enterovesical fistula

Introduction

fistula between the urinary bladder & the intestine

Etiology

• incomplete separation of the intestines & the bladder during embryonic development (failure of urorectal septum to divide the common cloaca)
• infection
  • coccidioidomycosis
  • pelvic actinomycosis
• inflammatory conditions
  • diverticulitis
  • Crohn's disease
• cancer
  • transitional cell carcinoma of the bladder
  • colorectal carcinoma
• trauma or foreign body
• iatrogenic causes (presenting either postoperatively or as a treatment complication)
  • pelvic surgery, pelvic irradiation

Pathology

• low pressure in the bladder permits movement of fecal material from the bowel

Clinical manifestations

• suprapubic pain
• dysuria
• symptoms associated with chronic urinary tract infection
• pneumaturia
• fecaluria
• malodrous urine

Laboratory

• urinalysis
  • pyruia
  • bacteriuria
  • debris
• chemistry 7 panel is typically normal
• complete blood count (CBC)
  • leukocytosis may associated with urinary tract infection
  • anemia of chronic disease

Radiology

• abdominal computed tomography (CT)
• magnetic resonance imaging is more expensive

Management

• surgical correction

More general terms

• intestinal fistula
• urinary bladder fistula

More specific terms

• colovesicle (vesicocolic) fistula
• rectovesicle (vesicorectal) fistula