Inflammatory vesicosigmoidal fistula. A case report

Clinical course of a case of inflammatory vesicosigmoidal fistula is presented. The patient, a 44-year-old-male, had chief complaints of pollakisuria and pain upon voiding. Fistula was identified with colon-fiberscopic examination. Primary resection of lesion was performed and postoperative course was uneventful. Histological findings of the specimen were compatible with those of nonspecific inflammation. There was no evidence of neoplastic change. Twenty nine cases of inflammatory vesicosigmoidal fistula were reported in the recent 5 years. It was remarkable that the cases of vesicosigmoidal fistula due to sigmoidal diverticulitis have increased.     

A case of vesicosigmoidal fistula secondary to diverticulitis of the colon

A case of vesicosigmoidal fistula secondary to the diverticulitis of colon is reported. A 63-year-old man was admitted to our clinic with the chief complaint of pneumaturia. Cystoscopy revealed an edematous, papillomatous lesion at the left posterior bladder wall. Although multiple diverticulosis of descending and sigmoid colon were demonstrated by barium enema, the presence of a fistula from the intestine to bladder was not confirmed. The presence of fistula was confirmed by detecting the orally administered charcoal in the urine. Resection of sigmoid colon with partial cystectomy was performed. Removed specimen revealed multiple sigmoidal diverticula and a fistula from a sigmoidal diverticulum to bladder through a firm mass. Histological examination of mass demonstrated inflammatory changes. This was the 58th case of vesicosigmoidal fistula due to diverticulitis of colon reported in the Japanese literature.     

The vesicosigmoidal fistula: Diagnosis and surgical treatment

The authors report their experience in the diagnosis and treatment of 10 cases of vesicosigmoidal fistula. In accordance with the literature the most frequent presenting symptoms were of urinary origin. For the diagnosis urography was helpful, cystography and cystoscopy allowed the observation of a fistulous orifice, while barium enema confirmed, or removed probable doubts about the nature of the intestinal pathology. Surgical treatment varied from one-stage to multi-stage procedures.     

A case of Crohn's disease developing bladder rupture 4 months after laparoscopic sigmoidectomy with partial cystectomy for vesicosigmoidal fistula

A 32-year-old well-nourished man having a vesicosigmoidal fistula due to Crohn's disease received laparoscopic sigmoidectomy with partial cystectomy. The bladder wall was closed with an all-layer running suture and additional interrupted sutures using 2-0 Vicryl. Four months after surgery, the suture site on the bladder showed perforation to the abdominal cavity. Since the same event occurred again 6 months after surgery, open partial cystectomy was performed to repair the perforated site 8 months after the initial surgery. The perforated site showed a thinning bladder wall composed of normal urothelium, scar tissue and thin detrusor muscle. Non-caseating granuloma was not found in the specimen, even though it was slightly observed in the margin of the detrusor muscle resected in the initial surgery. Although it was possible that the persisting activity of Crohn's disease, subclinical impaired nutrition due to Crohn's disease or insufficient suturing of the bladder wall were involved in the bladder rupture, the definitive cause remains unknown.     

A case of urethrorectal fistula

A 59-year-old man was hospitalized with complaints of diarrhea and pollakisuria. Retrograde urethrography, urethroscopy and urethral pressure profile revealed a fistula between the urethra and the rectum situated immediately above the external urethral sphincter. Surgical repair was performed by an abdominal approach. Following the total prostatectomy, the fistula was completely resected under direct vision. A closure of the anterior rectal wall and an anastomosis between the urethra and the bladder neck was performed. Operative results were satisfactory. Operative methods for the urethrorectal fistula are discussed.     

A case of postnephrectomy arteriovenous fistula

A rare case of a postnephrectomy arteriovenous fistula involving the major renal vessels is presented herein. This type of postnephrectomy arteriovenous fistula is very unusual; in fact, since first documented in 1934, only 65 cases have been reported in the world literature, including 2 cases from Japan. Even though postoperative arteriovenous fistulae are rare, one should bear this complication in mind when unknown causes of bruit or heart failure develop following surgery.