COLONIC FISTULAS
Section snippets
SYMPTOMS AND SIGNS
The main symptoms and signs of a colocutaneous fistula are self-evident, with the passage of flatus and feces through an incision on the abdominal wall following a surgical resection, or an injury to the colon at the time of another procedure. The passage of feces is generally preceded by signs of sepsis, fever (with or without rigors), tachycardia, leukocytosis, and pain from an associated abscess with local peritonitis. A surprisingly small number have any clinical findings on abdominal or
INVESTIGATION AND DIAGNOSIS
The methods used to confirm the presence of a fistula and define the anatomy of the tract are numerous. The reliability of these techniques is varied.
In all cases of colonic fistulas, a proctoscopy should be performed. This is usually not helpful other than to exclude underlying pathology. A colonoscopy for more proximal fistulas similarly does not demonstrate many fistulas. Long-standing fistulas, such as coloenteric or enterocolic fistula from disease in the small bowel such as Crohn's
MANAGEMENT
Fistulas from the colon are always associated with pathology from the underlying disease process or the complication that led to the fistula. General and systemic conditions, such as malnutrition or sepsis, are treated as required. The normal measures of resuscitation and restoration of nutrition and hydration are undertaken before any surgical intervention. Sepsis is drained. This may be done by percutaneous CT-guided drainage or limited laparotomy and drainage.
Colocutaneous fistulas, which
Colovesical Fistula
This is usually from diverticular disease. The treatment of this condition is usually not the formidable procedure that is often anticipated. The majority are well-established mature fistulas with little or no acute inflammation. Consideration should be given to nonoperative treatment in infirm patients unable to tolerate an abdominal operation. The majority of patients are best served by resection of the perforated colon and a colorectal anastomosis as a single-stage procedure, as described
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Colovesical fistula
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2002, Bailliere's Best Practice and Research in Clinical GastroenterologyEnterocutaneous fistulas: Current diagnosis and management
2000, Current SurgeryManagement of anastomotic leakage after nondiverted large bowel resection
1999, Journal of the American College of SurgeonsIatrogenic enterovesical fistula secondary to a permanent urinary catheter
2023, BMJ Case Reports
Address reprint requests to Ian C. Lavery, MD, FRACS, FACS, Department of Colorectal Surgery, The Cleveland Clinic Foundation, Desk A-111, 9500 Euclid Avenue, Cleveland, OH 44195
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From the Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio