- Matt Strickland, MD
Matt Strickland, MD
- Senior General Surgery Resident
- University of Toronto
- Marcus Burnstein, MD, MSc, FRCSC
Marcus Burnstein, MD, MSc, FRCSC
- Associate Professor of Surgery
- University of Toronto
- Zane Cohen, MD, FRCSC
Zane Cohen, MD, FRCSC
- Professor of Surgery
- University of Toronto
A colovesical fistula (CVF) is an abnormal connection between the colon and urinary bladder. Although they are uncommon, CVFs can cause significant morbidity, affect quality of life, and may lead to death, usually secondary to urosepsis [1,2]. Although a CVF can be diagnosed clinically, imaging and endoscopy are often required to delineate the extent of a fistula and to elucidate its etiology . Surgery is usually required to repair a CVF.
The epidemiology, etiology, clinical features, diagnosis, and management of colovesical fistulas are reviewed here. Other types of fistulas related to the gastrointestinal and urological systems are covered in separate topic reviews. (See "Overview of enteric fistulas" and "Rectovaginal and anovaginal fistulas" and "Anorectal fistula: Clinical manifestations, diagnosis, and management principles" and "Urogenital tract fistulas in women".)
The precise incidence of colovesical fistulas (CVFs) is unknown. It is estimated that CVFs account for 1 in every 3000 surgical hospital admissions . In patients with diverticular disease, 2 to 18 percent were found to have CVFs [5-8]. In patients with Crohn's disease, less than 1 percent developed a CVF .
The male-to-female ratio of CVF is approximately 2 to 3:1 [1,10-13]. Females are protected possibly because the uterus and broad ligaments act as a barrier between the sigmoid colon and the bladder. This theory is supported by the fact that a high percentage of females with CVFs (>50 percent in some series) have had a previous hysterectomy .
CVFs most commonly affect patients in their sixth or seventh decades. The mean age at presentation is between 55 and 75 years [1,10-12].
- Garcea G, Majid I, Sutton CD, et al. Diagnosis and management of colovesical fistulae; six-year experience of 90 consecutive cases. Colorectal Dis 2006; 8:347.
- Golabek T, Szymanska A, Szopinski T, et al. Enterovesical fistulae: aetiology, imaging, and management. Gastroenterol Res Pract 2013; 2013:617967.
- Melchior S, Cudovic D, Jones J, et al. Diagnosis and surgical management of colovesical fistulas due to sigmoid diverticulitis. J Urol 2009; 182:978.
- PUGH JI. ON THE PATHOLOGY AND BEHAVIOUR OF ACQUIRED NON-TRAUMATIC VESICO-INTESTINAL FISTULA. Br J Surg 1964; 51:644.
- Pollard SG. Colovesical fistula. Ann R Coll Surg Engl 1988; 70:184.
- Amin M, Nallinger R, Polk HC Jr. Conservative treatment of selected patients with colovesical fistula due to diverticulitis. Surg Gynecol Obstet 1984; 159:442.
- Menenakos E, Hahnloser D, Nassiopoulos K, et al. Laparoscopic surgery for fistulas that complicate diverticular disease. Langenbecks Arch Surg 2003; 388:189.
- Labs JD, Sarr MG, Fishman EK, et al. Complications of acute diverticulitis of the colon: improved early diagnosis with computerized tomography. Am J Surg 1988; 155:331.
- Gruner JS, Sehon JK, Johnson LW. Diagnosis and management of enterovesical fistulas in patients with Crohn's disease. Am Surg 2002; 68:714.
- Smeenk RM, Plaisier PW, van der Hoeven JA, Hesp WL. Outcome of surgery for colovesical and colovaginal fistulas of diverticular origin in 40 patients. J Gastrointest Surg 2012; 16:1559.
- Morrison PD, Addison NV. A study of colovesical fistulae in a district hospital. Ann R Coll Surg Engl 1983; 65:221.
- Holroyd DJ, Banerjee S, Beavan M, et al. Colovaginal and colovesical fistulae: the diagnostic paradigm. Tech Coloproctol 2012; 16:119.
- Woods RJ, Lavery IC, Fazio VW, et al. Internal fistulas in diverticular disease. Dis Colon Rectum 1988; 31:591.
- Najjar SF, Jamal MK, Savas JF, Miller TA. The spectrum of colovesical fistula and diagnostic paradigm. Am J Surg 2004; 188:617.
- Beatty JD, Witherow R. Diagnostic lessons learnt from a series of enterovesical fistulae. Colorectal Dis 2005; 7:196.
- McCaffrey JC, Foo FJ, Dalal N, Siddiqui KH. Benign multicystic peritoneal mesothelioma associated with hydronephrosis and colovesical fistula formation: report of a case. Tumori 2009; 95:808.
- Moss RL, Ryan JA Jr. Management of enterovesical fistulas. Am J Surg 1990; 159:514.
- Barbaryan A, Jabri H, Attakamvelly S, Mirrakhimov AE. A case of colovesical fistula caused by the eroded rectal stent. BMJ Case Rep 2013; 2013.
- Bandyopadhyay S, Das C, Maity PK, et al. Isolated colonic tuberculosis with colovesical fistula. J Assoc Physicians India 2010; 58:396.
- Genta RM, Ramchandani MK, Gyorkey F, et al. Enterovesical fistula due to non-Hodgkin lymphoma in AIDS. J Clin Gastroenterol 1993; 16:333.
- Gooneratne DL. A rare late complication of spilled gallstones. N Z Med J 2010; 123:62.
- Clements MB, Hedrick TL, Colen DL, Schenkman NS. Colovesical fistula caused by an ingested chicken bone. Urology 2013; 82:e37.
