Colovesical fistula complicating diverticular disease: one-stage resection

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Colorectal Surgery

Background:

• Colonic diverticular disease is a prevalent condition, particularly in aging populations.
• While often asymptomatic, complications like colovesical fistula necessitate treatment.
• Colovesical fistula, a connection between the colon and bladder, is the most frequent fistula associated with diverticular disease, occurring in 65% of cases.

Observation:

• This study reports on four patients diagnosed with colovesical fistula.
• All patients underwent primary resection of the sigmoid colon with colorectal anastomosis as a single-stage procedure.
• The study observed the outcomes of this one-step surgical approach.

Findings:

• Primary sigmoid colon resection with colorectal anastomosis is a safe and definitive treatment for colovesical fistula in 90% of patients.
• The one-stage procedure effectively resolves the fistula.
• Diverting colostomy or Hartmann procedures were not recommended due to lack of definitive resolution and potential for added complications.

Implications:

• A one-stage primary resection and anastomosis is a recommended surgical strategy for colovesical fistula.
• This approach offers definitive treatment and avoids the morbidity associated with staged procedures.
• Minimizing the need for ostomies can improve patient outcomes and reduce healthcare costs.