Fístula colovesical de origen diverticular / Results of surgical treatment of colovesical fistulas of diverticular origin

Background: The main causes of colovesical fistulas are diverticular disease of the colon and colon carcinoma. Aim: To analyze the results of the surgical treatment of colovesical fistulas of diverticular origin. Material and Methods: Retrospective analysis of all patients operated for a colovesical fistula of diverticular origin. Results: From 141 patients subjected to a colon excision for diverticular disease, 18 had a colovesical fistula. The latter, compared to patients without fistulas were male in a higher proportion, were younger and had more concomitant diseases. Pneumaturia was reported in 83 percent and urine fecal soiling in 56 percent. In two thirds of patients, the fistula appeared in the absence of a diverticular crisis. Abdominal CAT sean demonstrated the fistula in 80 percent of cases. It was complemented with barium enema and cystoscopy. Excision with immediate anastomosis was the surgical procedure used in 94 percent of patients, without sequelae or relapse, after a mean follow up of 74 months. No patient died during the procedure or required a new intervention. Conclusions: Colovesical fistulas are most common in young men with associated diseases and their treatment of choice, with good long-term results, is primary excision.

Antecedentes: El objetivo de este estudio es analizar los resultados del tratamiento quirúrgico de la Fístula Coló Vesical (FCV) de origen diverticular, los que se comparan con la enfermedad diverticular no fistulizada. Pacientes y Método: Análisis retrospectivo de todos los pacientes intervenidos por una FCV de origen diverticular en forma consecutiva. Resultados: De un total de 141 pacientes resecados por una enfermedad diverticular del colon sigmoides, la indicación quirúrgica en 27 (19,3 por ciento) fue la presencia de una fístula, de las cuales 18 corresponden a una FCV. El grupo con FCV tiene predominio de hombres (p = 0,0001), más joven (p = 0,027) y con mayor incidencia de enfermedades asociadas (p = 0,0001). La neumaturia se presentó en el 83 por ciento y la fecaluria en el 56 por ciento. En dos tercios de los casos la FCV se estableció en ausencia de una crisis diverticular previa. El estudio más relevante para demostrar la presencia de una FCV fue la tomografía computada (80 por ciento), que se complementa con el enema balitado y la cistoscopia. La resección con anastomosis inmediata, más simple sutura de la vejiga fue el procedimiento empleado en el 94 por ciento de los pacientes, sin secuelas ni casos de recidiva, con un seguimiento global promedio de 74,2 meses (extremos 12-158). No hubo reoperaciones ni mortalidad operatoria. Conclusiones: la FCV de origen diverticular es una condición patológica poco frecuente que afecta a pacientes varones en la séptima década de la vida, con múltiples enfermedades asociadas y que frecuentemente se instala en forma silenciosa. La resección primaria es el tratamiento de elección con buenos resultados a largo plazo.

Surgical Treatment for Diverticular Disease of the Colon

PURPOSE: To evaluate clinical features of patients who underwent surgical treatment for diverticular disease of the colon. METHODS: We retrospectively reviewed the hospital records of 27 patients who were surgically treated for diverticular disease of colon at the Seoul National University Hospital from July 1993 to September 1999. We also compared our data with that of previous study of 24 patients surgically treated for the same disease from March 1982 to June 1993. RESULTS: Although the changes in the distribution of age and sex are not remarkable, increment of total number of left side colonic diverticular disease was noted (from 3 cases among 24 cases in previous study to 11 cases among 27 cases in this study). In contrast to all of right side diverticulitis were classified to stage I or II, half of left side diseases were advanced to stage III or IV by Hinchey's severity classification. Patients with right side diverticular disease were treated with surgical resection of diseased colon with low postoperative morbidity. On the other hand, patients with left side diverticular disease were treated with variety of surgical modalities from drainage alone to staged operation and there were relatively high postoperative complications including 3 cases of reoperation due to peritonitis, and one case of reoperation due to recurred diverticular disease. CONCLUSIONS: Recent increment in surgical treatment for left side diverticular disease of the colon was noted. Operations for left side colonic diverticular disease, associated with relatively advanced disease stage, exhibited high emergency operation rate and complications.

Management of Complicated Diverticular Disease of the Colon

BACKGROUND: Colon diverticular disease is known to be prevalent in the western population and rare in the oriental population. Nowadays, the incidence in Korea is steadily increasing, so appropriate management has become clinically important. We must decide whether the patient needs surgical management and bowel preparation, or not. We must decide when and how to do it. METHODS: We retrospectively reviewed the medical records of 53 patients who were admitted with colon diverticular disease to Ewha Womans University Hospital from September 1993 to January 1999. RESULTS: They were 35 men and 18 women. The mean age was 47 years. The patients were divide into two groups: the conservatively managed group (Group C, n=28) and the operatively managed group (Group O, n=25). The lesions were located in the right colon in 23 cases of Group C (82%) and 17 cases of Group O (62%). The barium enema was the most commonly used diagnostic tool (Group C: 78.8%; Group O: 56%). However, an abdomino-pelvic CT was a more effective diagnostic tool in emergency cases (66.7%). Recurrence (n=12) was the most common indication for an operation. Bowels were not prepared in some elective (n=5) and all emergency cases (n=6). One-stage operations were performed in 19 cases of elective operations and in three cases of emergency operations. Two-stage operations were performed in the other three cases of emergency operations. Postoperative complications were noted in six cases of elective operation, four with bowel preparation (28.5%) and two without preparation (40.0%) and in five cases of emergency operations (83%). Also we had one mortality. CONCLUSIONS: The barium enema was the most accurate and commonly used diagnostic tool. However, in emergency cases, an abdomino-pelvic CT was effective for deciding on the treatment. It seems better to do an elective operation with bowel preparation than to do an emergency operation without bowel preparation for colon diverticulitis, provided the patient's condition permits.