Diagnosis
Colovesical fistula
A communication between two epithelialized surfaces: the colon and the bladder.
Also known as: Cystocolic fistula, Enterovesical fistula, Vesicocolic fistula
Etiology
Cause
Diverticulitis: [pqr][q4v][g7n]
o 87% of colovesical fistulas caused by diverticulitis
o 2-18% of all diverticulitis lead to colovesical fistula
o Erosion of the diverticular abscess into the bladder
Colon cancer 6% [q4v][kss]
Crohn´s disease 5% [q4v]
Iatrogenic injury: Complication of abdominal surgery (0.2%)
Radiotherapy
Congenital malformations of the urogenital tract
Abdominal trauma
Tuberculosis
Pathophysiology [g7n]
Anatomy: Sigmoid colon is close to the urinary bladder
Transmural inflammation and protrusion into nearby structures (diverticula, cancer, Crohn)
FRIENDS keep fistula open: Foreign body, Radiation, Inflammation/Infection, Epithelialization, Neoplasm, Distal obstruction, Short segment fistula.
Epidemiology
Incidence per 100.000 [49a][pqr][q4v]
Symptoms & findings
Symptoms
Cutaneous succus entericus, Diarrhea, Dry mucous membranes, Dysuria, Fecaluria, Fever, Hematuria, Hypotension, Hypothermia, Oliguria, Pneumaturia, Poor skin turgor, Prolonged capillary refill, Tachycardia, Weight loss
Clinical findings
Elevated CRP, Leukocytosis, Peritonitis
Anamneses
Localized findings
Approach
Blood test [g7n]
Urine stix
Urine culture
Poppy seed test (95% diagnostic) [kss]
CT abdomen (60% diagnostic)
MRI abdomen (60% diagnostic)
Retrograde colonic enema (36% diagnostic)
Cystogram (17% diagnostic)
Cystoscopy (10% diagnostic)
Colonoscopy (10% diagnostic)
Treatment
The etiology of the colovesicular fistula must be clear before treatment.
Surgery: single-stage vs. 2-stage, open vs. laparoscopic [q4v][kss][g7n]
Resection of the fistulized bowel
Bowel anastomosis with or without protective colostomy
Closure of the bladder defect
Conservative treatment in patients unfit for surgery or refuse treatment
Experimental treatment: endoscopic fibrin glue injection
Differential diagnoses
Abdominal abscess, Colorectal cancer, Crohn disease, Diverticulitis, Foreign body, Gastrointestinal obstruction, Hypovolemia, Urinary tract infection, Volvulus
References
[1] Hawkins AT, Wise PE, Chan T, Lee JT, Glyn T, Wood V, Eglinton T, Frizelle F, Khan A, Hall J, Ilyas MIM, Michailidou M, Nfonsam VN, Cowan ML, Williams J, Steele SR, Alavi K, Ellis CT, Collins D, Winter DC, Zaghiyan K, Gallo G, Carvello M, Spinelli A, Lightner AL. Diverticulitis: An Update From the Age Old Paradigm. Curr Probl Surg. 2020 Oct;57(10):100862.
[2] Froiio C, Bernardi D, Asti E, Bonavina G, Conti A, Carmignani L, Bonavina L. Burden of Colovesical Fistula and Changing Treatment Pathways: A Systematic Literature Review. Surg Laparosc Endosc Percutan Tech. 2022 Oct 1;32(5):577-585.
[3] Seeras K, Qasawa RN, Akbar H, et al. Colovesical Fistula. [Updated 2023 Jul 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518990/
[4] Melchior S, Cudovic D, Jones J, Thomas C, Gillitzer R, Thüroff J. Diagnosis and surgical management of colovesical fistulas due to sigmoid diverticulitis. J Urol. 2009 Sep;182(3):978-82.
[5] Randhawa, Navkiran DO1; Khalyfa, Ahamed DO1; Gabbert, Dave DO2; Arfeen, Mohammad DO1; Spyratos, Tilemahos DO1. S2197 A Case of Recurrent Urinary Tract Infections Secondary to Vaginovesicular and Vaginorectal Fistula. The American Journal of Gastroenterology 117(10S):p e1487, October 2022.