An enterovesical fistula (EVF) is a communication between the lumen of the bladder and any part of the intestines. EVF occur due to a number of factors that include infection, abdominal trauma, malignancies, chronic inflammation and surgery.

The most common form of EVF is a colovesical fistula. Rectovesical fistulae are more often observed after surgical procedures. Some larger EVF develop a system of numerous channels, frequently complicated by abscess formation, and the development of bowel obstruction [1].

Symptoms of EVF consist of both urinary and gastrointestinal complaints, which may occur simultaneously with those of the primary etiology [2]. Urinary symptoms include suprapubic pain, pneumaturia, and signs of fecal contamination of the urogenital tract, such as recurrent urinary tract infections, debris, foul smelling urine, fever and sepsis [3] [4] [5]. Gouveneur’s sign, which is frequency, dysuria, tenesmus and suprapubic pain, is highly suggestive of EVF [2]. Fecaluria is confirmation of the presence of an EVF, however pneumaturia can occur due to infections by certain micro-organisms.

• Recurrent Urinary Tract Infection

  Enterovesical fistula is a rare cause of recurrent urinary tract infections. This condition is unusual in young people as common etiologies include diverticular disease and cancer. [ncbi.nlm.nih.gov]

  urinary tract infections, or passage of urine rectally 4. [radiopaedia.org]

  Presenting features include fecaluria, pneumaturia and recurrent urinary tract infection [5] [6] [7]. [scirp.org]

• Fever

  A 73-year-old woman with rectal cancer that had directly invaded the bladder and metastasized to the liver was admitted to our hospital with high fever and severe perineal pain. Retrograde urography indicated an enterovesical fistula. [ncbi.nlm.nih.gov]

  Among older people, cystitis may also cause no symptoms related to urinating and may cause symptoms such as fever or confusion. [merck.com]

  Urinary symptoms include suprapubic pain, pneumaturia, and signs of fecal contamination of the urogenital tract, such as recurrent urinary tract infections, debris, foul smelling urine, fever and sepsis. [symptoma.com]

  B. general symptoms fever 38 0C, +/- chills Weight loss: diarhhea plus reduced surface for nutrient absorbtion 12 CROHN’s DISEASE C. extraintestinal Skin Urinary Joints Ocular „metastatic” ulcers – submamar, subpubian, abdomen; Parastomal ulceration Anal [slideplayer.com]

• Surgical Procedure

  Twelve patients underwent 13 surgical procedures. [ncbi.nlm.nih.gov]

  Rectovesical fistulae are more often observed after surgical procedures. Some larger EVF develop a system of numerous channels, frequently complicated by abscess formation, and the development of bowel obstruction. [symptoma.com]

  Iatrogenic pathophysiology Iatrogenic fistulae are usually induced by surgical procedures, primary or adjunctive radiotherapy, and/or postprocedural infection. [thehealthscience.com]

  In relation to laparoscopic treatment, several reports suggest that laparoscopic repair of colovesical fistula can be performed successfully with resection and anastomosis of the fistulous tract in the same surgical procedure, without adding morbidity [scielo.isciii.es]

• Inguinal Hernia

  This paper presents our experience with a case of mucocele of appendix with vesicoenteric fistula formation involving the mesh after surgery for inguinal hernia, together with a review of the literature. [iss.ndl.go.jp]

  Surgical procedures, including prostatectomies, resections of benign or malignant rectal lesions, and laparoscopic inguinal hernia repair, are well-documented causes of rectovesical and rectourethral fistulae. [21, 22] Unrecognized rectal injury at the [thehealthscience.com]

  Colovesical fistula after laparoscopic inguinal hernia repair. Br J Surg. 1994 Aug. 81(8):1213-4. [Medline]. Levenback C, Gershenson DM, McGehee R, et al. Enterovesical fistula following radiotherapy for gynecologic cancer. [emedicine.com]

  Gray MR, Curtis JM, Elkington JS (1994) Colovesical fistula after laparoscopic inguinal hernia repair. Br J Surg 81: 1213-1214. Abbas F, Memon A (1994) Colovesical fistula: an unusual complication of prostatomegaly. J Urol 152: 479-481. [omicsonline.org]

