What is the pathophysiology of inflammatory enterovesical fistula?

Updated: Dec 24, 2020
  • Author: Joseph Basler, MD, PhD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Diverticulitis accounts for approximately 50%-70% of vesicoenteric fistulae, almost all of which are colovesical. A phlegmon or abscess is a risk factor for fistula formation. [6] This complication occurs in 2%-4% of cases of diverticulitis, although referral centers have reported a higher incidence. [7]

Crohn disease accounts for approximately 10% of vesicoenteric fistulae and is the most common cause of an ileovesical fistula. Ileovesical fistulae develop in 10% of patients with regional ileitis. The transmural nature of the inflammation characteristic of Crohn colitis often results in adherence to other organs. Subsequent erosion into adjacent organs can then give rise to a fistula. The mean duration of Crohn disease at the time of first symptoms of fistula formation is 10 years, and the average patient age is 30 years. [8]

Less-common inflammatory causes of colovesical fistulae include Meckel diverticulum, [9] genitourinary coccidioidomycosis, [10] and pelvic actinomycosis. [11] In addition, case reports have described appendicovesical fistulae as a complication of appendicitis. [12, 13, 14, 15] Enterovesical fistula formation due to lymphadenopathy associated with Fabry disease has been reported. [16]

Rarely, the inflammatory process originates in the bladder, as noted in a case report from Spain of bladder gangrene that caused a colovesical fistula in a patient with diabetes mellitus. [17] Other case reports have demonstrated fistula formation in the setting of chronic outlet obstruction due to benign prostatic hypertrophy, with the formation of a large bladder stone and recurrent infections. [18]

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