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enterovesical fistula
fistula between the urinary bladder & the intestine
Etiology:
1) incomplete separation of the intestines & the bladder during embryonic development (failure of urorectal septum to divide the common cloaca)
2) infection
a) coccidioidomycosis
b) pelvic actinomycosis
3) inflammatory conditions
a) diverticulitis
b) Crohn's disease
4) cancer
a) transitional cell carcinoma of the bladder
b) colorectal carcinoma
5) trauma or foreign body
6) iatrogenic causes (presenting either postoperatively or as a treatment complication)
- pelvic surgery, pelvic irradiation
Pathology:
- low pressure in the bladder permits movement of fecal material from the bowel
Clinical manifestations:
1) suprapubic pain
2) dysuria
3) symptoms associated with chronic urinary tract infection
4) pneumaturia
5) fecaluria
6) malodrous urine
Laboratory:
- urinalysis
- pyruia
- bacteriuria
- debris
- chemistry 7 panel is typically normal
- complete blood count (CBC)
- leukocytosis may associated with urinary tract infection
- anemia of chronic disease
Radiology:
- abdominal computed tomography (CT)
- magnetic resonance imaging is more expensive
Management:
- surgical correction
Specific
colovesicle (vesicocolic) fistula
rectovesicle (vesicorectal) fistula
General
intestinal fistula
urinary bladder fistula
References
- Basler J
eMedicine (Medscape): Enterovesical Fistula
http://emedicine.medscape.com/article/442000-overview
- Scozzari G, Arezzo A, Morino M.
Enterovesical fistulas: diagnosis and management.
Tech Coloproctol. 2010 Dec;14(4):293-300.
PMID: 20617353 Review.