From the Research
The management of diverticulitis colovesical fistula typically requires surgical intervention, with a single-stage surgical approach being the most effective and safe method, as evidenced by the most recent and highest quality study 1. The definitive treatment involves resection of the affected colon segment (usually sigmoid colectomy), closure of the bladder defect, and primary colorectal anastomosis. Before surgery, patients should receive broad-spectrum antibiotics (such as piperacillin-tazobactam 3.375g IV every 6 hours or ciprofloxacin 500mg PO twice daily plus metronidazole 500mg PO three times daily) for 7-14 days to control infection, as suggested by 1 and 2. Some key points to consider in the management of diverticulitis colovesical fistula include:
- Preoperative evaluation should include CT imaging with contrast, cystoscopy, and colonoscopy to confirm the diagnosis and rule out malignancy, as recommended by 1 and 2.
- Patients may require urinary catheterization to manage symptoms and allow the bladder inflammation to subside before surgery.
- In high-risk surgical candidates, a temporary diverting colostomy may be considered, although this approach is not recommended by 3 due to the lack of fistula definitive resolution and the possibility of additional complications.
- Postoperatively, patients should maintain the urinary catheter for 7-10 days to allow proper healing of the bladder repair, as suggested by 2. This comprehensive approach is necessary because colovesical fistulas rarely close spontaneously due to the persistent communication between the colon and bladder, leading to recurrent urinary tract infections, pneumaturia (air in urine), and fecaluria (stool in urine) if left untreated, as noted by 4, 1, and 2.