• Hunting

  Ferguson GG, Lee EW, Hunt SR, Ridley CH, Brandes SB. Management of the bladder during surgical treatment of enterovesical fistulas from benign bowel disease. J Am Coll Surg 2008;207:569-72. [ Links ] 5. Joo JS, Agachan F, Wexner SD. [scielo.isciii.es]

  J Korean Med Sci 18:433–436 PubMed Google Scholar Ferguson GG, Lee EW, Hunt SR, Ridley CH, Brandes SB (2008) Management of the bladder during surgical treatment of enterovesical fistulas from benign bowel disease. [link.springer.com]

  Ferguson GG, Lee EW, Hunt SR et al (2008) Management of the bladder during surgical treatment of enterovesical fistulas from benign bowel disease. J Am Coll Surg 207:569–572 PubMed CrossRef 10. [springermedizin.de]

  Ferguson GG, Lee EW, Hunt SR, Ridley CH, Brandes SB. Management of the bladder during surgical treatment of enterovesical fistulas from benign bowel disease. J Am Coll Surg. 2008 Oct. 207(4):569-72. [Medline]. [emedicine.com]

• Abdominal Mass

  Fistulae are diagnosed preoperatively in 69% of cases and can be suspected in as many as 42% of patients with an abdominal mass. [scienceopen.com]

  Abdominal pain is more common in patients with Crohn disease, but an abdominal mass is discovered in fewer than 30% of patients. [thehealthscience.com]

  […] soft tissue masses [21]. [urotoday.com]

• Intestinal Disease

  Six patients underwent resection of the diseased intestinal segment with bladder repair, and a temporary stoma in 1 case. Conclusion: Enterovesical fistulae complicating Crohn disease is often clinically suspected preoperatively. [urotoday.com]

• Prolapse

  In addition, a drooping (prolapsed) uterus or bladder may cause poor emptying of the bladder and predispose to cystitis. A prolapsed uterus or bladder is more common among women who have had many children. [merck.com]

  O75.3, O86.2- ) Other diseases of the urinary system N32 ICD-10-CM Diagnosis Code N32 Other disorders of bladder 2016 2017 2018 2019 Non-Billable/Non-Specific Code Type 2 Excludes calculus of bladder ( N21.0 ) cystocele ( N81.1- ) hernia or prolapse [icd10data.com]

• Urinary Retention

  Three weeks post-operatively, the patient developed acute urinary retention following removal of the urinary catheter. [ncbi.nlm.nih.gov]

  Metabolic acidosis during urinary retention in a patient with an enterovesical fistula. Clin Nephrol. 2000 Jul;54(1):73-7. Murakami K, Tomita M, Kawamura N, et al. Severe metabolic acidosis and hypokalemia in a patient with enterovesical fistula. [nzma.org.nz]

  retention in a patient with an enterovesical fistula. ( 10939761 ) Gagnon RF...Kaye M 2000 47 Timing of surgery for enterovesical fistula in Crohn's disease: decision analysis using a time-dependent compartment model. ( 11149560 ) Sonnenberg A...Gavin [malacards.org]

  The patient developed acute urinary retention (AUR) after stent placement, which was initially managed with straight catheterization; however, he had persistently elevated post-void residuals. He ultimately elected for Foley catheter placement. [facs.org]

  Am J Kidney Dis 30:131–133 Article CAS PubMed Google Scholar Gagnon RF, Mangel R, Kaye M (2000) Metabolic acidosis during urinary retention in a patient with an enterovesical fistula. [link.springer.com]

• Urinary Urgency

  The most common symptoms of colovesical fistula are urinary urgency, dysuria, tenesmus, suprapubic pain, pneumaturia, fecaluria, hematuria, and UTI. [cureus.com]

  He denied fever, chills, weight change, cough, dyspnea, chest pain, hematochezia, melena, dysuria, hematuria, urinary urgency, numbness, and tingling. History. [consultant360.com]

  Sign Up A 17-year-old female presents with a 5-day history of vague lower abdominal pain and increased urinary urgency and frequency. She has also noticed bubbles of air in her urine, that is malodorous. [knowledge.statpearls.com]

