ABSTRACT
Objective To assess the diagnosis and treatment of enterovesical fistula.Methods The clinical data of 12 cases (10 men and 2 women;mean age,57 years) of enterovesical fistula were retro- spectively analyzed.Of the 12 cases,7 (58%) had colovesical fistula,3 (25%) had ileovesical fistula,and 2 (17%) had rectovesical fistula.The etiology of fistula was intestinal malignancy in 7 cases,Crohn disease in 3 ,and bladder cancer in 1,and intestinal diverticulitis in 1.The clinical features included fecaluria in 10 cases,recurrent urinary tract infection (UTI) in 6,abdominal pain in 4,and pneumaturia in 3.Five patients (5/9) had a definite diagnosis by CT;3 (3/6),by cystoseopy;2 (2/5),by cystography;and 1 (1/5),by barium enema.Among the 10 patients undergoing surgical intervention,resection of the involved bowl with one-stage anastomosis and partial cystectomy was performed in 4;resection of the bowl with one-stage anasto- mosis and repair of the fistula or single bladder drainage in each of 2;one-stage transverse colostomy and two- stage radical colectomy with partial cystectomy in 1;palliative proximal colostomy in 3;and conservative ther- apy in 2.Results One patient died of septic shock 10 d after admission.Nine patients were followed for 3 months to 16 years (mean,6.5 years).One patient had intestinal fistula recurrence and was cured with re- operation;1 patient with conservative therapy and 1 with palliative surgery died of tumor metastasis;and 1 died of cerebrovascular accident 2 years later without fistula recurrence previously.Five patients undergoing surgery had a better survival with no complication.Conclusions The major cause of enterovesical fistula is intestinal malignancy.Fecaluria and recurrent UTI are the most common symptoms.CT and cystoscopy are the preferred adjunctive examinations.Surgical intervention is the major therapeutic choice.