Colovesical fistula complicating diverticular disease: one-stage resection

Colonic diverticular disease is common in developed countries, and its prevalence increases with age. Most affected individuals remain asymptomatic throughout their lives, and relatively few patients require surgical intervention for obstructive or inflammatory complications. Colovesical fistula is the most common type (65%) of fistula associated with colonic diverticular disease. Primary resection of sigmoid colon with colorectal anastomosis performed as a one-stage procedure is its definitive treatment and can be performed safely--as simple closure, using an omental flap, or through resection and closure of bladder defect--in 90% of the patients. We report our experience with four patients suffering from colovesical fistula who were treated with primary resection of sigmoid colon and colorectal anastomosis performed as a one-step procedure. In our experience, diverting colostomy or Hartmann intervention is not recommended because of the lack of fistula definitive resolution and the possibility of additional complications.