Surgical approach of complicated diverticulitis with colovesical fistula: technical note in a particular condition

• Authors: Jacopo Desiderio , Stefano Trastulli , Chiara Listorti , Diego Milani , Michele Cerroni , Giovanni Cochetti , Roberto Cirocchi , Carlo Boselli , Amilcare Parisi , Ettore Mearini , Giuseppe Noya
• Languages of publication: EN

Abstracts

EN

Background: Diverticular disease of the colon is common in the Western world. With the first episode of diverticulitis, most patients will benefit from medical therapy, but in 10% to 20% of cases some complications will develop, such as intra-abdominal abscesses, obstructions, fistulas. In these conditions it is important to define the most appropriate surgical approach. Discussion: The management of diverticular disease has been successful owing to the advances in diagnostic methods, intensive care and surgical experience, but there is debate about the best treatment for some conditions. Fistulas complicating diverticulitis are the result of a localized perforation into adjacent viscera. In particular, the connection between the colon and the urinary tract is a serious anatomical abnormality that must be urgently corrected before a serious urinary infection results. Indications, timing and surgical procedures are determined by the severity of the disease and the patient’s general condition. Summary: Diverticular disease can lead to many complications. One of the most difficult to correct is an internal fistula, such as a colo-vesical fistula. The correct approach in cases where the disorder is clinically suspected has always been controversial, and the guidelines for sigmoid diverticulitis have not established the most appropriate method for diagnosis and treatment. At present, the surgical strategy for these cases requires interruption of the fistula and resection to remove the inflamed colonic segment, with or without primary anastomosis, focusing attention on the construction of the anastomosis to well vascularized and anatomically healthy tissues. It is clear, therefore, that establishing guidelines is difficult, because many pathological situations may be related to diverticulitis, and so, as our experience shows, the surgical approach has to be tailored to the patient’s general and local condition.

Keywords

EN

Diverticulitis; Colo-vesical fistula; Valdoni

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2012
• Volume: 7
• Issue: 5
• Pages: 578-583

Dates

published

1 - 10 - 2012

online

28 - 7 - 2012

Contributors

author

Jacopo Desiderio

• Department of General Surgery, University of Perugia, St. Maria Hospital, Terni, Italy

author

Stefano Trastulli

• Department of General Surgery, University of Perugia, St. Maria Hospital, Terni, Italy

author

Chiara Listorti

• Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy

author

Diego Milani

• Department of General Surgery, University of Perugia, St. Maria Hospital, Terni, Italy

author

Michele Cerroni

• Department of General Surgery, University of Perugia, St. Maria Hospital, Terni, Italy

author

Giovanni Cochetti

• Department of surgical specialties, Urological Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy

author

Roberto Cirocchi

• Department of General Surgery, University of Perugia, St. Maria Hospital, Terni, Italy

author

Carlo Boselli

• Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy

author

Amilcare Parisi

• Department of Digestive Surgery and Liver Unit, St. Maria Hospital, Terni, Italy

author

Ettore Mearini

• Department of surgical specialties, Urological Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy

