopy (74.5%) and cystoscopy (55.9%) were the most frequently performed diagnostic methods. Most CVF patients underwent surgery (97.1%) with open approach (63.3%). Almost all patients had colorectal resection with primary anastomosis with or without ostomy and 53.2% patients underwent primary repair or partial/total cystectomy. 4% anastomotic leak, 1.8% bladder leak and 3.1% reoperations rates were identified. In an average 5-68 month follow-up, overall morbidity, overall mortality and recurrences rates recorded were 8%-49%, 0%-63% and 1.2%, respectively. CONCLUSIONS CVF mainly affects males and has diverticular origin in almost all cases. Pneumaturia, fecaluria and urinary tract infections are the most characteristic symptoms. Endoscopic tests and imaging are critical tools for diagnostic completion. Management of CVFs depends on the underlying disease. Surgical treatment represents the final approach and consists of resection and re-anastomosis of offending intestinal segment, with or without bladder closure. In many cases, a single-stage surgical strategy is selected. Perioperative and long-term outcomes prove good.
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Affiliation(s)
- Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy - .,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy -
| | - David Tumiati
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria C Bassi
- Medical Library, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, Foggia, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Carolina Castro Ruiz
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Franco A Bergamaschi
- Urology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.,Department of Urology, Bonomo Teaching Hospital, Andria, Barletta-Andria-Trani, Italy
| | - Federico Biolchini
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Soriano
- Gastroenterology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Romano Sassatelli
- Gastroenterology and Digestive Endoscopy Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Ascani
- Hematology Unit, CREO, Azienda Ospedaliera di Perugia, University of Perugia, Perugia, Italy.,Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, Terni, Italy
| | - Valerio Annessi
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Giunta
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Sidhu A, Shaik NB, Sharma M. Management of fistula between neobladder and rectum using an atrial septal defect closure device. Endoscopy 2021; 53:1090. [PMID: 33242890 DOI: 10.1055/a-1298-3906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Ashlee Sidhu
- Aryavart Hospital, Daurala Sugar Mills, Meerut, Uttar Pradesh, India
| | | | - Malay Sharma
- Aryavart Hospital, Daurala Sugar Mills, Meerut, Uttar Pradesh, India
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Papanikolaou IS. Commentary. Endoscopy 2021; 53:1091. [PMID: 34551449 DOI: 10.1055/a-1526-9347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
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Rapi S, Bonari A, Dugheri S, Cappelli G, Trevisani L, Milletti E, Mucci N, Arcangeli G, Morettini A, Fanelli A. A case report: Use of FT-IR analysis to improve Colovesical fistula diagnosis. Pract Lab Med 2021; 27:e00255. [PMID: 34522752 PMCID: PMC8426557 DOI: 10.1016/j.plabm.2021.e00255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022] Open
Abstract
Colovesical fistula (CVF) is an abnormal connection between the colon and the urinary bladder. Faecaluria, reported in 40–70% of cases, is virtually pathognomonic for CVF. During the 5th day of recovery in an 84 years old subject, the passage of cloudy, malodorous urine with visible debris was observed. According to the pathognomonic character of faecaluria, the sample was signed to the laboratory for biochemical and microbiological investigation, able to define the type and origin of materials. Following clinical requirements, both biochemical pathways and instrumental procedures able to confirm or exclude the presence of faecal components in urine were considered. No biochemical compound or component addressing faecal compounds in urine results available between laboratory tests. The brown powder component of the pellet was identified as Keratin, with 90% overlapping with the reference spectrum of the compound. FT-IR analysis on urine pellet can be proposed as a simple, non-invasive, and fast method to improve the diagnostic course of CVF.
