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• W2013276342 abstract "A 62-year-old man was evaluated for acute diarrhea. He had undergone a robotic-assisted laparoscopic prostatectomy 3 weeks previously for prostate cancer. Postoperatively, he developed a pelvic hematoma and underwent arterial embolization. Two weeks after the prostatectomy he developed an infected pelvic hematoma treated with antibiotics. Concurrently he developed loose watery diarrhea with bowel movements every 60 minutes associated with urgency and scant hematochezia. Stool studies for enteric bacterial pathogens, ova, and parasites were negative. Clostridium difficile toxins were not detected by enzyme immunoassay. Because of the high suspicion for C difficile infection, a flexible sigmoidoscopy was performed. Endoscopic findings revealed a large 10-mm, well-circumscribed fistulous tract arising from the anterior rectal wall located 1-cm proximal from the dentate line (Figure A) communicating with a large cavity with purulent discharge (Figure B). A urinary bladder catheter was placed with drainage of turbid brown fluid and immediate cessation of diarrhea. Computerized tomography with contrast infused through the urinary bladder catheter (Figure C, black arrow) revealed a rectovesical fistula (Figure C, white arrow). The patient underwent a diverting colostomy to allow for fistula closure. A colovesical fistula is an abnormal communication between the urinary bladder and a segment of large intestine. The most common site involves the sigmoid colon. The majority of rectovesical fistulas present with pneumaturia or fecaluria. Nonspecific findings include urinary tract infection, urinary frequency, hematuria, or dysuria. Diarrhea as the only presenting symptom is very rare. Diagnosis is confirmed by computerized tomography, cystoscopy, cystogram, or colonoscopy. In adults, the most common causes of colovesical fistulas include Crohn's disease and diverticulitis. Cancer of the prostate, bladder, cervix, or colorectum accounts for 25% of colovesical fistulas.1King R.M. Beart Jr, R.W. McIlrath D.C. Colovesical and rectovesical fistulas.Arch Surg. 1982; 117: 680-683Crossref PubMed Scopus (46) Google Scholar Rectal injury after radical prostatectomy has an incidence of 1% to 11%, with subsequent formation of rectovesical fistulas.2Harpster L.E. Rommel F.M. Sieber P.R. et al.The incidence and management of rectal injury associated with radical prostatectomy in a community based urology practice.J Urol. 1995; 154: 1435-1438Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar Minimally invasive techniques, such as robotic-assisted laparoscopic prostatectomy, have been complicated by rectal injuries in 0.8% of cases.3Yee D.S. Ornstein D.K. Repair of rectal injury during robotic-assisted laparoscopic prostatectomy.Urology. 2008; 72: 428-431Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar The York–Mason and the Modified York–Mason have been successful surgical modalities for rectovesical fistulas.4Kasraeian A. Rozet F. Cathelineau X. et al.Modified York-Mason technique for repair of iatrogenic rectourinary fistula: the Montsouris experience.J Urol. 2009; 181: 1178-1183Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar Less-invasive repair methods, including laparoscopic and robotic assisted, have been successful and accompanied by fewer complications.5Sotelo R. de Andrade R. Carmona O. et al.Robotic repair of rectovesical fistula resulting from open radical prostatectomy.Urology. 2008; 72: 1344-1346Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar This case highlights an unusual presentation of a rectovesical fistula with the only presenting symptom of diarrhea. This case identifies 2 unique etiologies of a rectovesical fistula, including unrecognized rectal injury after robotic-assisted laparoscopic prostatectomy and an adjacent infected pelvic hematoma. The presence of diarrhea after prostatectomy should raise suspicion for a rectovesical fistula, and appropriate clinical evaluation should promptly ensue. The authors would like to thank Dr Ahsan F. Mahmood for his assistance and review of this article." @default.
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• W2013276342 date "2010-06-01" @default.
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• W2013276342 title "Acute Diarrhea Caused by a Rectovesical Fistula After Laparoscopic Prostatectomy" @default.
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• W2013276342 doi "https://doi.org/10.1016/j.cgh.2009.11.007" @default.
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