What are the signs and symptoms of enterovesical fistula?

Updated: Dec 24, 2020
  • Author: Joseph Basler, MD, PhD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

The presenting symptoms and signs of enterovesical fistulae occur primarily in the urinary tract. Symptoms include suprapubic pain, irritative voiding symptoms, and symptoms associated with chronic urinary tract infection (UTI). The hallmark of enterovesical fistulae may be described as Gouverneur syndrome, namely, suprapubic pain, frequency, dysuria, and tenesmus. Other signs include abnormal urinalysis findings, malodorous urine, pneumaturia, debris in the urine, hematuria, and UTIs. [33]

The severity of the presentation also varies. Chronic UTI symptoms are common, and patients with enterovesical fistula frequently report numerous courses of antibiotics prior to referral to a urologist for evaluation. Urosepsis may be present and can be exacerbated in the setting of obstruction. It has been demonstrated in dog models that surgically created colovesical fistulae are tolerated well in the absence of obstruction. [34]

Pneumaturia and fecaluria may be intermittent and must be carefully sought in the history. Pneumaturia occurs in approximately 50%-60% of patients with enterovesical fistula but alone is nondiagnostic, as it can be caused by gas-producing organisms (eg, Clostridium species, yeast) in the bladder, particularly in patients with diabetes mellitus (ie, fermentation of diabetic urine) or in those undergoing urinary tract instrumentation. Pneumaturia is more likely to occur in patients with diverticulitis or Crohn disease than in those with cancer. Fecaluria is pathognomonic of a fistula and occurs in approximately 40% of cases. Patients may describe passing vegetable matter in the urine. The flow through the fistula predominantly occurs from the bowel to the bladder. Patients very rarely pass urine from the rectum. [19]

Symptoms of the underlying disease causing the fistula may be present. Abdominal pain is more common in patients with Crohn disease, but an abdominal mass is discovered in fewer than 30% of patients. In patients with Crohn disease who have a fistula, abdominal mass and abscess are more common. [19]


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