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Vesico-diverticular fistula: a rare complication of Meckel's diverticulum
H M Hudson1, F H Millham, R Dennis
1Department of Surgery, Boston University Medical Center, Massachusetts 02118.
Abstract:
Enterovesical fistulas usually result from diverticulitis, Crohn's disease, or colorectal cancer. A perforated Meckel's diverticulum can also result in an vesico-diverticulum fistula, as noted in three previously reported cases. In all three cases, bladder or bowel disease was associated with the fistula. Herein, the authors describe a previously healthy, 23-year-old man who presented with an enterovesical fistula. Exploratory laparotomy revealed a vesico-diverticular fistula resulting from a perforated Meckel's diverticulum. Pathologic examination revealed that the diverticulum did not contain ectopic gastric or pancreatic tissue and that the perforation was secondary to an enterolith. The patient underwent a diverticulectomy and had an uneventful postoperative course. Unlike any of the three previously reported cases, the authors' patient had no coexisting bowel or bladder disease occurring with his vesico-diverticular fistula. To the authors' knowledge, this is only the third reported case of a vesico-diverticular fistula resulting from a perforated Meckel's diverticulum that did not contain ectopic tissue. It represents the first case where the perforation was secondary to an enterolith.
Insights
A rare enterovesical fistula in a young man was caused by a Meckel's diverticulum perforated by an enterolith. This case is unique as it lacked associated bowel or bladder disease.
Area of Science:
- Gastroenterology
- Urology
- Surgical Pathology
Background:
- Enterovesical fistulas commonly arise from diverticulitis, Crohn's disease, or colorectal cancer.
- Vesico-diverticular fistulas, a subtype, can result from Meckel's diverticulum perforation.
- Previous cases of Meckel's-related vesico-diverticular fistulas were associated with coexisting bladder or bowel disease.
Observation:
- A previously healthy 23-year-old man presented with an enterovesical fistula.
- Exploratory laparotomy identified a vesico-diverticular fistula originating from a perforated Meckel's diverticulum.
- Pathologic examination excluded ectopic tissue within the diverticulum and identified an enterolith as the cause of perforation.
Findings:
- This represents the third reported case of a vesico-diverticular fistula from a perforated Meckel's diverticulum without ectopic tissue.
- It is the first reported instance where an enterolith caused the Meckel's diverticulum perforation.
- The patient had no concurrent bowel or bladder disease, distinguishing this case from prior reports.
Implications:
- Highlights an unusual etiology for enterovesical fistulas, emphasizing Meckel's diverticulum and enterolithiasis.
- Suggests that Meckel's diverticulum should be considered in the differential diagnosis of enterovesical fistulas, even in the absence of other gastrointestinal or urological pathology.
- Underscores the importance of thorough histopathological examination in diagnosing the precise cause of such fistulas.