• Urinary Incontinence

  incontinence References [ edit ] ^ Bhatia J (8 January 2010). [en.wikipedia.org]

• Sexual Dysfunction

  This special expertise means you receive the most advanced and effective treatment for sexual dysfunction and fertility concerns. Find out more about our men's sexual health and fertility. [muschealth.org]

The diagnosis of EVF, initiated by clinical evaluation, is a challenge as there is no standard workup. Therefore, a significant part of investigation and management is dependent on medical imaging. Imaging can give information about the location of the fistula, as well as complications that may arise, exemplified by abscess or stricture formation [6]. Possible imaging modalities include:

• Cystoscopy: This is routinely done, although it lacks specificity for EVF. It may only reveal edematous and inflamed tissue. It correctly identifies EVF in about half of cases [3].
• Colonoscopy: This has little success in identifying EVF [7]. It is important that it is done, however, to visualize any colorectal cancer, a known etiology of EVF.
• Ultrasound: The concurrent application of pressure on the lower abdomen improves ultrasonographic diagnosis of EVF by eliciting the beak sign.
• Computerized tomography (CT) scanning: CT is the imaging modality of choice in the detection of colovesical fistulae [8]. It is excellent at visualizing collections of air or contrast outside the intestinal lumen. Three dimensional CT gives even more anatomical detail [9].
• Magnetic resonance imaging: This is advantageous as it does not involve radiation. T1 and T2 weighted images may be obtained, showing the extent of the fistula, and fluid accumulation in the tissue with associated muscle inflammation respectively. Because it is expensive, MRI is not routinely carried out [10].

Poppy seed test: Patients are asked to ingest 50 grams of poppy seeds, which are excreted in urine within a few days, confirming an EVF. Its detection rate is near perfect [7]. It cannot, however, indicate the location of the fistula or what part of the bowel is involved.

Biochemical testing may involve:

• Urinalysis: Signs of bacterial colonization, and leukocytes, are positive findings in EVF.
• Bourne test (variant): In the presence of a fistula, oral administration of charcoal causes it to appear in the urine.
• Urine culture: This will show growth of numerous bacterial species.

Reports of surgical or pharmacologic treatment of vesicoenteric fistula in terminally ill patients with cancer are rare. [ncbi.nlm.nih.gov]

Treatment / Management Treatment of enterovesical fistula includes treatment of the fistula itself and the underlying disease if it is treatable. Therefore, confirming the fistula etiology should be done before planning treatment. [statpearls.com]

Laparoscopic treatment of colovesical fistulas: technique and report of two cases. Surg Laparosc Endosc 1994;4:157-60. [ Links ] [scielo.isciii.es]

Results During the first 24 hours after the treatment patient suffered from temporal mild hypertension. No other AE were observed. Control cystoscopies after 2 and 3 weeks revealed complete healing of the fistula. [ecco-ibd.eu]

Treatment and prognosis Surgical resection of the fistula and abnormal segment of bowel is usually required for cure, although in the setting of malignancy this suggests advanced disease (T4) making surgery complex. [radiopaedia.org]

[…] underwent multistage repair. [69] In general, the overall outcome and prognosis are excellent in patients with non–radiation-induced or cancer-induced fistulae. [emedicine.medscape.com]

[…] earliest treatment for colovesical fistula was defunctioning colostomy, proposed by Barbier de Melle in 1843. [9] However, it is rare for the fistula to close following this procedure alone [10] and it is therefore reserved now for patients with a poor prognosis [jscisociety.com]

Symptoms of EVF consist of both urinary and gastrointestinal complaints, which may occur simultaneously with those of the primary etiology. [symptoma.com]

This condition is unusual in young people as common etiologies include diverticular disease and cancer. When an enterovesical fistula occurs in women of childbearing age, Crohn's disease is a likely cause. [ncbi.nlm.nih.gov]

Presenting symptoms, diagnostic progression, etiology, therapy, and complications of 44 patients with enterovesical fistulae who came to three Yale teaching hospitals over a 9-year period were reviewed. [scienceopen.com]

