World Congress of Gastroenterology

WCOG 2019


 
Management of fistula between neo bladder & rectum by ASD closure device
Malay Sharma Nikhil Mahajan Mahesh Patil Sunil Reddy Gaurav Ratnaparkhi Sarthak Atri

1- Jaswant Rai Speciality Hospital
 
Abstract:

Enterovesical fistula (EVF) is an abnormal communication between the intestine and the bladder first described in modern literature by W.H. Cripps in 1888. Around 80% of fistulas are secondary to inflammatory causes (diverticulitis being the most common) and 20% are attributable to malignant causes.These are life threatening as patient is in perpetual state of urosepsis and because of underlying advanced disease, surgical interventions are risky.

58-year-old man with Ca Urinary bladder status post-surgery with construction of neobladder followed by chemo radiation, presented with pneumaturia and fecaluria. On examination, he had fever and hypotension. CECT abdomen showed fistula of 1.4 cm X 1.9 cm between neo-bladder and rectum. Colonoscopy confirmed the fistula. Fistula mapping was done by advancing the colonoscope into the bladder. Subsequently simultaneous Colonoscopy and Cystoscopy were done. Guidewire was advanced through the colonoscope into the fistulous opening and brought out via cystoscope out of urethra. Fistula was closed by Amplatzer double-disk nitinol wire mesh under direct colonoscopic and cystoscopic vision. Patient did well post procedure. But he succumbed 3 months post procedue due to advanced disease.

There is no substantial literature for treatment of enterovesical fistula secondary to malignancy. Endoscopic therapies have been tried with mixed results. Of the modalities described in literature Self expandable metallic stents (SEMS), Sealants, stem cell transplantation have been used to close the fistula tract especially in small fistulous openings. We attempted closure of a malignant fistula with ASD device as it was a wide fistula not amenable to closure by other endoscopic modalities.

 

Keywords:

Enterovesical fistula (EVF)

Amplatzer double-disk nitinol wire mesh