COLONIC FISTULAS

https://doi.org/10.1016/S0039-6109(05)70506-5Get rights and content

Colonic fistulas are uncommon. They are frequently external but also occur internally to a variety of organs. External fistulas invariably are caused by a complication or are the result of a surgical procedure, such as a leaking anastomosis or incision and drainage of an abscess resulting from underlying pathology. The most common disease process implicated in the spontaneous development of fistulas from the colon is diverticular disease. Less commonly, we encounter fistulas caused by Crohn's disease or a malignancy of the colon. Of 412 patients with diverticular disease treated at the Cleveland Clinic from 1960 to 1986, 84 (20.4%) had internal fistulas.10 Eight had multiple fistulas. The majority (65%) were colovesical. The next most common was colovaginal (25%), and the remainder were coloenteric or colouterine. In another series of patients with colocutaneous fistulas in diverticular disease,8 88 of 93 fistulas followed surgery. This compares with only 5 of 93 who developed a fistula in the absence of surgery on the colon. Ten of the patients with complicated fistulas were also diagnosed with Crohn's disease.

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

References (11)

  • H. Abcarian et al.

    Coloenteric fistulas

    Dis Colon Rectum

    (1978)
  • H.E. Bacon et al.

    Surgical management of peridiverticulitis of the colon

    Surg Gynecol Obstet

    (1971)
  • V.W. Fazio et al.

    Colocutaneous fistulas complicating diverticulitis

    Dis Colon Rectum

    (1987)
  • G.R. Geier et al.

    Colovesical fistula

    Arch Surg

    (1972)
  • G.J. Hool et al.

    Diverticular colo-enteric fistulae

    Aust NZ J Surg

    (1981)
There are more references available in the full text version of this article.

Cited by (31)

  • Endoscopic Management of Vesical Fistulas

    2016, Endoscopic Diagnosis and Treatment in Urinary Bladder Pathology: Handbook of Endourology
  • Third- and fourth-degree perineal laceration in vaginal delivery

    2012, Taiwanese Journal of Obstetrics and Gynecology
  • Clinical features and differential diagnosis of diverticular disease

    2002, Bailliere's Best Practice and Research in Clinical Gastroenterology
  • Management of anastomotic leakage after nondiverted large bowel resection

    1999, Journal of the American College of Surgeons
View all citing articles on Scopus

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

*

From the Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio

View full text