- Cockell A, McQuillan T, Doyle TN, Reid DJ. Colovesical fistula caused by appendicitis. Br J Clin Pract 1990; 44:682.
- Kuntze JR, Herman MH, Evans SG. Genitourinary coccidioidomycosis. J Urol 1988; 140:370.
- Krco MJ, Jacobs SC, Malangoni MA, Lawson RK. Colovesical fistulas. Urology 1984; 23:340.
- Crispen PL, Kansas BT, Pieri PG, et al. Immediate postoperative complications of combined penetrating rectal and bladder injuries. J Trauma 2007; 62:325.
- Solkar MH, Forshaw MJ, Sankararajah D, et al. Colovesical fistula--is a surgical approach always justified? Colorectal Dis 2005; 7:467.
- Daniels IR, Bekdash B, Scott HJ, et al. Diagnostic lessons learnt from a series of enterovesical fistulae. Colorectal Dis 2002; 4:459.
- Raymond PL, Gibler WB. Detection of colovesical fistula in the emergency department: report of a case. Am J Emerg Med 1989; 7:191.
- Carson CC, Malek RS, Remine WH. Urologic aspects of vesicoenteric fistulas. J Urol 1978; 119:744.
- Yang CH, Liu KH, Chen TC, et al. Enterovesical fistula caused by a bladder squamous cell carcinoma. World J Gastroenterol 2009; 15:4215.
- Tang YZ, Booth TC, Swallow D, et al. Imaging features of colovesical fistulae on MRI. Br J Radiol 2012; 85:1371.
- Kwon EO, Armenakas NA, Scharf SC, et al. The poppy seed test for colovesical fistula: big bang, little bucks! J Urol 2008; 179:1425.
- Schwaibold H, Popiel C, Geist E, Hartung R. Oral intake of poppy seed: a reliable and simple method for diagnosing vesico-enteric fistula. J Urol 2001; 166:530.
- Amendola MA, Agha FP, Dent TL, et al. Detection of occult colovesical fistula by the Bourne test. AJR Am J Roentgenol 1984; 142:715.
- Mayo CW, Miller JM. Surgical treatment of sigmoidovesical fistulas. Arch Surg 1940; 40:897.
- O'Leary DP. Use of the greater omentum in colorectal surgery. Dis Colon Rectum 1999; 42:533.
- Köhler L, Sauerland S, Neugebauer E. Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery. Surg Endosc 1999; 13:430.
- Cirocchi R, Cochetti G, Randolph J, et al. Laparoscopic treatment of colovesical fistulas due to complicated colonic diverticular disease: a systematic review. Tech Coloproctol 2014; 18:873.
- Burke JP, Talha S, Yii H, et al. Laparoscopic-assisted sigmoid colectomy for diverticular colovesical fistula. Am Surg 2013; 79:e289.
- Giovanni C, Emanuele C, Roberto C, et al. Laparoscopic conservative surgery of colovesical fistula: is it the right way? Wideochir Inne Tech Maloinwazyjne 2013; 8:162.
- Cirocchi R, Arezzo A, Renzi C, et al. Is laparoscopic surgery the best treatment in fistulas complicating diverticular disease of the sigmoid colon? A systematic review. Int J Surg 2015; 24:95.
- Purkayastha S, Constantinides VA, Tekkis PP, et al. Laparoscopic vs. open surgery for diverticular disease: a meta-analysis of nonrandomized studies. Dis Colon Rectum 2006; 49:446.
- Walker KG, Anderson JH, Iskander N, et al. Colonic resection for colovesical fistula: 5-year follow-up. Colorectal Dis 2002; 4:270.
- Kirsh GM, Hampel N, Shuck JM, Resnick MI. Diagnosis and management of vesicoenteric fistulas. Surg Gynecol Obstet 1991; 173:91.
- de Moya MA, Zacharias N, Osbourne A, et al. Colovesical fistula repair: is early Foley catheter removal safe? J Surg Res 2009; 156:274.
- Ferguson GG, Lee EW, Hunt SR, et al. Management of the bladder during surgical treatment of enterovesical fistulas from benign bowel disease. J Am Coll Surg 2008; 207:569.
- Radwan R, Saeed ZM, Phull JS, et al. How safe is it to manage diverticular colovesical fistulation non-operatively? Colorectal Dis 2013; 15:448.
- Khanbhai M, Hodgson C, Mahmood K, et al. Colo-vesical fistula: Complete healing without surgical intervention. Int J Surg Case Rep 2014; 5:448.
- Sharma SK, Perry KT, Turk TM. Endoscopic injection of fibrin glue for the treatment of urinary-tract pathology. J Endourol 2005; 19:419.
- Yashi M, Muraishi O, Yuzawa M, Tokue A. [A case of colo-vesico-vaginal fistula caused by sigmoid colon diverticulitis]. Hinyokika Kiyo 1998; 44:513.
- Ahmad M, Nice C, Katory M. Covered metallic stents for the palliation of colovesical fistula. Ann R Coll Surg Engl 2010; 92:W43.
- Watt AM, Faragher IG, Griffin TT, et al. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 2007; 246:24.
- CLINICAL MANIFESTATIONS
- EVALUATION AND DIAGNOSIS
- Initial tests to diagnose colovesical fistula
- - Urinalysis and urine culture
- - Abdominopelvic CT with oral or rectal contrast
- Lower gastrointestinal endoscopy to identify etiology
- Cystoscopy for suspected malignant fistula
- Infrequently performed tests
- Treat symptomatic infection if present
- Definitive treatment of fistula
- - Operative management
- Benign fistula
- - Multistage operation
- - Laparoscopic operation
- Malignant fistula
- - Postoperative management of the bladder
- Nonoperative management
- SUMMARY AND RECOMMENDATIONS