Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Urol. Mar 24, 2017; 6(1): 30-33
Published online Mar 24, 2017. doi: 10.5410/wjcu.v6.i1.30
Radical cystectomy and en-bloc resection of enterovesical fistula from bladder cancer
Zi Qin Ng, Willy K W Low, Sathiyananthan Jr, Pradeep Subramanian, Joel Stein
Zi Qin Ng, Willy K W Low, Pradeep Subramanian, Joel Stein, Department of General Surgery, Royal Perth Hospital, Perth 6000, Australia
Sathiyananthan Jr, Department of Urology, Royal Perth Hospital, Perth 6000, Australia
Author contributions: Ng ZQ designed the study, analyzed the data and drafted the article; Low WKW, Jr S and Subramanian P critically reviewed the article; Stein J co-designed the study, critically revised the article; Ng ZQ, Low WKW, Jr S, Subramanian P and Stein J approved final version of the article to be published.
Institutional review board statement: This study does not require an approval from the institutional review board.
Informed consent statement: Written consent was obtained from the patient prior to submission of the article.
Conflict-of-interest statement: Nil.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zi Qin Ng, MBBS (Hons), Department of General Surgery, Royal Perth Hospital, Wellington Street, Perth 6000, Australia. kentng@hotmail.co.uk
Telephone: +61-8-92242244 Fax: +61-8-92243511
Received: December 23, 2016
Peer-review started: December 28, 2016
First decision: January 16, 2017
Revised: January 21, 2017
Accepted: February 20, 2017
Article in press: February 21, 2017
Published online: March 24, 2017
Processing time: 68 Days and 23.5 Hours
Abstract

Enterovesical fistulae secondary to benign or malignant bowel disease are not uncommonly reported in the literature. However, bladder malignancy as the primary pathology is exceedingly rare. We report a case of muscle invasive urothelial carcinoma of bladder with an enterovesical fistula to a loop of small bowel. The patient first presented with signs and symptoms of per rectal bleeding, haematuria, pneumaturia, faecaluria and rectal micturition. Her initial biochemistry test revealed significant metabolic acidosis with normal anion gap and hypokalemia. A computed tomography abdomen/pelvis with rectal contrast demonstrated an enterovesical fistula from the dome of bladder to a loop of small bowel. The patient underwent radical cystectomy with en-bloc resection of a loop of involved ileum and sigmoid colon due to the intraoperative findings of the sigmoid colon adherent to the tumour. The published literature is reviewed, focusing on the incidence, diagnostic modality and treatment strategies available for this rare condition.

Keywords: Bladder cancer; Enterovesical fistula; En-bloc resection; Malignant fistula; Urothelial carcinoma

Core tip: A 68-year-old lady presented with per rectal bleeding and haematuria. Other important history includes her reporting diarrhea with associated weight loss over the last 3 mo and faecaluria, pneumaturia and rectal micturition. On presentation, she was found to be in severe metabolic acidosis with hypokalemia. A computed tomography scan with rectal contrast showed an enterovesical fistula from bladder to a loop of small bowel. She underwent radical cystectomy, en-bloc resection of a loop of the involved small bowel and sigmoid colon with formation of ileal conduit and end-colostomy.