[Uretero-colic fistula. Apropos of 2 cases complicating sigmoid diverticulitis after surgery]

The authors report on two cases of uretero-colic fistulization in the post-operative period, following surgery for infectious complications involving sigmoidal diverticulitis. In the aftermath of surgery for sigmoidal diverticula, the appearance of very liquid stools at the exact moment when the infectious and semi-occlusive picture seems to resolve, the occurrence of a uro-steraceous fistula should make one suspect a uretero-colic fistula. Air pyelography and the retrograde opacification of the ureter following a radio-opaque enema are diagnostic. The IVU does not help to establish a firm diagnosis but is useful for showing the state of the adjacent kidney and above all the state of the contralateral kidney. In regard to the sepsis which accompanies these complications (there is nearly always a pericolic abscess at the site of the utero-colic fistula) all attempts at repair are futile. Only nephrectomy may be sometimes appropriate. At the same time, nothing except treatment of the infectious focus (colic or pericolic) will safeguard the patient from the risk of further infection which might end in death. The risk of damage to the ureter which sigmoidal diverticular surgery carries, necessitates the following precautions: a pre-operative IVU, a painstaking dissecting-out and well wide of the neighbouring ureter, the systematic injections of dye to colour the urine at the time of operation in order to avoid ureteric injury and of course to ensure the repair of any injury as soon as it happens. It is only possible to save the adjacent kidney and protect the normal urinary outlet if the ureteric lesion is properly identified at operation.