Techniques in Coloproctology

, Volume 16, Issue 2, pp 119–126 | Cite as

Colovaginal and colovesical fistulae: the diagnostic paradigm

  • D. J. Holroyd
  • S. Banerjee
  • M. Beavan
  • R. Prentice
  • V. Vijay
  • S. J. Warren
Original Article

Abstract

Background

Colovaginal and colovesical fistulae (CVF) are relatively uncommon conditions, most frequently resulting from diverticular disease or colorectal cancer. A high suspicion of a CVF can usually be obtained from an accurate clinical history. Demonstrating CVF radiologically is often challenging, and patients frequently undergo a multitude of investigations prior to definitive management. The aim of this study was to develop an algorithm for the investigation of suspected CVF in order to improve diagnosis and subsequent management.

Methods

Thirty-seven patients from a single NHS Trust with a diagnosis of colovaginal or colovesical fistula were included in the study. Clinical records and imaging were reviewed retrospectively, and data on demographics, symptoms, investigations, management and outcome were collated.

Results

A total of 87.5% patients with a colovesical fistula presented with pathognomic symptoms of faecaluria or pneumaturia. The commonest aetiologies were diverticular disease (72.9%), colonic and gynaecological neoplasia (10.8% each). Computerised tomography (CT) was the most frequently performed investigation (91.9%) and was most sensitive in detecting the fistula (76.5%) and underlying aetiology (94.1%). Colonoscopy was most sensitive in detecting an underlying colonic malignancy (100%). Resectional surgery was performed in 62.1% of cases, although morbidity and 1-year mortality was significant, with rates of 21.7 and 17.4%, respectively.

Conclusions

The diagnosis of CVF is predominately a clinical one, and patients with a suspected CVF are over-investigated. Investigations should be focused on determining aetiology rather than demonstrating the fistulous tract itself. We propose that, in the majority of cases, CT and lower gastrointestinal endoscopy should suffice.

