How are inflammatory enterovesical fistula repaired?

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

Diverticulitis is generally managed with blunt dissection of the colon from the bladder, resection of the colon, and primary anastomosis. Often, when the colon is freed from the bladder, the bladder does not contain an actual opening. Many of these fistulous tracts are tiny, and, if the opening into the bladder is not apparent, it can be demonstrated by distending the bladder via a catheter with fluid that contains methylene blue. A large visible opening can be closed in two layers with interrupted absorbable sutures. Smaller lesions can be left alone. [4]

Fibrin sealant closure of a contaminated fistula has been described, with no evidence of fistula recurrence at 4 years. [69] The diseased bowel is resected, and a primary anastomosis is usually created. If suitable omentum is available, it may be interposed with tacking sutures between the bladder and bowel. Extensive inflammatory involvement of the bladder wall, once thought to require partial bladder resection, does not necessarily require removal of any part of the bladder. Excision of involved bladder tissue is necessary only for carcinoma. [4]


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