Fístula Colovesical de Origen Diverticular. Resolución Laparoscópica con Nuevo Recurso Técnico

Abstract

Background: Diverticular disease is a high prevalent colonic pathology. Initial presentation as complicated disease includes fistulas, perforation and bleeding.
Objetive: To present technical surgical aspects of surgical treatment of laporoscopic resection of colovesical fistula after diverticular disease.
Methods: A 63 years old patient presented with low abdominal pain and no transit symptoms. There was no previous surgery and diverticulitis episode. Abdominal ultrasound and CT scan showed air in the bladder. Urine culture was positive to Escherichia coli. Colonic barium x-rays showed a colovesical fistula. Laparoscopic resection was decided as treatment of
choice.
Results: Laparoscopic sigmoid colectomy, aisolation of fistula tract and posterior clips ligation and section. Primary mecanic anastomosis and 15 days vesical catheter completed the treatment. Postoperative evolution was satisfactory.
Conclusions: Colovesical fistula is a frequent complication of complicated diverticular disease, however its debut without previous episodes is rare. The colonic fistula presented as unique tract is unfrequent. Resolution by polimer clips and section associated with colonic resection by laparoscopic is a good option to avoid bladder sutures. This procedure resulted safe and effective.