European Journal of Biomedical and Pharmaceutical Sciences

LAPAROSCOPIC RESECTION OF A SIGMOID COLO - VESICAL FISTULA

Kaushika Gunasekera, Mohmed Mushraf, Wasula Rathnaweera*, Nirmalasingham Rajiv and K. B. Galketiya

ABSTRACT

Colo vesical fistula can be a result of a variety of conditions. Patients commonly present with lower urinary tract symptoms (LUTS) and recurrent urinary tract infections (UTI).The management is surgical resection. Urinary and faecal diversion may be considered in advanced cases whereas infliximab is used to treat fistulating Crohn’s disease. Here the surgery was performed laparoscopicaly which contributed to minimal analgesic requirement, early mobilization and early discharge. Introduction: Acquired colo vesical fistula can result from a variety of pathologies. The commonest is secondary to diverticular disease and the others are malignancy, Crohn’s disease, actinomycosis and radiation injury.[1,2,4] Patients commonly present with lower urinary tract symptoms (LUTS), recurrent urinary infections. The management is surgical resection, which if performed laparoscopicaly results in less morbidity.[4] Case report: A 65 years old otherwise healthy male had presented to a local hospital with storage predominant LUTS for 3 months duration and was investigated and treated at a urology clinic for a culture positive cystitis. He developed three episodes of cystitis despite adequate antibiotic therapy and medication to improve bladder outflow obstruction. Later he had experienced passage of air through urethra during micturition. Cystoscopy, colonoscopy and contrast enhanced computer tomography of the abdomen were performed which revealed a colo -vesical fistula from mid sigmoid to the dome of the bladder due to sigmoid diverticulosis.[fig 1] He underwent a laparoscopic segmental resection of sigmoid colon with excision of the fistula with a cuff of the bladder. Intra corporeal end to end stapler anastomosis of the sigmoid colon without defunctioning stoma and an intra corporeal suturing of the bladder were performed.

Keywords: colo visical fistula, diverticular disease, pneumaturia, recurrent cystitis, laparoscopic resection.