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Affiliation(s)
- S Rapi
- General Laboratory, Careggi University Hospital, Florence, Italy
| | - A Bonari
- General Laboratory, Careggi University Hospital, Florence, Italy
| | - S Dugheri
- Industrial Toxicology Laboratory, Careggi University Hospital, Florence, Italy
| | - G Cappelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - L Trevisani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - E Milletti
- General Laboratory, Careggi University Hospital, Florence, Italy
| | - N Mucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - G Arcangeli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - A Morettini
- Internal Medicine, Careggi University Hospital, Florence, Italy
| | - A Fanelli
- General Laboratory, Careggi University Hospital, Florence, Italy
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da Silva Barroso FM, Dorgam Maués CA, Lopes de Castro G, da Silva Galvão R, Guedes Saint Clair JP, Riberio Aref Kzam L. Colovesical fistula in a young adult due to sigmoid colon diverticulitis undetected in computed tomography: Case report and review of literature. Ann Med Surg (Lond) 2021; 69:102658. [PMID: 34457250 PMCID: PMC8379433 DOI: 10.1016/j.amsu.2021.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Colovesical fistula is the pathological communication between the colon and urinary bladder. It is related with high morbimortality rate and it is and uncommon complication of diverticulosis in young adults. Case presentation We report a case of a 38-year-old Brazilian man with fecaluria and pneumaturia for eight months, whose colovesical fistula was undetectable in CT scan and with surgical management. Discussion Diverticulosis is the main inflammatory condition causing colovesical fistulas and the sigmoid colon is the most common part involved. It is more prevalent in patients over 60 years old and in western countries due to low fiber diet. Conclusion Colovesical fistula diagnosis is difficult, requiring high suspicious and proper investigation through good anamnesis, CT scan and also colonoscopy and cystoscopy when necessary.
Colovesical fistula is an uncommon disorder in young adults and it is more frequently in western countries. Diverticulits is the main inflammatory condition causing enterovesical fistulas and the sigmoid colon the most common. Colovesical fistula diagnosis is difficult, requiring proper investigation through CT scan or other exams. Most cases of colovesical fistula are diagnosed during surgery approach and surgically managed.
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Affiliation(s)
- Francisco Marcos da Silva Barroso
- Urology Service at Hospital e Pronto-Socorro 28 de Agosto, Avenida Mário Ypiranga, 1581, Adrianópolis, Manaus, Amazonas, 69057-000, Brazil
| | - Carolina Augusta Dorgam Maués
- General Surgery Service at Hospital e Pronto-Socorro 28 de Agosto, Avenida Mário Ypiranga, 1581, Adrianópolis, Manaus, Amazonas, 69057-000, Brazil
| | - Gustavo Lopes de Castro
- Faculty of Medicine of the Federal University of Amazonas (UFAM), Rua Afonso Pena, 1053, Praça 14 de Janeiro, Manaus, Amazonas, 69020-160, Brazil
| | - Renato da Silva Galvão
- General Surgery Service at Getúlio Vargas University Hospital (HUGV), Avenida Apurinã, 4 - Praça 14 de Janeiro, Manaus, Amazonas, 69020-170, Brazil
| | - José Paulo Guedes Saint Clair
- General Surgery Service at Getúlio Vargas University Hospital (HUGV), Avenida Apurinã, 4 - Praça 14 de Janeiro, Manaus, Amazonas, 69020-170, Brazil
| | - Laura Riberio Aref Kzam
- Faculty of Medicine of the Federal University of Amazonas (UFAM), Rua Afonso Pena, 1053, Praça 14 de Janeiro, Manaus, Amazonas, 69020-160, Brazil
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Pradhan U, Kumar R, Agarwal PN, Singh G, Puri P. First Case of Enterovesical Fistula Caused by Ischaemic Enteritis. Cureus 2021; 13:e16452. [PMID: 34422482 PMCID: PMC8369859 DOI: 10.7759/cureus.16452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 11/09/2022] Open
Abstract
We present the case of an enterovesical fistula (EVF) caused by ischemic enteritis. Ischemic enteritis is caused either by mesenteric macrovasculature occlusion or any pathophysiologic vasospasm of the microvasculature. In other words, ischemic enteritis (IE) occurs when the inflow of blood to the small intestines is reduced. The frequency of ischemic enteritis is less as compared to ischemic colitis because of the vast blood supply to the small intestine. It is the first case to be reported in the medical literature to date. EVF is a rare entity. It is a pathological connection between the bowel loops and the urinary bladder. EVF is a result of an underlying disease or injury. EVF is mostly caused by diverticular diseases, carcinoma colon, Crohn's, and inflammatory bowel disease, iatrogenic, appendicitis, carcinoma cervix, etc. Due to the formation of this abnormal connection, contents of the intestines, including the air, food content, etc., are usually found in the urine. Patients usually present with the complaint of irritative urinary tract symptoms and recurrent urinary tract infection (UTI). Surgical management is the mainstay of treatment although medical management is tried for those who cannot bear to undergo surgery.
