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COLOVESICAL FISTULA
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COLOVESICAL FISTULA
FELICIANO MERA
DEFINITION
A colovesical fistula (CVF) is an abnormal connection between the colon and urinary bladder. The most common cause of colovesicular fistulas is the sequelae of complicated diverticulitis and accounts for over two-thirds of cases.
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APPLICATION IN NURSING
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The preferred treatment for a colovesical fistula is surgery. Conservative treatment may be tried if the fistula is small enough, is not due to malignancy, and is in a patient with limited symptoms. Doctors may also recommend conservative treatment when a patient has other illnesses that are so severe, surgery is not considered safe, or when cancer is advanced and inoperable. The goal of conservative treatment is for the fistula to close and heal on its own. However, surgery may still be necessary in cases where the fistula does not heal on its own
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PRO AND CONS
PRO
An operation can remove or repair the fistula and stop the exchange of fluids between the bladder and the colon.
An Australian study of laparoscopic colovesical fistula repair found that the average hospital stay after the surgery was six days
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CONS
Complicated diverticular disease (abscess, fistula formation, strictures, and free perforation) is associated with a higher risk of colonic malignancy.
There is about a 3% to 5% incidence of concomitant malignancy in patients who have uncomplicated diverticulitis and about an 11% incidence of harboring a malignancy for complicated diverticulitis
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ISSUES APPLIED RECORD IN ECUADOR
At the Hospital Luis Vernaza , according to a study which aimed to describe post-surgical complications in patients with diverticular disease of the colon, laparoscopic surgery was chosen as a better technique due to the differences in reference to the time of hospital stay and the blood loss after surgery
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CONCLUSION
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Laparoscopic conservative surgery not including colic resection for colovesical fistula is safe and feasible. Efficacy of this technique is proved by no recurrence and no complications at 4-year follow-up. Larger series are necessary before proposing it as standard treatment. Laparoscopic conservative surgery may represent a therapeutic option in selected cases, especially if diverticular disease and inflammation are slight.