Diagnosis and management of colovesical fistulas

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Abstract
There are different theories concerning the best method of managing colovesical fistulas. To assess various methods, a 10 yr combined hospital review was undertaken. Subjects for the review included 37 patients who had colovesical fistulas. Patients with rectovesical fistulas were excluded. Of these 37 cases, 29 were caused by diverticular disease, 7 by carcinoma and 1 by Crohn''s disease. The most consistent diagnostic findings were a history of pneumaturia and cystoscopic findings of localized bullous edema or fistula. Ba enema examinations delineated colonic disease but demonstrated the fistulas in only 6 cases. Other diagnostic tests rarely delineated the fistulas. When the fistulas were secondary to cancer, the methods of management were dictated by the location and extent of the tumor. When the fistulas were secondary to diverticulitis, a concomitant problem such as abscess or infection dictated the method of management, usually more than a single-step procedure. Such concomitant problems occurred in only 4 of these 29 diverticular patients. The other 25 had minor abdominal complaints or none. Of the 25 cases in the latter category, 15 were managed by 1 stage resection, and there was no anastomotic complication or infection. Four had no operative treatment; the 6 who were treated by more than a single stage resection had no apparent contraindication to a single stage procedure and probably could have been spared the prolonged disability resulting from repeated operations. Colovesical fistulas from diverticular disease usually result from localized perforations and/or abscesses and the appearance of a fistula in itself does not indicate an urgent need for operation. Fistulas in patients can be managed electively with 1 stage resection following the usual surgical criteria for anastomosis in diverticular disease.

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