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Background: We report a rare case of spontaneous vesicorectal fistula., Case Presentation: A 13-year-old female spina bifida patient who complained of fecal and urinary incontinence was eventually diagnosed with a spontaneous vesicorectal fistula. We hypothesized that infection, neurogenic bowel and neurogenic bladder caused her vesicorectal fistula. The patient refused the operation, and she is currently in a delicate balance., Conclusions: Early repair of the fistula is necessary. The treatment of neurogenic bladder after fistula repair is difficult and deserves further observation and follow-up.

The repair of rectourinary fistulas is frequently a matter of great difficulty. We report the case of a young man who sustained a shotgun wound to his pelvis and developed a fistula from the bladder neck to the rectum, which was repaired by a combined transabdominal and posterior sagittal transrectal approach. We recommend that this procedure should be part of the surgical armamentarium available to deal with such complicated lesions.

In the literature many different ways are described of treating rectal injured during radical prostatectomy. Therefore, following this procedure we evaluated our patients with rectal injuries. Rectal injury occurred in 16 of 299 patients with radical prostatectomy for treatment of localized prostate cancer. Seven developed a vesicorectal fistula, 4 of whom needed no further surgical intervention. Only 3 (1%) had to undergo an additional operation.

A new operative technique that uses ultrasonography during sacroperineal or sacroabdominoperineal anorectoplasty was performed on seven patients with an intermediate or high anorectal malformation. Ultrasonography was used for the purpose of making a pull-through tunnel under visual guidance. The results of this technique were evaluated by computed tomography scanning to find the anatomic position of the pulled-through rectum in relation to the anal sphincter muscle. Postoperative computed tomography scans showed that the rectum was correctly placed in the center of the sphincter muscle in all patients.

Vesico-rectal fistula is a rare congenital abnormality causing severe early second trimester oligohydramnios. Prenatal diagnosis of such a case is reported here. Ultrasound diagnosis could be aided by transabdominal amnio-infusion and, if necessary, fetal intraperitoneal saline installation. In a karyotypically normal fetus with normal somatic growth, demonstration of normal fetal kidneys together with a functioning urinary bladder, in presence of severe oligohydramnios, is very suggestive of the diagnosis. Since pulmonary hypoplasia is the major cause of neonatal mortality in these cases, restoration of normal amniotic fluid volume by serial amnio-infusion was attempted. Although amnio-infusion is an important diagnostic aid in the evaluation of severe midtrimester oligohydramnios, the role of multiple therapeutic amnio-infusion in improving lung growth remains to be evaluated.

Severe oligohydramnios and extremely dilated bowel filled with hyperechogenic material floating in fluid were the ultrasonographic findings in a fetus at 27 weeks' gestation. Vesicorectal communication and urethral-anal atresia permitted urine to empty into the colon, causing megacolon, oligohydramnios, and markedly increased intraabdominal pressure resulting in pulmonary hypoplasia.

A case of an enterovesical fistula demonstrated by computed tomography (CT) scan in an AIDS patient with cryptosporidiosis is reported. Other studies including barium enema and endoscopy were unsuccessful in detection of the fistula. The value of CT in both the AIDS patient and the patient with suspected enterovesical fistula is reviewed.

Rectourethral and vesical fistulas in patients with high anorectal atresia can be demonstrated by using a pressure Gastrografin enema through the distal colostomy opening. A technique is described where contrast medium is forced by gentle pressure, filling the fistula and the urethra. This picture is of great value during the repair of these anomalies.

Rectal invasion by carcinoma of the prostate occurs in a significant number of cases (approaching 10%). A case of a rectovesical fistula owing to direct extension of a prostatic carcinoma is reported. This complication of the disease has not been described previously.

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.