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• W3022508717 abstract "Introduction Colovesical fistulas (CVFs) occur as a complication of diverticulitis, cancer, or Crohn’s disease. The sigmoid colon is the most frequently involved segment. The most common presenting symptoms are pneumaturia and dysuria, followed by faecaluria, abdominal pain and, rarely, haematuria. The diagnosis is usually made clinically but can be confirmed by cystoscopy, sigmoidoscopy, barium enema, CT scan, MRI, or virtual colonoscopy. The usual management for symptomatic patients is colonic resection (which can be performed laparoscopically) but this approach is associated with morbidity and mortality. Only a few cases of endoscopic management by clip closure, using through-the-scope (TTS) or over-the-scope (OTS) clips have been described in the literature. Here, we present a case of a CVF, which was managed with multiple TTS clips, thus avoiding surgical intervention. Methods A frail 84 year old man had a background history of coronary artery bypass graft, aortic valve replacement (tissue valve), dialysis dependent chronic renal failure and sigmoid diverticular disease. He was investigated for pneumaturia and recurrent urinary tract infections 12 months ago and was diagnosed on CT scan as having CVF secondary to sigmoid diverticular disease. He developed faecaluria, He was referred by the colorectal surgeon for endotherapy as he was considered too frail for any surgical intervention. A combined simultaneous cystoscopy and flexible sigmoidoscopy (using a gastroscope) was undertaken under conscious sedation. The cystoscopy identified a fistula in the dome of the bladder (on left side). The sigmoid colon was carefully examined and revealed diverticular disease but no obvious fistula was visible. Hence, indigocarmine solution (16 mg/litre), warmed to body temperature, was instilled into the bladder via the cystoscope and the blue solution was eventually seen to emerge in the sigmoid colon through the fistula. This site was marked with a Resolution 360 clip (Boston Scientific). After this, 4 further clips were placed onto the fistula in order to close it. Finally, the site was marked with a tattoo, in case a repeat procedure was needed in the future. Results The procedure took almost two hours and was successfully performed. The patient was discharged on the same day. Conclusion Although there are many surgical options available for management of CVF, only a few case reports exist regarding non-surgical management of CVF. We recommend that combined endoscopic management of CVF should be considered in patients who are too frail for surgery or have multiple co-morbidities." @default.
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• W3022508717 date "2019-06-01" @default.
• W3022508717 modified "2023-10-16" @default.
• W3022508717 title "PTH-071 Combined endoscopic closure of colovesical fistula" @default.
• W3022508717 doi "https://doi.org/10.1136/gutjnl-2019-bsgabstracts.96" @default.
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