From the Guidelines
Fistula formation is indeed considered a complication of diverticulitis, as it represents a severe disease process that has progressed beyond simple inflammation. According to the most recent and highest quality study, complicated diverticulitis includes the presence of abscess, peritonitis, obstruction, stricture, and/or fistula 1. The development of a fistula in diverticulitis occurs when the inflammation erodes through the bowel wall into adjacent structures, such as the bladder, vagina, small intestine, or skin. Management of diverticulitis with fistula typically requires surgical intervention, often including resection of the affected bowel segment and repair of the involved organ. Antibiotics are usually prescribed before surgery, commonly including combinations like ciprofloxacin 500mg twice daily plus metronidazole 500mg three times daily, or a broad-spectrum option like piperacillin-tazobactam 3.375g every 6 hours. Some key points to consider in the management of diverticulitis with fistula include:
- The presence of a fistula indicates a more severe disease process that has progressed beyond what can typically be managed with conservative treatment alone 1.
- The clinical presentation of diverticulitis with fistula can vary, but often includes symptoms such as abdominal pain, fever, and changes in bowel habits 1.
- The risk of complications, such as abscess or perforation, is higher in patients with diverticulitis and fistula, and prompt surgical intervention is often necessary to prevent these complications 1.
- The management of diverticulitis with fistula requires a multidisciplinary approach, including surgical, medical, and radiological interventions 1.
From the Research
Definition of Complicated Diverticulitis
- Complicated diverticulitis is characterized by the presence of abscesses, perforation, peritonitis, or obstruction 2
- Fistula formation is considered a complication of diverticulitis, which can involve the formation of abnormal connections between the colon and other organs, such as the bladder, vagina, or skin 3, 4, 5
Types of Fistulas
- Colovesical fistulas: abnormal connection between the colon and the bladder 3, 5
- Colovaginal fistulas: abnormal connection between the colon and the vagina 3, 5
- Colocutaneous fistulas: abnormal connection between the colon and the skin 3, 4, 5
- Coloenteric fistulas: abnormal connection between the colon and the small intestine 3, 5
Management of Fistulas
- Surgical treatment is often required for fistulas, with procedures such as resection and primary anastomosis or Hartmann's procedure 3, 4, 5
- Conservative management with antibiotics may be considered for patients who are poor operative risks or have resolved symptoms 5
- Percutaneous drainage may be used to manage abscesses, but there is a risk of fistula formation 4