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Affiliation(s)
- Uma Pradhan
- Surgery, Shree Guru Gobind Singh Tricentenary (SGT) Medical College, Gurgaon, IND
| | - Ravi Kumar
- General Surgery, Shree Guru Gobind Singh Tricentenary (SGT) Medical College, Gurugram, IND
| | - Prem Narayan Agarwal
- General Surgery, Shree Guru Gobind Singh Tricentenary (SGT) Medical College, Gurugram, IND
| | - Gulshanjit Singh
- General Surgery, Shree Guru Gobind Singh Tricentenary (SGT) Medical College, Gurugram, IND
| | - Piyush Puri
- Critical Care Medicine, Rama Medical College Hospital & Research Center, Hapur, IND
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Mallaiyappan M, Sankarapandian GP, Sarveswaran V, TB N, Venkatesan J, Venugopal V. Novel Endoscopic Management of Colovesical Fistula Secondary to Colonic Diverticular Disease. JOURNAL OF DIGESTIVE ENDOSCOPY 2021. [DOI: 10.1055/s-0040-1715283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractColovesical fistula (CVF) is an abnormal communication between bowel and urinary bladder. Most common cause is complicated colonic diverticular disease. The treatment of choice for CVF is surgery. Conservative treatment is reserved for highly selected patients who are unfit for definitive surgery. We report the case of an 86-year-old gentleman with multiple comorbidities, who presented with pneumaturia, fecaluria, and recurrent urinary tract infection. He was diagnosed to have sigmoid colonic diverticulosis with a CVF and was successfully managed with the novel combined endoscopic approach (a simultaneous cystoscopy and flexible colonoscopy), which could be the first to be reported from India.
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Affiliation(s)
- Murugesh Mallaiyappan
- Department of Gastroenterology, Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu, India
| | | | - Venugopal Sarveswaran
- Depatment of General Surgery, Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu, India
| | - Noufal TB
- Depatment of General Surgery, Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu, India
| | | | - Vishmaya Venugopal
- Depatment of General Surgery, Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu, India
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41
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Granieri S, Sessa F, Bonomi A, Paleino S, Bruno F, Chierici A, Sciannamea IM, Germini A, Campi R, Talso M, Facciorusso A, Deiana G, Serni S, Cotsoglou C. Indications and outcomes of enterovesical and colovesical fistulas: systematic review of the literature and meta-analysis of prevalence. BMC Surg 2021; 21:265. [PMID: 34044862 PMCID: PMC8157688 DOI: 10.1186/s12893-021-01272-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/21/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Entero-colovesical fistula is a rare complication of various benign and malignant diseases. The diagnosis is prominently based on clinical symptoms; imaging studies are necessary not only to confirm the presence of the fistula, but more importantly to demonstrate the extent and the nature of the fistula. There is still a lack of consensus regarding the if, when and how to repair the fistula. The aim of the study is to review the different surgical treatment options, focus on surgical indications, and explore cumulative recurrence, morbidity, and mortality rates of entero-vesical and colo-vesical fistula patients. METHODS A systematic review of the literature was conducted according to PRISMA guidelines. Random effects meta-analyses of proportions were developed to assess primary and secondary endpoints. I2 statistic and Cochran's Q test were computed to assess inter-studies' heterogeneity. RESULTS Twenty-two studies were included in the analysis with a total of 861 patients. Meta-analyses of proportions pointed out 5, 22.2, and 4.9% rates for recurrence, complications, and mortality respectively. A single-stage procedure was performed in 75.5% of the cases, whereas a multi-stage operation in 15.5% of patients. Palliative surgery was performed in 6.2% of the cases. In 2.3% of the cases, the surgical procedure was not specified. Simple and advanced repair of the bladder was performed in 84.3% and 15.6% of the cases respectively. CONCLUSIONS Although burdened by a non-negligible rate of complications, surgical repair of entero-colovesical fistula leads to excellent results in terms of primary healing. Our review offers opportunities for significant further research in this field. Level of Evidence Level III according to ELIS (SR/MA with up to two negative criteria).
