[Clinical Experience with Colovesical and Rectovesical Fistulas : A Case Series from Rakuwakai Otowa Hospital]

Colovesical and rectovesical fistulas are relatively rare, and there is no consensus on the gold standard for diagnostic workup and treatment. Here we retrospectively analyzed clinical courses from four patients with colovesical or rectovesical fistulas diagnosed at our hospital between January 2024 and December 2024. Among the four cases, three were male, and one was female. Fever was the chief complaint in three of the four cases, and sigmoid diverticulitis was identified as the underlying disease in two cases. All patients underwent abdominal plain CT scan and cystoscopy. CT scan revealed intravesical air in all cases. In one case, there was a discrepancy between the fistula location identified on CT and cystoscopic findings. One patient underwent laparoscopic sigmoidectomy as curative treatment, with an uneventful postoperative course. In the three cases managed conservatively, laparoscopic colostomy was performed, and postoperative complications such as urinary tract infection and urethral catheter obstruction occurred. In our case series, cystoscopy was useful for assessing the fistula location accurately. Preoperative evaluation with cystoscopy should be considered, especially in patients scheduled for curative surgery.