Large Intestine: Colovesicular Fistula

General Enteric Fistulas

• *See Large Intestine: General Enteric Fistula

Basics

• A Fistula from the Colon to the Urinary Bladder
• Most Common in Males (2-3:1) – Female Protected by Uterus

Causes

• Diverticulitis – Most Common (65-79%)
• Malignancy
• Crohn’s Disease
• Surgery
• Colonic Stents
• Radiation
• Trauma

Symptoms

• Pneumaturia (50-95%) – Most Often at the End of Urination
• Fecaluria (40-70%)
• Suprapubic Pain (30-90%)
• Recurrent UTI – Dysuria, Urgency & Frequency

Diagnosis

• Dx: CT with Oral/Rectal Contrast (No IV Contrast – Renal Excretion will Obscure)
• Colonoscopy to Rule Out Malignancy
• Cystoscopy if Needed to Evaluate Malignant Invasion of Bladder
• Other Tests:
  • Poppy Seed Test – Oral Ingestion of Poppy Seeds See Seeds Passed in the Urine within 48 Hours
    • High Sensitivity (Nearly 100%) but No Localization Detail
  • Barium Enema – Low Sensitivity (30%)

Treatment

• Tx: ABX & Surgical Repair
• Surgical Repair:
  • Segmental Bowel Resection (Sigmoidectomy)
  • Primary Closure of Bladder
    • If Unable to Find – Instill Methylene Blue Retrograde Through Foley Catheter
  • Place Omentum Interposition Between Colon & Bladder
• Other Considerations:
  • Low Rectum: Rectal Advancement Flap
  • Consider Two-Stage Procedure with Temporary Ostomy if High-Risk for Leak or Unable to Tolerate a Prolonged Operation