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Affiliation(s)
- Stefano Granieri
- General Surgery Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
| | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Largo Piero Palagi, 1, 50139 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Piazza di San Marco, 4, 50121 Florence, Italy
| | - Alessandro Bonomi
- University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
- General Surgery Unit, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, 20157 Milan, Italy
| | - Sissi Paleino
- General Surgery Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
- University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Federica Bruno
- General Surgery Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
| | - Andrea Chierici
- General Surgery Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
- University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | | | - Alessandro Germini
- General Surgery Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Largo Piero Palagi, 1, 50139 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Piazza di San Marco, 4, 50121 Florence, Italy
| | - Michele Talso
- Urology Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871 Vimercate, Italy
| | - Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, Viale Luigi Pinto, 1, 71122 Foggia, Italy
| | - Gianfranco Deiana
- Urology Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871 Vimercate, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Largo Piero Palagi, 1, 50139 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Piazza di San Marco, 4, 50121 Florence, Italy
| | - Christian Cotsoglou
- General Surgery Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871 Vimercate, Italy
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42
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Prischl FC, Wiesinger CG, Hafez A, Wimmer L. A rare clinical sign-Pneumaturia. Wien Klin Wochenschr 2021; 133:1076-1077. [PMID: 33945008 DOI: 10.1007/s00508-021-01878-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Friedrich C Prischl
- Dept. Nephrology, 4th Department of Internal Medicine, Klinikum Wels-Grieskirchen, Grieskirchnerstraße 42, Wels, Austria.
| | | | - Ahmed Hafez
- Dept. Nephrology, 4th Department of Internal Medicine, Klinikum Wels-Grieskirchen, Grieskirchnerstraße 42, Wels, Austria
| | - Ludwig Wimmer
- Dept. Nephrology, 4th Department of Internal Medicine, Klinikum Wels-Grieskirchen, Grieskirchnerstraße 42, Wels, Austria
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43
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Ramanathan S, Krishnamoorthy V, Ratnakar K, Thangavel P, Sundarraj R. Colovesical fistula secondary to hernia mesh migration: an unusual incident. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2016.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AbstractWe evaluated a 27-year old male with pneumaturia and fecaluria with a past history of right inguinal hernia repair. Though, cystoscopy and contrast enhanced computed tomography did not furnish any evidence to arrive at a diagnosis, interestingly, colonoscopy revealed a mesh in the sigmoid colon making apparent the diagnosis of colovesical fistula secondary to mesh migration. Later, surgical removal of the mesh from the sigmoid colon with rent closure of the fistulous opening was done successfully. Our case thus, highlights the vital role of common diagnostic tool like colonoscopy in making an uncommon diagnosis.
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Affiliation(s)
| | | | - Kini Ratnakar
- Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, India
| | | | - Raju Sundarraj
- Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, India
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44
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Incarbone GP, Palmisano F, Lorusso V, Granata AM, Romanò ALL, Marchesotti F, Ranzoni S, Gregori A. Repair of a rectovesical fistula following laparoscopic radical prostatectomy with Martius fat pad flap interposition: a proposal of a new technique. Turk J Urol 2021; 47:81-85. [PMID: 33112733 PMCID: PMC7815234 DOI: 10.5152/tud.2020.20356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/07/2020] [Indexed: 11/22/2022]
Abstract
Rectovesical fistula (RVF) is defined as an abnormal communication between the rectum and the urinary bladder, most commonly after an iatrogenic injury during pelvic surgery. Patients with RVF may have various clinical presentations, ranging from fecaluria, pneumaturia, to urine leakage through the anus. The quality of life for patients with this pathology is adversely affected owing to the associated psychological burden. Surgery is the preferred treatment given the low success rates reported for conservative or minimally invasive approaches. Herein, we present a case of a 65-year-old man with RVF after radical prostatectomy successfully treated by a transperineal approach using a modified Martius procedure.
