腸道膀胱廔管-病患的夢靨：2例病例報告與文獻探討
廖丞晞1,2,3、王柏仁1,3、沈敬棟1,3、岳德政2,3,4
1國軍台中總醫院外科部泌尿外科; 2中國醫藥大學生物醫學研究所; 3國防醫學院臨床醫學研究所; 4國軍台中總醫院外科部大腸直腸外科
Entero-vesical Fistulas-A Nightmare of the Patient: 2 Case Reports and Review of Literature
Cheng-Hsi Liao1,2,3, Bo-Ren Wang1,3, Jing-Dung Shen1,3, and Te-Cheng Yueh2,3,4
1Division of Urology, Department of Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan, R.O.C.; 2Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan, R.O.C.; 3Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, R.O.C. 4Division of Colorectal Surgery, Department of Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan, R.O.C.
Abstract:
Case 1: A 54-year-old woman, who suffered from repeat UTI, pyuria, difficulty in urination, and burning micturition off-and-on for almost months s/p vesicorrhaphy at LMD on 106/12/08. She was transferred from LMD hospital, where CT revealed entero-vesical fistulas. Due to old CVA with long-term bed ridden and Foley indwelling, weakness of left lower limb was noted. Under the diagnosed of (1) Vesico-bowel fistula; (2) Type 2 diabetes mellitus; (3) Hypertension, she was admitted in our CRS ward for surgical intervention: fistulectomy & repair of small bowel & U-bladder wall. After GU/CRS combined surgery and post-op care, she got progressively improved of the EVF(Entero-vesical fistula) problems.
Case 2: A 68-year-old male with a medical history of hypertension and type 2 DM under medical control, who was admitted via OPD due to abdominal pain and diarrhea for 3 days. Initially he was admitted in GI ward for tumor survey, and then GI man consulted CRS Dr. and performed colonoscopy with biopsy to prove the AdenoCa. of S-colon, stage IV. Due to the terminal stage, C/Tx was arranged after he got discharged from the hospital. But he came to our ER and GU OPD for many times because of tumor related EVF(Entero-vesical fistula) problems.
Entero-vesical Fistulas(EVF) are an uncommon complication of both benign and malignant processes. The diagnosis of EVF may be challenging. With a high index of suspicion for fistula formation in patients presenting with symptoms suggestive of abnormal communication between the intestine and the bladder, appropriate radiological investigation can lead to a significant reduction in morbidity. Recognition of a fistulous tract, delineation of its course, and characteristics of its complexity affect the EVF management.
Cross-sectional imaging with CT and MRI remains an ideal modality option in patients with EVF. Medical treatment consists of nutritional support and treatment of urinary tract infection with broad-spectrum antibiotics. Definitive Treatment is surgical resection of the fistula, involved intestine, and bladder wall (like our 1st case). Management of EVF is mainly dependent on the underlying pathology, site of the bowel lesion, and patient’s preoperative performance status. Surgical one-stage strategy is a preferred option in most of the cases.