When the bowel meets the bladder: Optimal management of colorectal pathology with urological involvement.
MetadataShow full item record
JournalWorld journal of gastrointestinal surgery
AbstractFistulae between the gastrointestinal and urinary systems are rare but becoming increasingly more common in current surgical practice. They are a heterogeneous group of pathological entities that are uncommon complications of both benign and malignant processes. As the incidence of complicated diverticular disease and colorectal malignancy increases, so too does the extent of fistulous connections between the gastrointestinal and urinary systems. These complex problems will be more common as a factor of an aging population with increased life expectancy. Diverticular disease is the most commonly encountered aetiology, accounting for up to 80% of cases, followed by colorectal malignancy in up to 20%. A high index of suspicion is required in order to make the diagnosis, with ever improving imaging techniques playing an important role in the diagnostic algorithm. Management strategies vary, with most surgeons now advocating for a single-stage approach to enterovesical fistulae, particularly in the elective setting. Concomitant bladder management techniques are also disputed. Traditionally, open techniques were the standard; however, increased experience and advances in surgical technology have contributed to refined and improved laparoscopic management. Unfortunately, due to the relative rarity of these entities, no randomised studies have been performed to ascertain the most appropriate management strategy. Rectourinary fistulae have dramatically increased in incidence with advances in the non-operative management of prostate cancer. With radiotherapy being a major contributing factor in the development of these complex fistulae, optimum surgical approach and exposure has changed accordingly to optimise their management. Conservative management in the form of diversion therapy is effective in temporising the situation and allowing for the diversion of faecal contents if there is associated soiling, macerated tissues or associated co-morbidities. One may plan for definitive surgical intervention at a later stage. Less contaminated cases with no fibrosis may proceed directly to definitive surgery if the appropriate expertise is available. An abdominal approach with direct repair and omentum interposition between the repaired tissues has been well described. In low lying fistulae, a transperineal approach with the patient in a prone-jack knife position provides optimum exposure and allows for the use of interposition muscle grafts. According to recent literature, it offers a high success rate in complex cases.
- Diverticular colovesical fistula: What should we really be doing?
- Authors: Bertelson NL, Abcarian H, Kalkbrenner KA, Blumetti J, Harrison JL, Chaudhry V, Young-Fadok TM
- Issue date: 2018 Jan
- Elective laparoscopic surgery for benign internal enteric fistulas: a review of 43 cases.
- Authors: Pokala N, Delaney CP, Brady KM, Senagore AJ
- Issue date: 2005 Feb
- Urorectal fistulae following the treatment of prostate cancer.
- Authors: Mundy AR, Andrich DE
- Issue date: 2011 Apr
- [The current view of surgical treatment of diverticular disease].
- Authors: Zonca P, Jacobi CA, Meyer GP
- Issue date: 2009 Oct
- Laparoscopic surgery of benign entero-vesical or entero-vaginal fistulae.
- Authors: Kraemer M, Kara D
- Issue date: 2016 Jan
Showing items related by title, author, creator and subject.
Multimodal treatment of perianal fistulas in Crohn's disease: seton versus anti-TNF versus advancement plasty (PISA): study protocol for a randomized controlled trial.de Groof, E Joline; Buskens, Christianne J; Ponsioen, Cyriel Y; Dijkgraaf, Marcel G W; D'Haens, Geert R A M; Srivastava, Nidhi; van Acker, Gijs J D; Jansen, Jeroen M; Gerhards, Michael F; Dijkstra, Gerard; et al. (BioMed Central, 2015-08-20)Currently there is no guideline for the treatment of patients with Crohn's disease and high perianal fistulas. Most patients receive anti-TNF medication, but no long-term results of this expensive medication have been described, nor has its efficiency been compared to surgical strategies. With this study, we hope to provide treatment consensus for daily clinical practice with reduction in costs.
Tracheo-oesophageal fistula diagnosed with multidetector computed tomography.Hodnett, Pa; McSweeney, S E; Coyle, J; Barry, J; Plant, R; Maher, M M; Department of Anaethesia and Intensive Care Medicine. (2009-04)This case highlights important issues in investigation of patients with suspected tracheo-oesophageal fistula including the value of multidetector computed tomography, the importance of thorough imaging evaluation when high clinical suspicion of tracheo-oesophageal fistula exists and the value of close interaction between radiologists and intensive care physicians in the investigation of these patients.
Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case reportMartin-Smith, James D; Larkin, John O; O'Connell, Finbar; Ravi, Narayanasamy; Reynolds, John Vincent (2009-12-24)Abstract Background The development of a fistula between the tracheobronchial tree and the gastric conduit post esophagectomy is a rare and often fatal complication. Case presentation A 68 year old man underwent radical esophagectomy for esophageal adenocarcinoma. On postoperative day 14 the nasogastric drainage bag dramatically filled with air, without deterioration in respiratory function or progressive sepsis. A fiberoptic bronchoscopy was performed which demonstrated a gastro-bronchial fistula in the posterior aspect of the left main bronchus. He was managed conservatively with antibiotics, enteral nutrition via jejunostomy, and non-invasive respiratory support. A follow- up bronchoscopy 60 days after the diagnostic bronchoscopy, confirmed spontaneous closure of the fistula Conclusions This is the first such case where a conservative approach with no surgery or endoprosthesis resulted in a successful outcome, with fistula closure confirmed at subsequent bronchoscopy. Our experience would suggest that in very carefully selected cases where bronchopulmonary contamination from the fistula is minimal or absent, there is no associated inflammation of the tracheobronchial tree and the patient is stable from a respiratory point of view without evidence of sepsis, there may be a role for a trial of conservative management.