Sigmoidovesical Fistula Caused by Diverticulitis Detected with Sigmoidoscopy / 대한소화기학회지

Enterovesical fistular is an abnormal communication between the intestine and the bladder. It represents a rare complication of intestinal diverticulitis, colorectal malignancy, bladder cancer, inflammatory bowel disease, radiotherapy, and trauma. The most common etiology is diverticular disease. A 70-year-old man came to our hospital due to frequent urinary tract infection, dysuria, pneumaturia and fecaluria. Sigmoidoscopy revealed a large diverticulum with impacted stool at the sigmoid colon. When the scope was inserted into the site, the patient complained of severe urgency and pneumaturia. CT scan was performed. 1.5 cm sized fistular tract between the sigmoid colon and bladder was noted. According to the endoscopy and CT finding, the diagnosis of colovesical fistula was made. The patient underwent surgical intervention. At laparotomy, there were multiple diverticula and fistular tract was noted.

Resultado do tratamento das fístulas enterovesicais para doença de Crohn / The result of treatment enterovesical fistulas for Crohn's disease

A fístula enterovesical na doença de Crohn é relativamente incomum. O objetivo deste estudo é analisar sua incidência e o resultado do seu tratamento em doentes de Crohn no ambulatório de Doenças Inflamatórias Intestinais do Serviço de Cólon e Reto do Departamento de Gastroenterologia do HCFMUSP. MÉTODOS:Dos 647 pacientes com doença de Crohn , quatorze apresentaram fístula enterovesical no período de 1984 a 2006, tendo sido todos tratados cirurgicamente. RESULTADOS: Dos quatorze pacientes, doze são homens sendo a média de idade do início da doença de Crohn de 28,8 anos. O tempo médio de evolução da doença até o diagnóstico da fístula enterovesical foi de 155,1 meses. Em relação à extensão da doença, sete pacientes tinham Crohn em intestino delgado, cólon e região perianal; cinco apenas no intestino delgado; um em cólon e região perianal e outro com acometimento de intestino delgado e perianal. No total treze pacientes tinham doença de Crohn em intestino delgado. O trajeto da fístula enterovesical mais comum foi de intestino delgado (seis pacientes). Os demais pacientes apresentaram fístula enterovesical em: cólon sigmóide (quatro pacientes), entero-colo-vesical (dois pacientes), colo-vesico-cutânea (um paciente) e outra entero-reto-vesical (um paciente). Todos foram tratados cirurgicamente com ressecção da porção intestinal acometida e sutura da lesão da bexiga, e em um doente foi feito cistectomia parcial. No pós-operatório imediato tivemos duas recorrências da fistula enterovesical, um paciente permanece em tratamento clínico e o outro foi a óbito. No acompanhamento dos demais doentes, observou-se que: oito pacientes apresentam-se sem sintomas e com medicação, três assintomáticos e sem medicação; um paciente com medicação e com sintomas relacionados à doença de Crohn (mas sem queixas ou recorrência de fístula enterovesical). CONCLUSÃO: O índice de fístula enterovesical em doentes com Crohn neste estudo foi de 2,1 por cento. O tratamento...

Enterovesical fistula is relatively uncommon in Crohn's disease. The objective of this study is to analyze the incidence and the result of the treatment of patients with Crohn's disease at the Inflammatory Bowel Clinic of Service of Colon and Rectum of Gastroenterology Department (HCFMUSP). METHODS: 14 out of 647 patients with Crohn's disease presented enterovesical fistula between 1984 and 2006, in which all of them were treated with surgical intervention. RESULTS: 12 out of 14 patients were male and the Crohn's symptoms started with a mean age of 28,8 years. The mean age of evolution of Crohn's disease before discovering the enterovesical fistula was 155,1 months. In regard to Crohn's disease extension, there were seven patients with Crohn's disease in the small intestine, colon and perianal region; five with manifestation only in the small intestine; one had colon and perianal disease and other had small intestine and perianal disease. 13 out of 14 patients studied had Crohn's disease in small intestine. The most commonly encountered type of fistula was in the small intestine (six patients). The others patients presented enterovesical fistula in: sigmoid (four patients), entero-colo-vesical (two patients), colo-vesico-cutaneous (one patient) and entero-reto-vesical (one patient). All the patients were treated with surgical intervention involving resection of the affected bowel and closure of the bladder defect and one patient needed partial cystectomy. In the postoperative period there were two enterovesical fistula recurrences: one patient is still being treated with medical therapy and the other died. In the clinical follow-up of the other patients, eight of them are without symptoms and taking medications, three patients are asymptomatic and under no medications, and one patient is taking medications for Crohn's disease but without enterovesical fistula. CONCLUSIONS: the rate of enterovesical fistula of the Crohn's patients was...

Ileocolovesical Fistula Caused by Crohn's Disease: Report of a Case / 대한비뇨기과학회지

Enterovesical fistula is a relatively rare disease and usually caused by primary intestinal disease (diverticulitis, colon cancer and inflammatory bowel disease including Crohn's disease etc.). We experienced a rare case of ileocolovesical fistula caused by Crohn's disease. The 34 year old man had had chronic dysuria, lower abdominal pain and turbid urine for 3 years. Contrast studies including cystography, small bowel series, barium enema and abdominal Of showed ileocolovesical fistula. Small bowel segmental resection, Hartmann's colostomy and suprapubic cystostomy were performed. Histological examination of operative specimen showed a granulomatous inflammation caused by Crohn's disease. Our case suggests that Crohn's disease may be a rare cause of enterovesicalfistula in Korean.