VESICO-COLIC FISTULAS IN THE GRAMPIAN REGION - PRESENTATION, ASSESSMENT, MANAGEMENT AND OUTCOME

Over a 12-year period, 67 patients presented with a vesico-colic fistu la. The mean age was 69 years (range 19-96 years), with symptoms predo minately referred to the urinary tract. Cystoscopy and barium enema co nfirmed the presence of a fistula in 60 and 44% of patients respective ly. A computerized tomography (CT) scan, used in only seven patients, revealed the fistula in each case. The underlying pathology included d iverticular disease (62%), carcinoma (27%) and inflammatory bowel dise ase (6%). Fifty-one patients proceeded to surgery, of whom 32 (63%) ha d a sigmoid/recto sigmoid resection with primary anastomosis, and 13 ( 25%) a Hartmann's procedure. A diverting colostomy alone was employed to palliate cases of widespread carcinoma. No patient subsequently had the Hartmann's reversed, In addition to colonic resection, 48 (92%) p atients had a simultaneous bladder procedure, varying from simple over sew in 32 (70%) patients to cystectomy and ileal conduit in three (6%) . Wedge excision with primary bladder closure was practised in 12 (24% ). Fistula recurrence occurred in seven (14%) patients, and the 30-day mortality was 10%. Surgery for vesico-colic fistula has an appreciabl e morbidity and mortality, yet if offers the only hope of achieving pe rmanent symptomatic control.