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Colonic diverticular disease is common in developed countries, and its prevalence increases with age. Most affected individuals remain asymptomatic throughout their lives, and relatively few patients require surgical intervention for obstructive or inflammatory complications. Colovesical fistula is the most common type (65%) of fistula associated with colonic diverticular disease. Primary resection of sigmoid colon with colorectal anastomosis performed as a one-stage procedure is its definitive treatment and can be performed safely--as simple closure, using an omental flap, or through resection and closure of bladder defect--in 90% of the patients. We report our experience with four patients suffering from colovesical fistula who were treated with primary resection of sigmoid colon and colorectal anastomosis performed as a one-step procedure. In our experience, diverting colostomy or Hartmann intervention is not recommended because of the lack of fistula definitive resolution and the possibility of additional complications.

A case of colovesical fistula is reported. The anatomy of the pelvis was determined preoperatively with 3-D computed tomography (CT), and the fistula, including adjacent structures, could clearly be seen. Compared with conventional axial CT imaging, 3-D CT provided better and more complete visualization of the anatomical relationships, which facilitated the surgical procedure and provided a good outcome.

We report the case of a 74-year-old man with a colovesical fistula caused by a gallstone that was lost during a laparoscopic cholecystectomy 7 months earlier. The patient was cured after undergoing colonoscopic removal of the stone. To our knowledge this is the first case report of such a complication in the English literature. The report reviews the outcome and complications of retained intraperitoneal gallstones.

Purpose: Use of 3-dimensional tomographic reconstruction in evaluating colovesical fistulas is discussed., Materials and Methods: We compared 3-dimensional computerized tomographic (CT) images of colovesical fistulas to conventional CT images., Results: Successful surgical repair was facilitated by preoperative radiographic data., Conclusions: Three-dimensional CT reconstruction provides superior spacial detail and can clarify complex anatomical relationships preoperatively.

Two cases of colovesical fistulae secondary to colonic diverticulosis are reported. Urinary symptoms were the prominent presenting features. Barium enema was helpful in documenting the fistulae, which cystoscopically was not localised. Definitive treatment included resection of the fistula and the diseased segment of the intestine. Both patients are well on follow-up. Diverticulosis coli should be considered in the differential diagnosis of colovesical fistulae even in tropical countries.

We reviewed 9 consecutive patients with colovesical fistula secondary to diverticulitis during a 2-year period. Preoperative evaluation included computerized tomography (CT) and a barium enema or colonoscopy in all patients (8 underwent cystoscopy). All patients subsequently underwent laparotomy with a single or multiple staged repair. Using CT criteria for diagnosis of colovesical fistulas, the study accurately predicted the presence and location of fistula in 8 patients, and was suspicious in 1. Findings at cystoscopy only diagnosed 3 fistulas and were suspicious in 4. The remaining diagnostic tests, including excretory urography, barium enema, abdominal plain films, colonoscopy and cystogram, were unremarkable except for a single cystogram and barium enema. In addition to documenting the fistula, CT provided important intraluminal and extraluminal pathological findings helpful in planning subsequent surgery. Thus, CT should be included in the initial evaluation of patients with suspected colovesical fistula.

When the clinical manifestations of colovesical fistulae lack diagnostic features, significant diagnostic delay may result. The literature contains conflicting recommendations regarding the optimal method of imaging such fistulae. We describe the transabdominal ultrasound appearances of a colovesical fistula and review the relevant literature. The identification of the ureteric orifices with their associated urinary jets and the use of abdominal compression are essential components of the technique.

The authors describe a 91-year-old man with a malignant stricture of the sigmoid colon complicated with a colovesical fistula, which was successfully managed with insertion of a metallic esophageal stent. The fistula closed, and the stent function was good during the observation time of 1 month. Temporary stent placement for treatment of malignant strictures in the large bowel is proposed.

