Enterovesical fistulae: aetiology, imaging, and management

Abstract

Background and Study Objectives. Enterovesical fistula (EVF) is a devastating complication of a variety of inflammatory and neoplastic diseases. Radiological imaging plays a vital role in the diagnosis of EVF and is indispensable to gastroenterologists and surgeons for choosing the correct therapeutic option. This paper provides an overview of the diagnosis of enterovesical fistulae. The treatment of fistulae is also briefly discussed. Material and Methods. We performed a literature review by searching the Medline database for articles published from its inception until September 2013 based on clinical relevance. Electronic searches were limited to the keywords: "enterovesical fistula," "colovesical fistula" (CVF), "pelvic fistula", and "urinary fistula". Results. EVF is a rare pathology. Diverticulitis is the commonest aetiology. Over two-thirds of affected patients describe pathognomonic features of pneumaturia, fecaluria, and recurrent urinary tract infections. Computed tomography is the modality of choice for the diagnosis of enterovesical fistulae as not only does it detect a fistula, but it also provides information about the surrounding anatomical structures. Conclusions. In the vast majority of cases, this condition is diagnosed because of unremitting urinary symptoms after gastroenterologist follow-up procedures for a diverticulitis or bowel inflammatory disease. Computed tomography is the most sensitive test for enterovesical fistula.

Figure 1

Diagnostic imaging and procedures algorithm for enterovesical fistulae.

Figure 2

Rectovesical fistula: anorectal endosonographic view of a fistulous orifice in the urinary bladder (arrows) (a), transrectal ultrasonographic view of a fistulous orifice (arrows) located 6 mm from the internal outlet of the bladder (crosses) (b), and transrectal ultrasonographic view of a fistulous tract adjacent to the left lobe of the prostate (arrows) (c).

Figure 3

Colovesical fistula: axial image in the delayed phase of CT urogram demonstrates bladder and rectal wall thickening (arrows) with contrast present in both (∗).

Figure 4

Colovesical fistula: axial image of contrast enhanced CT of the abdomen and pelvis demonstrates air in the bladder (arrow) and thickened left bladder wall (a); sagittal image shows bladder wall thickening (arrow) adjacent to a loop of thickened sigmoid colon (arrow head) (b).