What are the possible complications 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

In a 1988 study, Woods et al reported a 3.5% operative mortality rate and a complication rate of 27%. [43] Fistula recurrences have been reported in 4%-5% of patients. Most other studies have not reported such high operative mortality rates, except in the cases of severely ill patients with other significant medical problems.

Short-term complications include the usual potential problems after general surgery (eg, fever, atelectasis, slow return of bowel function, catheter-related UTI, deep vein thrombosis [DVT], wound breakdown and infection). These complications are largely preventable with incentive spirometry, early ambulation, thromboembolic hose or anticoagulation in susceptible patients, and appropriate wound-closure techniques.

Long-term complications include persistent bladder leak (usually observed after radiotherapy for carcinoma), recurrence of a fistula (also more likely after radiotherapy), pelvic/abdominal abscess (from a leaking anastomosis), cutaneous fistulization (also from a leaking anastomosis), and bowel obstruction (from adhesions or recurrent diverticulitis).

Consider recurrent cancer in the abdomen or previously involved bladder wall when patients return with signs of bowel obstruction, new hematuria, or irritative voiding. Repeat CT scanning, serum carcinoembryonic antigen (CEA) measurement, urine culture and cytology, and cystoscopy are indicated in these settings.


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