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Affiliation(s)
- Giacomo Piero Incarbone
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Franco Palmisano
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Vito Lorusso
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio Maria Granata
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Ai Ling Loredana Romanò
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Federica Marchesotti
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Stefania Ranzoni
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Andrea Gregori
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
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45
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Mandava A, Koppula V, Kandati M, Sharma G, Potlapalli A, Juluri R. Ultrasound in the Diagnosis of Malignant Pelvic Fistulas: Sonographic Findings in Correlation with Computed Tomography Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3460-3467. [PMID: 32958290 DOI: 10.1016/j.ultrasmedbio.2020.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 06/11/2023]
Abstract
Even though ultrasound is an extensively used imaging modality, it has not been effectively utilized in the evaluation and diagnosis of malignant pelvic fistulas. In this study, we tried to correlate the accuracy of sonographic findings in identifying malignant fistulas with that of computed tomography (CT) imaging. Thirty-five patients with advanced pelvic malignancies were examined over a period of 2 y. Patients underwent CT of the abdomen and pelvis with intravenous and oral/rectal contrast followed by ultrasound of the abdomen. Sonographic examinations were performed using a standardized protocol with a full bladder. Real-time ultrasound images of the abdomen and pelvis in multiple planes were acquired and stored as both image files and audio-video interleaves (AVIs). On ultrasound, the majority of the fistulas were visualized either as a continuous hyper-echoic tract within a hypo-echoic neoplastic mass ("air contrast sign") or as multiple discontinuous hyper-echoic foci with "ring down" artifacts. The sensitivity and specificity of ultrasound in the detection of malignant fistulas were 72% (confidence interval [CI]: 52%-87%) and 66% (CI: 22%-95%), respectively. We also reviewed the literature and compared the sensitivities of ultrasound in the detection of various types of pelvic fistulas obtained in previous studies with those in the present study. Results suggest that although ultrasound cannot be used as a primary imaging modality for the detection of fistulas, it can provide the earliest clue to the presence of a malignant fistula.
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Affiliation(s)
- Anitha Mandava
- Department of Radiology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, Telangana, India.
| | - Veeraiah Koppula
- Department of Radiology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, Telangana, India
| | - Meghana Kandati
- Department of Radiology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, Telangana, India
| | - Gaurav Sharma
- Department of Radiology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, Telangana, India
| | - Alekya Potlapalli
- Department of Radiology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, Telangana, India
| | - Rakesh Juluri
- Department of Radiology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, Telangana, India
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46
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Gökyer A, Küçükarda A, Sayın S, Keskin FEU, Çiçin İ. Stage I colon cancer that spreads into a colovesical fistula-mediated bladder due to crohn's disease: A case report. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2020. [DOI: 10.1016/j.cpccr.2020.100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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47
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Lightner AL, Ashburn JH, Brar MS, Carvello M, Chandrasinghe P, van Overstraeten ADB, Fleshner PR, Gallo G, Kotze PG, Holubar SD, Reza LM, Spinelli A, Strong SA, Tozer PJ, Truong A, Warusavitarne J, Yamamoto T, Zaghiyan K. Fistulizing Crohn's disease. Curr Probl Surg 2020; 57:100808. [PMID: 33187597 DOI: 10.1016/j.cpsurg.2020.100808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/22/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Amy L Lightner
- Department of Colorectal Surgery, Digestive Disease Surgical Institute, Cleveland Clinic, OH.
| | - Jean H Ashburn
- Department of Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC
| | - Mantaj S Brar
- Department of Surgery, Mount Sinai Hospital, Toronto, ON; Zane Cohen Center for Digestive Diseases, Toronto, ON; Department of Surgery, University of Toronto, ON
| | - Michele Carvello
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | | | - Anthony de Buck van Overstraeten
- Department of Surgery, Mount Sinai Hospital, Toronto, ON; Zane Cohen Center for Digestive Diseases, Toronto, ON; Department of Surgery, University of Toronto, ON
| | | | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Paulo Gustavo Kotze
- IBD Outpatient Clinics, Colorectal Surgery Unit, Catholic University of Parana (PUCPR), Curitiba, Brazil
| | - Stefan D Holubar
- Department of Colorectal Surgery, Digestive Disease Surgical Institute, Cleveland Clinic, OH
| | - Lillian M Reza
- Fistula research Unit, St Mark's Hospital and academic institute, London, UK
| | - Antonino Spinelli
- Humanitas Clinical and Research Center, Colon and Rectal Surgery Unit, Italy; Humanitas University, Department of Biomedical Sciences, Italy
| | - Scott A Strong
- Department of Gastrointestinal Surgery, Northwestern University, Chicago, IL
| | - Philip J Tozer
- Fistula research Unit, St Mark's Hospital and academic institute, London, UK
| | - Adam Truong
- Department of Surgery, Cedars Sinai, Los Angeles, CA
| | | | - Takayuki Yamamoto
- Inflammatory Bowel Disease Center & Department of Surgery, Yokkaichi Hazu Medical Center, Yokkaichi, Japan
