Laparoscopic Resection of a Colovesical Fistula Secondary to Diverticulitis Using Near-Infrared Fluorescent Ureteral...

A colovesical fistula is a rare complication most often caused by diverticulitis, typically requiring surgical repair due to the pressure gradient in which the intraluminal pressure within the colon exceeds that of the bladder.

We report a 49-year-old man with pneumaturia and fecaluria secondary to chronic sigmoid diverticulitis. Imaging demonstrated a colovesical fistula, and cystoscopy confirmed fecal discharge at the bladder dome. Laparoscopic sigmoidectomy with bladder repair was performed after preoperative placement of bilateral near-infrared fluorescent ureteral catheters (NIRFUCs). Intraoperatively, dense adhesions were encountered, but the ureters were instantly and clearly identified with fluorescence prior to and throughout dissection, preventing iatrogenic injury. The fistula was resected, the bladder defect closed, and colorectal anastomosis completed without diversion. Operative time was 360 min with minimal blood loss, and recovery was uneventful. Histopathological examination confirmed diverticulitis without malignancy.

This case highlights the feasibility of laparoscopic management of colovesical fistula and demonstrates the usefulness of NIRFUCs in ensuring ureteral safety during challenging pelvic surgery, especially in the era of minimally invasive surgery where fluorescence compensates for the lack of tactile feedback.