What are congenital enterovesical fistula?

Answer

Fistulae may be either congenital or acquired (eg, inflammatory, surgical, neoplastic). Congenital vesicoenteric fistulae are rare and are often associated with an imperforate anus.

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Media Gallery

CT scan showing the adherence of the sigmoid colon to the lateral edge of the bladder.
A lower cut of the CT scan from the related image. Note the sigmoid colon in direct proximity to the fistula and the air in the bladder.
A CT scan one cut further inferiorly from the related images, showing the typical air pattern in the bladder and more obvious inflammatory changes at the site of the vesicoenteric fistula.
An endoscopic view of colovesical fistula (upper right). Note the prominent edema and erythema characteristic of the fistula (ie, herald patch). Occasionally, a whitish discharge with the consistency of toothpaste can be observed emanating from the orifice. The presentation of a vesicoenteric fistula includes the presence of air, fecal material, and polymicrobial recurrent urinary tract infection.
A white mucinous exudate is observed emanating from the site of a colovesical fistula in a patient with both a sigmoid diverticular abscess and colon cancer.
After a bladder wash-out, the fistula appears as a raised, edematous, sessile lesion in the bladder. The air bubble is observed at the top of the photo, and some remnant mucus threads are adherent at the bottom.
The edema surrounding the fistula often extends for a considerable distance around the bladder wall. A cobblestone appearance is typical when chronic inflammation is present.
Colovesical fistula identified on CT scan in a patient with diverticular disease and fecaluria. Arrow – fistula, B – bladder, C – sigmoid colon with diverticula.
Colovesical fistula visualization on sagittal MRI. Arrow – fistula, B – bladder, C – sigmoid colon.
Operative view from superior and anterior showing the bladder (B) and colon (C) with area of erythema at the site surrounding the fistula.
Cystoscopic view of an anastomotic urethrorectal fistula that developed after radical prostatectomy. The patient remains asymptomatic with occasional pneumaturia. This is an uncommon complication of radical prostatectomy.

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Author

Joseph Basler, MD, PhD Thomas P Ball Residency Education Professor, Urology Residency Program Director, Department of Urology, University of Texas Health Science Center at San Antonio; Chief, Section of Urology, Audie Murphy Veterans Affairs Hospital

Joseph Basler, MD, PhD is a member of the following medical societies: American Urological Association, Society of University Urologists, SWOG, Texas Medical Association, Society for Basic Urologic Research, Society of Urologic Oncology

Disclosure: Nothing to disclose.

Coauthor(s)

Eminajulo Adekoya, MD Resident Physician, Department of Urology, University of Texas Health Science Center at San Antonio School of Medicine

Eminajulo Adekoya, MD is a member of the following medical societies: American Medical Association, American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, Society of University Urologists

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Endourological Society Board of Directors; President Elect North Central Section of the American Urological Association<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cook Medical.

Additional Contributors

Erik T Goluboff, MD Professor, Department of Urology, College of Physicians and Surgeons, Columbia University College of Physicians and Surgeons; Director of Urology, Allen Pavilion, New York Presbyterian Hospital

Erik T Goluboff, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Medical Society of the State of New York, New York Academy of Medicine, Phi Beta Kappa, Society for Basic Urologic Research

Disclosure: Nothing to disclose.

Acknowledgements

Christopher H Cantrill, MD Resident Physician, Department of Urology, University of Texas Health Sciences Center at San Antonio

Christopher H Cantrill, MD is a member of the following medical societies: American Association of Clinical Urologists, American Urological Association, and Endourological Society

Disclosure: Nothing to disclose.

Ann S Fenton, MD, MPH Chief, Urology Flight Surgical Services/SGOSU, 1st Fighter Wing Hospital, Langley Air Force Base; Consulting Staff, Department of Urology, Naval Medical Center Portsmouth; Assistant Professor, Eastern Virginia Medical School

Ann S Fenton, MD, MPH is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Angela Kamerer Schang, MD Attending Urologist, McKay Urology

Angela Kamerer Schang, MD is a member of the following medical societies: American Medical Association and American Urological Association

Disclosure: Nothing to disclose.

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