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48
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Watts A, Kocher NJ, Pauli E, Raman JD. Endoscopic Closure of a Large Rectovesical Fistula Following Robotic Prostatectomy. J Endourol Case Rep 2020; 6:139-142. [PMID: 33102710 DOI: 10.1089/cren.2019.0132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Rectovesical fistulae (RVF) are uncommon complications of pelvic surgeries and are a potential cause of significant morbidity. RVF are not typically closed endoscopically but rather require reoperative surgery of the lower pelvis with closure of tract, interposition of fat or omentum, and possible permanent bowel diversion. We present a unique case of a rectovesical fistula developing after robotic prostatectomy that was managed by multimodal multistage endoscopic therapy as an alternative to conventional operative repair. Case Presentation: A healthy 78-year-old Caucasian man underwent a robot-assisted laparoscopic radical prostatectomy with bilateral pelvic lymph node dissection for high-risk adenocarcinoma of the prostate. The patient's postoperative course was complicated by an unrecognized rectal injury culminating in emergent exploration, abdominal washout, creation of a diverting loop transverse colostomy, and resultant development of a large rectovesical fistula. Given the patient's hostile abdomen and desire for conservative management the fistula was managed through a combined cystoscopic and endoscopic procedure that utilized suturing and clipping to close the fistula. This novel technique was followed by a series of three subsequent endoscopic procedures that enabled us to gradually downsize the fistula over time and ultimately achieve complete closure. The patient's colostomy was eventually reversed with return of bowel continuity. Conclusion: Although uncommon, RVF are significant complications of pelvic surgery. The presence of abdominal/pelvic adhesions from previous surgeries or patient comorbidities can make open surgical repair extremely challenging or impracticable. Therefore, it is important to recognize and consider the use of endoscopic techniques as potential options for closure of rectovesical fistula in certain situations.
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Affiliation(s)
- Andrew Watts
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Neil J Kocher
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric Pauli
- Division of Minimally Invasive Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jay D Raman
- Division of Urology, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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49
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Coakley KM, Davis BR, Kasten KR. Complicated Diverticular Disease. Clin Colon Rectal Surg 2020; 34:96-103. [PMID: 33642949 DOI: 10.1055/s-0040-1716701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The modern management of colonic diverticular disease involves grouping patients into uncomplicated or complicated diverticulitis, after which the correct treatment paradigm is instituted. Recent controversies suggest overlap in management strategies between these two groups. While most reports still support surgical intervention for the treatment of complicated diverticular disease, more data are forthcoming suggesting complicated diverticulitis does not merit surgical resection in all scenarios. Given the significant risk for complication in surgery for diverticulitis, careful attention should be paid to patient and procedure selection. Here, we define complicated diverticulitis, discuss options for surgical intervention, and explain strategies for avoiding operative pitfalls that result in early and late postoperative complications.
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Affiliation(s)
- Kathleen M Coakley
- Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
| | - Bradley R Davis
- Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
| | - Kevin R Kasten
- Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
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50
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Darii Plopa N, Gica N, Gerard M, Nollevaux MC, Pavlovic M, Anton E. A Very Rare Case of Colosalpingeal Fistula Secondary to Diverticulitis: An Overview of Development, Clinical Features and Management. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:477. [PMID: 32957717 PMCID: PMC7557829 DOI: 10.3390/medicina56090477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colosalpingeal fistula is a rare complication secondary to diverticular disease. The pathogenesis is still not clearly understood. We present the case of a colosalpingeal fistula and a review of the management of this pathology. CASE REPORT A 69-year-old patient with uncomplicated diverticular disease was referred to our department for recurrent vaginal discharge. The clinical examination was unremarkable, hysteroscopy revealed the presence of air in the uterine cavity in the absence of a uterine fistula. A preliminary diagnosis of colosalpingeal fistula was made and was confirmed by computed tomography (CT) scan and hysterosalpingography. A one-stage surgery via laparotomy was successfully performed with remission of the symptoms. CONCLUSION Colotubal fistula is a rare complication resulting from intestinal diverticular disease. The purpose of this paper was to emphasize the presence of a rare, but serious complication occurring in diverticular disease with atypical symptoms and one-stage surgery treatment.
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Affiliation(s)
| | - Nicolae Gica
- Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Marie Gerard
- Department of Radiology, CHU Dinant Godinne|UCL Namur, 5530 Yvoir, Belgium;
| | | | - Milenko Pavlovic
- Department of Gynecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, 833-0073 Santiago, Chile;
| | - Emil Anton
- University of Medicine and Pharmacology Gr T Popa, 700115 Iasi, Romania;
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