Etiologies were diverticulitis (19), Crohn disease (three), postradiation therapy (four), previous trauma (one), and bladder carcinoma (one). The fistulas were demonstrated by barium enema in 10 of 20 patients and by cystography in eight of 26. [doi.org]

Describe the epidemiology of enterovesical fistulas. Describe the pathophysiology of enterovesical fistulas. [statpearls.com]

Journal Journal ID (nlm-ta): Pan Afr Med J Journal ID (iso-abbrev): Pan Afr Med J Journal ID (publisher-id): PAMJ Title: The Pan African Medical Journal Publisher: The African Field Epidemiology Network ISSN (Electronic): 1937-8688 Publication date (Electronic [scienceopen.com]

Epidemiology Frequency Colovesical fistulae are the most common type of fistulous communication between the urinary bladder and the bowel. [thehealthscience.com]

Epidemiology Among the 6081 CD patients screened, 97 patients with entero-urinary fistulas were identified, thus giving an overall frequency of 1.6% (95% CI 1.3–1.9). [academic.oup.com]

Epidemiology Colovesical fistulae are the most common type of fistulous communication between the bowel and the urinary bladder. heT incidence in patients with diverticular disease approximately 2%. [knowledge.statpearls.com]

Pathophysiology An enterovesical fistula usually refers to a predisposing pathophysiologic process. Therefore, pathophysiology depends on the predisposing cause of disease. [statpearls.com]

Inflammatory pathophysiology Diverticulitis accounts for approximately 50%-70% of vesicoenteric fistulae, almost all of which are colovesical. [thehealthscience.com]

Pathophysiology An enterovesical fistula usually refers to a predisposing pathophysiologic process. Therefore, the pathophysiology depends on the predisposing cause or disease. [knowledge.statpearls.com]

A high index of suspicion is required to prevent a delay in the diagnosis of this disease condition. As seen in this case report, diagnosis and surgical repair of enterovesical fistula was done three years after myomectomy. [scirp.org]

Women who take antibiotics regularly to prevent bladder infections may need to discuss contraceptive options with their doctor. [merck.com]

When fistulae enter the bladder close to the trigone, avoid periureteral dissection to prevent devascularization. [emedicine.medscape.com]

1. McBeath RB, Schiff M Jr, Allen V, Bottaccini MR, Miller JI, Ehreth JT. A 12-year experience with enterovesical fistulas. Urology. 1994;44(5):661–665.
2. Pontari MA, McMillen MA, Garvey RH, Ballantyne GH. Diagnosis and treatment of enterovesical fistulae. American Surgeon. 1992;58(4):258–263.
3. Daniels IR, Bekdash B, Scott HJ, Marks CG, Donaldson DR. Diagnostic lessons learnt from a series of enterovesical fistulae. Colorectal Disease. 2002;4(6):459–462.
4. Najjar SF, Jamal MK, Savas JF, Miller TA. The spectrum of colovesical fistula and diagnostic paradigm. American Journal of Surgery. 2004;188(5):617–621.
5. Melchior S, Cudovic D, Jones J, Thomas C, Gillitzer R, Thüroff J. Diagnosis and surgical management of colovesical fistulas due to sigmoid diverticulitis. The Journal of Urology. 2009;182(3):978–982.
6. Solkar MH, Forshaw MJ, Sankararajah D, Stewart M, Parker MC. Colovesical fistula—is a surgical approach always justified? Colorectal Disease. 2005;7(5):467–471.
7. Kwon EO, Armenakas NA, Scharf SC, Panagopoulos G, Fracchia JA. The poppy seed test for colovesical fistula: big bang, little bucks! The Journal of Urology. 2008;179(4):1425–1427.
8. Golabek T, Szymanska A, Szopinski T, et al. Enterovesical fistulae: aetiology, imaging, and management. Gastroenterol Res Pract. 2013;2013:617967.
9. Shinojima T, Nakajima F, Koizumi J. Efficacy of 3-D computed tomographic reconstruction in evaluating anatomical relationships of colovesical fistula. Int J Urol. 2002;9(4):230-232.
10. Ravichandran S, Ahmed HU, Matanhelia SS, Dobson M. Is there a role for magnetic resonance imaging in diagnosing colovesical fistulas?. Urology. 2008;72(4):832-837.