Vesico-colic fistulae in the Grampian region: presentation, assessment, management and outcome.
Over a 12-year period, 67 patients presented with a vesico-colic fistula. The mean age was 69 years (range 19-96 years), with symptoms predominantly referred to the urinary tract. Cystoscopy and barium enema confirmed the presence of a fistula in 60 and 44% of patients respectively. A computerized tomography (CT) scan, used in only seven patients, revealed the fistula in each case. The underlying pathology included diverticular disease (62%), carcinoma (27%) and inflammatory bowel disease (6%). Fifty-one patients proceeded to surgery, of whom 32 (63%) had a sigmoid/recto sigmoid resection with primary anastomosis, and 13 (25%) a Hartmann's procedure. A diverting colostomy alone was employed to palliate cases of widespread carcinoma. No patient subsequently had the Hartmann's reversed. In addition to colonic resection, 48 (92%) patients had a simultaneous bladder procedure, varying from simple oversew in 32 (70%) patients to cystectomy and ileal conduit in three (6%). Wedge excision with primary bladder closure was practised in 12 (24%). Fistula recurrence occurred in seven (14%) patients, and the 30-day mortality was 10%. Surgery for vesico-colic fistula has an appreciable morbidity and mortality, yet if offers the only hope of achieving permanent symptomatic control.
Driver
C P
CP
Aberdeen Royal Hospitals NHS Trust, Foresterhill, UK.
Anderson
D N
DN
Findlay
K
K
Keenan
R A
RA
Davidson
A I
AI
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D001466:Barium Sulfate; D002277:Carcinoma / Q000453:epidemiology; D003082:Colectomy / Q000706:statistics & numerical data; D012809:Colon, Sigmoid / Q000601:surgery; D003108:Colonic Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D003110:Colonic Neoplasms / Q000453:epidemiology; D003125:Colostomy / Q000706:statistics & numerical data; D003287:Contrast Media; D015653:Cystectomy / Q000706:statistics & numerical data; D003558:Cystoscopy; D004241:Diverticulum, Colon / Q000453:epidemiology; D004733:Enema; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology; D007412:Intestinal Fistula / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012007:Rectum / Q000601:surgery; D012008:Recurrence; D012606:Scotland / Q000453:epidemiology; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D001747:Urinary Bladder Fistula / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D014547:Urinary Diversion / Q000706:statistics & numerical data
D003287:Contrast Media; D001466:Barium Sulfate