Treatment of Vesico-enteric Fistula

About the disease

Vesico-enteric fistula, also known as vesico intestinal, is characterized by a hole that develops between the bowel and the intestine. “Fistula” is a general term for a hole that develops in some part of the body and can occur following surgery of the intestinal tract if it does not grow back together properly.

A fistula can also develop in people who overstrain their muscles or have problems with muscle tone. People who are overweight have a predisposition for muscle weakness, because visceral fat in the abdominal area takes away the initial strength of the abdominal muscles. Weightlifting can also cause a person to develop a vesico-enteric fistula, especially if they lift objects heavier than their own weight. Manual labor and child birth can also overstrain the lower abdominal muscles and cause problems later on.

A vesico-enteric fistula can also result from intestinal diseases, such as diverticulitis or colorectal cancer. Diverticulitis is the inflammation of the diverticulum. According to statistics, 60% of all vesico-enteric fistula cases are caused by diverticulitis and another 10% are caused by colorectal cancer. Crohn’s disease can also lead to the development of a vesico-enteric fistula, as can undergoing radiotherapy, appendicitis or trauma to the lower abdominal area.

Symptoms

• Gas, or air, in the urine
• Feces and urine are mixed together, due to the hole
• Discomfort or pain in the lower abdomen
• Diarrhea or constipation
• Pain when urinating

Diagnosis

• During a general examination, the doctor will inquire about the patient’s medical history, specifically asking about any intestinal diseases. This should help to rule out any other causes of abdominal pain.
• The doctor will internally examine the patient’s genitals and rectum.
• An ultrasound can be useful when examining the bowel and intestines. Any sign of a fistula, diverticulitis or other diseases of the intestinal tract should show up.
• Other imaging tests, such as a CT or MRI scan, can give doctors a clear picture of the intestines, so that they can rule out other conditions.
• A biopsy is performed if there is a suspicion of malignancy.
• A blood test can rule out the possibility of an infection.

Treatment

• Operational closure is a surgical procedure whereby the fistula is repaired. Surgeons may be able to correct any other intestinal problems at the same time, and prevent any blood leakage.
• The patient will need to take things easy during the recovery period, to prevent the hole from reopening.

Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko