How are radiation-induced 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

Surgery to manage radiation-induced fistulae can be difficult. In severe cases, the colorectal and adjacent organs are matted together with no natural planes, making mobilization and resection hazardous. In this situation, diverting proximal colostomy or ileostomy is advisable. In milder cases in which resection can be safely performed, a descending anal anastomosis, with or without a colonic J pouch, can be performed. [51]

The urinary system can be left intact with catheter drainage, although healing in this situation is slow and may require longer periods of catheterization. Typically, surgical separation of the genitourinary and gastrointestinal systems is required, and staged operations are more commonly performed because of the poor quality of tissues. When healing is not expected, a transverse colon conduit is often successful at restoring quality of life. Ileal and sigmoid conduits are less favorable because they have often been in the field of radiation. [24]


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