Colovesical fistulas were identified in 42 patients. Diverticulitis was the underlying cause in 40 per cent of the patients. Carcinoma of the colon or cervix caused 33 per cent of the fistulas. Cystoscopy was the most effective procedure in diagnosing the fistulas. Surgical therapy had to be individualized to the patient's condition. Fistulas secondary to radiation were associated with a high complication rate.

Colovesical fistula, a not infrequent complication of diverticulitis, can be difficult to demonstrate by commonly used diagnostic imaging modalities. We present four cases in which computed tomography was used to detect the presence of such a fistula. Computed tomography readily detected air within the bladder earlier and without equivocation when compared with other imaging techniques. It was useful also in the assessment of the extent and the degree of pericolonic inflammation, thus playing an important role in preoperative surgical planning and postoperative follow-up.

We have evaluated the diagnostic role of computerized tomography in 42 patients suspected clinically of having a complication of acute diverticulitis (abscess, colovesical fistula, or both). Diverticular abscesses were confirmed at operation in 10 patients. All 10 patients were diagnosed preoperatively on computerized tomography by the triad of diverticula, a segmentally thickened colon, and extravisceral fluid collection with (6 patients) or without (4 patients) associated gas. Contrast enema study suggested the presence of a diverticular abscess in only two of eight patients studied. Colovesical fistulas were confirmed in 12 patients. Eleven of 12 were diagnosed preoperatively on computerized tomography by the triad of air in the bladder, thickened colon adjacent to an area of thickened bladder, and the presence of colonic diverticula. Contrast enema examinations demonstrated the fistula in only three of eight patients studied. The remaining 20 patients proved to have uncomplicated acute diverticulitis. Findings on computerized tomography included the presence of a segmentally thickened colon with diverticula but without the findings of an abscess or a colovesical fistula. Computerized tomography correctly visualized acute diverticular complications in 21 of 22 patients and it excluded an abscess or fistula in all 20 patients with uncomplicated acute diverticulitis who were suspected of having a diverticular complication. Computerized tomography is the most sensitive and specific test for diagnosing complications of acute diverticulitis. It should be an early consideration in patients with suspected diverticular abscesses or fistulas so that appropriate therapy is not delayed.

The 'beehive' sign on the bladder as seen in cystograms is valuable in diagnosing the presence of colovesical fistula and is invariably associated with the vesical end of the fistulous tract.

A 6-year-old girl with meningomyelocele and a neurogenic bladder was managed with clean intermittent catheterization. After 3 months she developed a vesicocolonic fistula, demonstrated on cystography. This is the first such complication reported since this type of management was popularized.

During a period of 18 months, 24 patients were identified with enterovesical fistulas. The fistulas were colovesical in 18, ileovesical in four and rectovesical and appendicovesical in one each. Fifteen of the 23 patients in whom this information was available had pneumaturia and four had fecaluria. The standard battery of diagnostic tests for enterovesical fistulas was performed. Thirteen patients with colovesical fistulas had small intestinal series; the fistula was demonstrated in only five patients. Sixteen patients had an intravenous pyelogram and the fistula was demonstrated in none. Cystoscopy was performed upon 15 patients and the fistula was demonstrated in one. A cystogram was performed upon ten patients and the fistula was demonstrated in four. In contrast, all patients had positive computed tomographic findings. The pathognomonic finding of air within the bladder was demonstrated in 20 of 23 patients without recent transurethral instrumentation. All 24 computed tomographic scans demonstrated an abnormally thickened segment of intestine in intimate contact with a thickened bladder wall at the site of the fistula. This was associated with a paravesical mass in 23 of the patients. Two of the four patients in whom bladder air was not seen had a vesical fistula of the small intestine. All 24 fistulas were confirmed by operation (22 patients) or subsequent clinical course (two patients). These findings suggest that computed tomography is the most accurate diagnostic tool available for demonstrating enterovesical fistulas. Computed tomography should supplant the use of other less sensitive diagnostic test currently included in the evaluation of patients with a suspected enterovesical fistula.