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Perioperative Management of Patients with Colovesical Fistula

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Colovesical fistula (CVF) is an uncommon complication of diverticulitis. Substantial heterogeneity exists in the perioperative management of this condition. We seek to evaluate the role of bladder leak testing, closed suction drainage, prolonged bladder catheter usage, and routine postoperative cystogram in the management of CVF.

Study Design

This is a retrospective study from a single academic health center investigation patients undergoing operation for diverticular CVF from 2005 to 2015 (n = 89).

Results

Patients undergoing operative repair for diverticular CVF resection had a mortality of 4% and overall morbidity of 46%. Intraoperative bladder leak test was performed in 36 patients (40%) and demonstrated a leak in 4 patients (11%). No patients with a negative intraoperative bladder leak test developed a urinary leak. Overall, five (6%) patients developed postoperative bladder leak. Three were identified by elevated drain creatinine and two by cystogram. The diagnostic yield of routine cystogram was 3%. All bladder leaks were diagnosed between postoperative day 3 and 7. Of patients with a postoperative bladder leak, none required reoperation and all resolved within 2 months.

Conclusions

There is significant variability in the management of patients undergoing operation for CVF. Routine intraoperative bladder leak test should be performed. Cystogram may add cost and is low yield for routine evaluation for bladder leak after operation for CVF. Urinary catheter removal before postoperative day 7 should be considered.

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Abbreviations

CVF:

Colovesical fistula

ICD:

International Classification of Diseases

CT:

Computed tomography

DC-SC:

Drain creatinine to serum creatinine

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Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, Indianapolis, USA

    Scott C. Dolejs, Alyssa J. Penning, Michael J. Guzman, Alyssa D. Fajardo, Bryan K. Holcomb, Bruce W. Robb & Joshua A. Waters

  2. 1801 N. Senate Blvd., Suite 635, Indianapolis, IN, 46202, USA

    Joshua A. Waters

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  1. Scott C. Dolejs
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  2. Alyssa J. Penning
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  3. Michael J. Guzman
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Contributions

Dr.’s Dolejs, Penning, Guzman, Fajardo, Holcomb, Robb, and Waters made substantial contributions to the conception of the work, revising the work for important intellectual content, final approval of the version to be published, and agree to be accountable for all aspects of the work. Dr.’s Dolejs, Penning, and Waters made substantial contributions to the acquisition, analysis, and interpretation of data and drafting the work.

Corresponding author

Correspondence to Joshua A. Waters.

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The authors declare that they have no conflict of interest.

Additional information

This was a poster presentation at the American Society of Colon and Rectal Surgeons Tripartite Meeting on June 10–14, 2017, in Seattle, Washington

The manuscript has not been previously published and is not under consideration by another publication or electronic medium.

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Dolejs, S.C., Penning, A.J., Guzman, M.J. et al. Perioperative Management of Patients with Colovesical Fistula. J Gastrointest Surg 23, 1867–1873 (2019). https://doi.org/10.1007/s11605-018-4034-0

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  • DOI: https://doi.org/10.1007/s11605-018-4034-0

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