Dear Editor,
The most common cause of colovesical fistulas is complicated diverticulitis [1]. The treatment is surgery, but the complex procedure can be associated with severe postoperative complications [2,3]. Studies have shown that laparoscopic surgery is safe, with relatively low rates of surgical site and medical complications. The robotic approach is still rarely reported, and most of the cases that have been described were cases of Crohn’s disease or transanal repairs [4,5].
An 82-year-old woman with a past medical history of diverticulitis presented with recurrent urinary tract infections and intermittent pneumaturia over the course of a year (Video S1). On examination, she was afebrile, without tachycardia and without abdominal tenderness. CT demonstrated diverticulosis without evidence of diverticulitis as well as air tracking from the sigmoid colon to the urinary bladder, consistent with colovesical fistula. Cystoscopy confirmed the diagnosis. Colonoscopy demonstrated diverticulosis with an associated stricture. Biopsies were negative for cancer.
The patient underwent a robot-assisted sigmoid resection and ligation of the fistula tract. Resection proceeded with a medial-to-lateral approach with full mobilization of the splenic flexure. The sigmoid colon and upper rectum were resected, and healthy descending colon was anastomosed to the rectal stump. An abscess cavity was noted in the bladder; it was excised along with the fistula tract, and the bladder was repaired primarily. The postoperative course was uneventful, and the patient was discharged on postoperative day 5. Surgical pathology demonstrated benign colon tissue, benign bladder tissue, and an associated fistula with acute and chronic inflammation.
Supplementary Material
ACKNOWLEDGMENTS
This work was supported in part by grant P30 CA008748 from the National Cancer Institute. J. B. Yuval’s research fellowship at Memorial Sloan Kettering was funded in part by grant T32 CA009501 from the National Cancer Institute.
Footnotes
CONFLICT OF INTERESTS
None.
SUPPORTING INFORMATION
Additional supporting information may be found in the online version of the article at the publisher’s website.
DATA AVAILABILITY STATEMENT
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
REFERENCES
- 1.Woods RJ, Lavery IC, Fazio VW, Jagelman DG, Weakley FL. Internal fistulas in diverticular disease. Dis Colon Rectum. 1988;31:591–6. [DOI] [PubMed] [Google Scholar]
- 2.Dolejs SC, Penning AJ, Guzman MJ, Fajardo AD, Holcomb BK, Robb BW, et al. Perioperative management of patients with colovesical fistula. J Gastrointestinal Surg. 2019;23:1867–73. [DOI] [PubMed] [Google Scholar]
- 3.Gilshtein H, Yellinek S, Maenza J, Wexner SD. Surgical management of colovesical fistulas. Tech Coloproctol. 2020;24:851–4. [DOI] [PubMed] [Google Scholar]
- 4.Guerra F, Stortoni P, Patriti A. Robotic repair of colovesical fistula due to complicated Crohn’s disease – a video vignette. Colorectal Dis. 2020;22:843–4. 10.1111/codi.14980 [DOI] [PubMed] [Google Scholar]
- 5.Tseng SI, Huang CW, Huang TY. Robotic-assisted transanal repair of rectourethral fistula. Endoscopy. 2019;51:E96–7. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.