Theoretical and Practical Considerations in Colo-Rectal Diverticulosis Complicated with Multiple Sigmoido-Recto-Vesical FistulasCălin Molnar1*, Ciprian Silaghi2, Adrian Chiujdea3, Ecaterina Daniela Dobru4, Ciprian Rosca2, Cosmin Nicolescu5, Victor Iosif Neagoe2, Vlad Olimpiu Butiurca2, Claudiu Varlam Molnar6 and Constantin Copotoiu1
- *Corresponding Author:
- alin Molnar, MD, PhD
First Surgical Unit
Emergency County Hospital
Târgu Mure Str. N. Grigorescu 31/12
540136, Târgu Mure, Mure, Romania
Tel: +40 (0) 722 69 66 10
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E-mail: [email protected]
Received Date: January 09, 2014; Accepted Date: March 13, 2014; Published Date: September 20, 2014
Citation: Molnar C, Silaghi C, Chiujdea A, Dobru ED, Rosca C, et al. Theoretical and Practical Considerations in Colo-Rectal Diverticulosis Complicated Multiple Sigmoido-Recto-Vesical Fistulas. Journal of Surgery [Jurnalul de chirurgie] 2014;10(2):168-171 doi: 10.7438/1584-9341-10-2-16
Copyright: © 2014 Molnar C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Although there is a complete anatomical separation between urinary and digestive tract, in certain pathological conditions, the direct proximity between the bladder and the sigmoid colon allows the development of entero-vesical fistulas. Colic diverticulosis is the second leading cause of entero-vesical fistulas, after malignancy. Usually, the enterovesical fistula is unique, on a single bowel segment; rarely is multiple, involving different intestinal segments. We present the case of a 41 years old man, with a double fistula: sigmoido-vesical and recto-vesical, respectively. The diagnosis was challenging despite the clinical aspect included pneumaturia and fecaluria. A particular symptom was sexual dysfunction. CT scan and a pelvic MRI revealed the two fistula colo-vesical and recto-vesical. A recto-sigmoid resection with subperitoneal colo-rectal anastomosis and partial cystectomy were performed with uneventful postoperative recovery.
Conclusion: The multiple entero-vesical fistulas developed on a single intestinal segment are extremely rare, and, to our knowledge this is the only case reported in the literature. The management is challenging, and in our opinion the resection with anastomosis and partial cystectomy is the best choice.