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      Jejunovesical Fistula Diagnosis After Normal Vaginal Delivery: A Case Report

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          ABSTRACT

          Enterovesical fistula represents an abnormal communication between the intestine and bladder. The causes are diverticulitis (56.3%), malignant tumours, which are located mainly in the intestine (20.1 %), and Crohn's disease (9.1%). Other causes include iatrogenic injury (3.2%); trauma; foreign bodies in the intestinal tract; radiotherapy; chronic appendicitis; tuberculosis; and syphilis. Normal vaginal delivery as a cause for enterovesical fistula has not been reported in many publications yet. We report a case of a 30-year-old female, who developed an jejunovesical fistula after normal vaginal delivery. It was diagnosed after diagnostic cystoscopy and computed tomography of the abdomen and pelvis. There was jejuno-vesical fistula. Resection of the segment of the jejunum with side-to- side anastomosis with bladder repair was done. A follow-up cystogram was done which showed no contrast extravasation into the peritoneum. The patient was followed up for 9 months after surgery.

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          Enterovesical Fistulae: Aetiology, Imaging, and Management

          Tomasz Golabek, Anna Szymańska-Dubowik, Tomasz Szopinski … (2013)
          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.
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            Fibrin sealant for the management of genitourinary injuries, fistulas and surgical complications.

            L. Andrew Evans, Kenneth Ferguson, John P Foley … (2003)
            We report our preliminary experience with the use of fibrin sealant to manage iatrogenic urinary tract injuries, complex urinary fistulas, and urological surgical complications. Topical fibrin sealant was used in 19 patients for iatrogenic urinary tract injury during gynecological or general surgical procedures (7), complex urinary fistulas (5) or urological surgical complications (7). Successful resolution of the injury, fistula or complication was attained after a single application of fibrin sealant in the 18 patients (94.7%) in whom a direct injection technique was used. The only failure (formation of a vesicovaginal fistula) occurred with the air driven sprayed sealant delivery technique after sutured closure of iatrogenic cystotomy during vaginal hysterectomy. Liquid fibrin sealant appears to be safe and prudent for use in urological "damage control" from trauma, fistulas or surgical complications. Direct injection over a sutured urinary anastomosis appears to be highly effective in preventing urinary drainage. Additional study is needed to define further the role and best use of tissue adhesives in urology.
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              Diagnosis and treatment of enterovesical fistulae.

              M Pontari, Cynthia M. McMillen, R H Garvey … (1992)
              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. Patients with diverticulitis as the cause of their fistula were older and came to the hospital with pneumaturia/fecaluria. Patients with pelvic cancer were more likely to have fecaluria, gastrointestinal symptoms, or hematuria. Patients with Crohn's disease were an average of 20 years younger than the patients with cancer or diverticulitis and they came to the hospital with pneumaturia, abdominal pain, abdominal mass, and tenderness. Computerized axial tomography scanning, cystoscopy, charcoaluria, and barium enema were useful in making the diagnosis; intravenous pyelography and colonoscopy were not. One-tenth of the patients were not candidates for operation, and one-quarter of the patients did not undergo complete operative resolution with restoration of enteric and urinary continuity. Nine patients underwent a two-stage repair consisting of resection/repair of the fistula with proximal fecal diversion and subsequent re-establishment of bowel continuity. These patients had a higher morbidity than the 19 patients who underwent one-stage repair. Enterovesical fistula is a challenging entity, the etiology of which may be suspected upon taking the patient's history or performing the physical assessment; however, the definitive diagnosis of enterovesical fistula can remain elusive. Single-stage repair can be achieved with low morbidity and mortality in many candidates.
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                Author and article information

                Journal
                Journal ID (nlm-ta): JNMA J Nepal Med Assoc
                Journal ID (iso-abbrev): JNMA J Nepal Med Assoc
                Journal ID (publisher-id): J Nepal Med Assoc
                Journal ID (publisher-id): JNMA
                Title: JNMA: Journal of the Nepal Medical Association
                Publisher: Journal of the Nepal Medical Association
                ISSN (Print): 0028-2715
                ISSN (Electronic): 1815-672X
                Publication date (Print): January 2024
                Publication date (Electronic): 31 January 2024
                Volume: 62
                Issue: 269
                Pages: 58-61
                Affiliations
                [1 ]Department of Urology and Kidney Transplant, Nepal Mediciti Hospital, Nakhkhu Patan , Karyabinayak, Lalitpur, Nepal
                Author notes
                Correspondence: Dr Deepak Kumar Yadav, Department of Urology and Kidney Transplant, Nepal Mediciti Hospital, Nakhkhu Patan, Karyabinayak, Lalitpur, Nepal. Email: deepak16444@ 123456gmail.com , Phone: +977-9842050172
                Article
                DOI: 10.31729/jnma.8407
                PMC ID: 10924501
                PubMed ID: 38410006
                SO-VID: e7ac2fb1-7b5a-4beb-8704-acd835fee267
                Copyright © © The Author(s) 2024.
                License:

                This is an Open-Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                Keywords: case reports,fistula,jejunum,urinary bladder
                Data availability:
                Keywords: case reports, fistula, jejunum, urinary bladder

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