Thirty patients with colovesical fistula due to diverticulitis were encountered in the past ten years. Six patients did not receive any of the standard operative therapies. Four of these patients were observed for three to 14 years with nonoperative management, with little inconvenience and without significant complications. Five of the 24 patients in the surgical group died in the postoperative period. Nonoperative therapy seems to be a viable option in selected patients.