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Colovesical and rectovesical fistulas

R M King, R W Beart, D C McIlrath

Archives of Surgery (Chicago, Ill. : 1960)

|May 1, 1982

Summary

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Inflammation, such as diverticulitis or Crohn's disease, is the most common cause of colovesical and rectovesical fistulas. While many fistulas caused by inflammation can be treated in one stage, those caused by cancer often require more complex surgical approaches.

Area of Science:

Gastroenterology
Colorectal Surgery
Urology

Background:

Colovesical or rectovesical fistulas are abnormal connections between the colon/rectum and the bladder/rectum.
Causes include congenital abnormalities, trauma, inflammation (diverticulitis, Crohn's disease), and cancer.

Purpose of the Study:

To analyze the causes, treatment outcomes, and recurrence rates of colovesical and rectovesical fistulas.
To compare management strategies for inflammatory versus malignant fistulas.

Main Methods:

Retrospective review of 109 patients diagnosed with colovesical or rectovesical fistulas between 1965 and 1980 at the Mayo Clinic.
Analysis of patient demographics, fistula etiology, surgical interventions, and follow-up data.

Main Results:

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Inflammation (diverticulitis, Crohn's disease) caused 67% of fistulas; 64% of these inflammatory colovesical fistulas were treated with one-stage resection and anastomosis.
Cancer (cervix, prostate, bladder, colon, rectum) accounted for 27% of fistulas; only 26% of these malignant fistulas were treated with one-stage anterior resection.
Fifteen patients required fecal diversion; two patients experienced fistula recurrence at follow-up.

Conclusions:

Inflammatory fistulas generally have better outcomes and are more amenable to one-stage surgical repair compared to malignant fistulas.
Malignant fistulas often necessitate more extensive surgery, including fecal diversion, and carry a risk of recurrence.