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Ann Ital Chir. 2002 May-Jun;73(3):311-5.

[Complication of acute diverticulitis: colo-vesical fistula (a clinical case)].

[Article in Italian]

Author information

1
VI Divisione di Clinica Chirurgica Generale e d'Urgenza, Seconda Università degli Studi di Napoli.

Abstract

BACKGROUND:

A patient presenting a colo-vescical fistula together with a number of other pathologies, and the absolute absence of a set scheme for the treatment of septic diverticular complications has prompted us to publish this case.

PATIENT AND METHODS:

The patient aged 80 was admitted urgently, diagnosed with intestinal occlusion. Generally poor conditions: renal insufficiency, abdomen globose and hypertympanic, systaltic mass in the epigastric site. The patient had experienced abdominal pains for about 4 months; severe tenesmo during evacuation: fever temperature as high as 38.5 degrees C; dysuria; aero-hydro levels; stenosis of the sigmoid. A decision was taken to operate.

SURGERY:

The presence of a large mass at the level of the sigmoid, which subsumed the ileal ansae, the vescical and the sigmoid itself. While isolating the pelvic anatomical structures, a purulent sac in the Douglas was uncovered, which united the bladder and the sigmoid. It was thought appropriate only to fit a colostomy, thus excluding the descendents.

DISCUSSION:

Surgery must resolve the peritonitis and the fenestration itself. Due to the existing septic conditions, it was not believed advisable to perform a primary anastomosis; a Hartmann's or a simple colostomy was thought preferable.

CONCLUSIONS:

This case underlines the difficulty in standardising operational conduct when this in turn will depend on the experience of the operator and the circumstances met at the time.

PMID:
12404899
[Indexed for MEDLINE]
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