Keywords

Fistula Diverticular disease Colorectal cancer Investigation Diagnosis 

References

  1. 1.
    Scozzari G, Arezzo A, Morino M (2010) Enterovesical fistulas: diagnosis and management. Tech Coloproctol 14:293–300PubMedCrossRefGoogle Scholar
  2. 2.
    Solkar MH, Forshaw MJ, Sankararajah D, Stewart M, Parker MC (2005) Colovesical fistula—is a surgical approach always justified? Colorectal Dis 7:467–471PubMedCrossRefGoogle Scholar
  3. 3.
    Hjern F, Goldberg SM, Johansson C, Parker SC, Mellgren A (2007) Management of diverticular fistulae to the female genital tract. Colorectal Dis 9:438–442PubMedCrossRefGoogle Scholar
  4. 4.
    Dowling CM, Floyd MS, Power RE, Hyland JM, Quinlan DM (2009) Ureterocolic fistula in the presence of a solitary kidney. BMJ Case Rep. doi:10.1136/bcr.06.2008.0301
  5. 5.
    Engledow AH, Pakzad F, Ward NJ, Arulampalam T, Motson RW (2007) Laparoscopic resection of diverticular fistulae: a 10-year experience. Colorectal Dis 9:632–634PubMedCrossRefGoogle Scholar
  6. 6.
    Garcea G, Majid I, Sutton CD, Pattenden CJ, Thomas WM (2006) Diagnosis and management of colovesical fistulae; six-year experience of 90 consecutive cases. Colorectal Dis 8:347–352PubMedCrossRefGoogle Scholar
  7. 7.
    Pollard SG, Macfarlane R, Greatorex R, Everett WG, Hartfall WG (1987) Colovesical fistula. Ann R Coll Surg Engl 69:163–165PubMedGoogle Scholar
  8. 8.
    Daniels IR, Bekdash B, Scott HJ, Marks CG, Donaldson DR (2002) Diagnostic lessons learnt from a series of enterovesical fistulae. Colorectal Dis 4:459–462PubMedCrossRefGoogle Scholar
  9. 9.
    Driver CP, Anderson DN, Findlay K, Keenan RA, Davidson AI (1997) Vesico-colic fistulae in the Grampian region: presentation, assessment, management and outcome. J R Coll Surg Edinb 42:182–185PubMedGoogle Scholar
  10. 10.
    Melchior S, Cudovic D, Jones J, Thomas C, Gillitzer R, Thüroff J (2009) Diagnosis and surgical management of colovesical fistulas due to sigmoid diverticulitis. J Urol 182:978–982PubMedCrossRefGoogle Scholar
  11. 11.
    White SI, Frenkiel B, Martin PJ (2010) A ten-year audit of perforated sigmoid diverticulitis: highlighting the outcomes of laparoscopic lavage. Dis Colon Rectum 53:1537–1541PubMedCrossRefGoogle Scholar
  12. 12.
    Andreani SM, Dang HH, Grondona P, Khan AZ, Edwards DP (2007) Rectovaginal fistula in Crohn’s disease. Dis Colon Rectum 50:2215–2222PubMedCrossRefGoogle Scholar
  13. 13.
    Hawary A, Clarke L, Taylor A, Duffy P (2009) Enterovesical fistula: a rare complication of urethral catheterization. Adv Urol 591204 [Epub ahead of print]Google Scholar
  14. 14.
    Bahadursingh AM, Longo WE (2003) Colovaginal fistulas. Etiology and management. J Reprod Med 48:489–495PubMedGoogle Scholar
  15. 15.
    Ho KM, Sole GM (1994) Pneumaturia due to gas-producing E. coli and urinary stasis. Br J Urol 73:588–589PubMedCrossRefGoogle Scholar
  16. 16.
    Sultana SR, McNeill SA, Phillips G, Byrne DJ (1998) Candidal urinary tract infection as a cause of pneumaturia. J R Coll Surg Edinb 43:198–199PubMedGoogle Scholar
  17. 17.
    Ravichandran S, Ahmed HU, Matanhelia SS, Dobson M (2008) Is there a role for magnetic resonance imaging in diagnosing colovesical fistulas? Urology 72:832–837PubMedCrossRefGoogle Scholar
  18. 18.
    Kavanagh D, Neary P, Dodd JD, Sheahan KM, O’Donoghue D, Hyland JM (2005) Diagnosis and treatment of enterovesical fistulae. Colorectal Dis 7:286–291PubMedCrossRefGoogle Scholar
  19. 19.
    Maconi G, Sampietro GM, Parente F et al (2003) Contrast radiology, computed tomography and ultrasonography in detecting internal fistulas and intra-abdominal abscesses in Crohn’s disease: a prospective comparative study. Am J Gastroenterol 98:1545–1555PubMedCrossRefGoogle Scholar
  20. 20.
    Lau KC, Spilsbury K, Farooque Y et al (2011) Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded? Dis Colon Rectum 54:1265–1270PubMedCrossRefGoogle Scholar
  21. 21.
    McBeath RB, Schiff M Jr, Allen V, Bottaccini MR, Miller JI, Ehreth JT (1994) A 12-year experience with enterovesical fistulas. Urology 44:661–665PubMedCrossRefGoogle Scholar
  22. 22.
    Redan JA, McCarus SD (2009) Protect the ureters. JSLS 13:139–141PubMedGoogle Scholar
  23. 23.
    Jones OM, John SK, Lawrance RJ, Fozard JB (2007) Long-term survival is possible after stenting for malignant ureteric obstruction in colorectal cancer. Ann R Coll Surg Engl 89:414–417PubMedCrossRefGoogle Scholar
  24. 24.
    Rex DK, Rahmani EY, Haseman JH, Lemmel GT, Kaster S, Buckley JS (1997) Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology 112:17–23PubMedCrossRefGoogle Scholar
  25. 25.
    de Zwart IM, Griffioen G, Shaw MP, Lamers CB, de Roos A (2001) Barium enema and endoscopy for the detection of colorectal neoplasia: sensitivity, specificity, complications and its determinants. Clin Radiol 56:401–409PubMedCrossRefGoogle Scholar
  26. 26.
    Winawer SJ, Stewart ET, Zauber AG et al (2000) A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med 342:1766–1772PubMedCrossRefGoogle Scholar
  27. 27.
    Rosman AS, Korsten MA (2007) Meta-analysis comparing CT colonography, air contrast barium enema, and colonoscopy. Am J Med 120:203–210PubMedCrossRefGoogle Scholar
  28. 28.
    Najjar SF, Jamal MK, Savas JF, Miller TA (2004) The spectrum of colovesical fistula and diagnostic paradigm. Am J Surg 188:617–621PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • D. J. Holroyd
    • 1
    • 2
  • S. Banerjee
    • 1
  • M. Beavan
    • 1
  • R. Prentice
    • 1
  • V. Vijay
    • 1
  • S. J. Warren
    • 1
  1. 1.Department of SurgeryBarnet and Chase Farm NHS TrustEnfield, MiddlesexUK
  2. 2.Nuffield Department of Surgical Sciences, Oxford Transplant Centre, Churchill HospitalUniversity of OxfordOxfordUK

Personalised recommendations