author

Giuseppe Noya

• Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy

References

• [1] Kang JY, Dhar A, Pollok R, Leicester RJ, Benson MJ, Kumar D et al. Diverticular disease of the colon: ethnic differences in frequency. Aliment Pharmacol Ther. 2004;19(7):765–769. doi:10.1111/j.1365-2036.2004.01908.x APT1908 [pii] http://dx.doi.org/10.1111/j.1365-2036.2004.01908.x[Crossref]
• [2] Kang JY, Melville D, Maxwell JD. Epidemiology and management of diverticular disease of the colon. Drugs Aging. 2004;21(4):211–228. doi:2141 [pii] http://dx.doi.org/10.2165/00002512-200421040-00001[WoS][Crossref]
• [3] Weizman AV, Nguyen GC. Diverticular disease: epidemiology and management. Can J Gastroenterol. 2011;25(7):385–389 [PubMed]
• [4] Ferzoco LB, Raptopoulos V, Silen W. Acutediverticulitis. N Engl J Med. 1998;338(21):1521–1526. doi:10.1056/NEJM199805213382107 http://dx.doi.org/10.1056/NEJM199805213382107[Crossref]
• [5] Meagher AP, Frizelle FA, Janes S. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2007;50(5):683–685. doi:10.1007/s10350-006-0856-z http://dx.doi.org/10.1007/s10350-006-0856-z[Crossref]
• [6] Klarenbeek BR, de Korte N, van der Peet DL, Cuesta MA. Review of current classifications for diverticular disease and a translation into clinical practice. Int J Colorectal Dis. 2011. doi:10.1007/ s00384-011-1314-5 [WoS][Crossref]
• [7] Kohler L, Sauerland S, Neugebauer E. Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery. Surg Endosc. 1999;13(4):430–436 [Crossref][PubMed]
• [8] Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg. 1978;12:85–109 [PubMed]
• [9] Pavlidis TE, Pavlidis ET, Sakantamis AK. Current management of diverticular disease of the colon. Tech Coloproctol. 2010;14 Suppl 1:S79–81. doi:10.1007/s10151-010-0629-5 http://dx.doi.org/10.1007/s10151-010-0629-5[WoS][Crossref]
• [10] Ambrosetti P, Jenny A, Becker C, Terrier TF, Morel P. Acute left colonic diverticulitis-compared performance of computed tomography and water-soluble contrast enema: prospective evaluation of 420 patients. Dis Colon Rectum. 2000;43(10):1363–1367 http://dx.doi.org/10.1007/BF02236631[Crossref]
• [11] Linder MM, Wacha H, Feldmann U, Wesch G, Streifensand RA, Gundlach E. [The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis]. Chirurg. 1987;58(2):84–92
• [12] Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–1451. doi:0895-4356(94)90129-5 [pii] http://dx.doi.org/10.1016/0895-4356(94)90129-5
• [13] Dripps RD. New classification of physical status. Anesthesiology. 1963;24(111)
• [14] Senagore AJ, Warmuth AJ, Delaney CP, Tekkis PP, Fazio VW. POSSUM, p-POSSUM, and Cr-POSSUM: implementation issues in a United States health care system for prediction of outcome for colon cancer resection. Dis Colon Rectum. 2004;47(9):1435–1441. doi:10.1007/s10350-004-0604-1 http://dx.doi.org/10.1007/s10350-004-0604-1[Crossref]
• [15] Aydin HN, Tekkis PP, Remzi FH, Constantinides V, Fazio VW. Evaluation of the risk of a nonrestorative resection for the treatment of diverticular disease: the Cleveland Clinic diverticular disease propensity score. Dis Colon Rectum. 2006;49(5):629–639. doi:10.1007/s10350-006-0526-1 http://dx.doi.org/10.1007/s10350-006-0526-1[Crossref]
• [16] Lockhart-Mummery JP. Late results of diverticulitis. Lancet. 1938;2:1401–1404. doi:10.1016/S0140-6736(00)83834-9 http://dx.doi.org/10.1016/S0140-6736(00)83834-9[Crossref]
• [17] Sanderson ER. Henri Hartmann and the Hartmann operation. Arch Surg. 1980;115(6):792–793 http://dx.doi.org/10.1001/archsurg.1980.01380060088026[Crossref]
• [18] Nagorney DM, Adson MA, Pemberton JH. Sigmoid diverticulitis with perforation and generalized peritonitis. Dis Colon Rectum. 1985;28(2):71–75 http://dx.doi.org/10.1007/BF02552645[Crossref]
• [19] Zeitoun G, Laurent A, Rouffet F, Hay J, Fingerhut A, Paquet J et al. Multicentre, randomized clinical trial of primary versus secondary sigmoid resection in generalized peritonitis complicating sigmoid diverticulitis. Br J Surg. 2000;87(10):1366–74. doi:bjs1552 [pii]_10.1046/j.1365-2168.2000. 01552.x http://dx.doi.org/10.1046/j.1365-2168.2000.01552.x[Crossref]
• [20] Karran SJ, Restoration of intestinal continuity following Hartmann’s procedure: the Lothian experience 1987–1992. Br J Surg. 1995;82(8): 1138–1139 http://dx.doi.org/10.1002/bjs.1800820843[Crossref]
• [21] Constantinides VA, Tekkis PP, Athanasiou T, Aziz O, Purkayastha S, Remzi FH et al. Primary resection with anastomosis vs. Hartmann’s procedure in nonelective surgery for acute colonic diverticulitis: a systematic review. Dis Colon Rectum. 2006;49(7):966–981. doi:10.1007/s10350-006-0547-9 http://dx.doi.org/10.1007/s10350-006-0547-9[Crossref]
• [22] Valdoni P, Virno F, Aureggi A. Preservation and peeling of the inferior mesenteric artery as a complication-preventing technique in the anterior resection of the rectum. Surg Italy. 1972;2:85–89
• [23] Melchior S, Cudovic D, Jones J, Thomas C, Gillitzer R, Thuroff J. Diagnosis and surgical management of colovesical fistulas due to sigmoid diverticulitis. J Urol. 2009;182(3):978–982. doi:S0022-5347(09)01162-8 [pii]_10.1016/j. juro.2009.05.022 http://dx.doi.org/10.1016/j.juro.2009.05.022[Crossref]
• [24] Basile G. [Colovesical fistulas caused by diverticular disease]. Minerva Chir. 1992;47(5):257–260
• [25] Practice parameters for sigmoid diverticulitis. The Standards Task Force, American Society of Colon and Rectal Surgeons. Surg Laparosc Endosc Percutan Tech. 2000;10(3):142–148
• [26] Garcea G, Majid I, Sutton CD, Pattenden CJ, Thomas WM. Diagnosis and management of colovesical fistulae; six-year experience of 90 consecutive cases. Colorectal Dis. 2006;8(4): 347–352. doi:CDI928 [pii]_10.1111/j.1463-1318.2005.00928.x http://dx.doi.org/10.1111/j.1463-1318.2005.00928.x[Crossref]
• [27] Messinetti S, Giacomelli L, Manno A, Finizio R, Fabrizio G, Granai AV et al. Preservation and peeling of the inferior mesenteric artery in the anterior resection for complicated diverticular disease. Ann Ital Chir. 1998;69(4):479–482; discussion 82–83
• [28] Tocchi A, Mazzoni G, Fornasari V, Miccini M, Daddi G, Tagliacozzo S. Preservation of the inferior mesenteric artery in colorectal resection for complicated diverticular disease. Am J Surg. 2001;182(2):162–167. doi:S0002-9610(01)00681-X [pii] http://dx.doi.org/10.1016/S0002-9610(01)00681-X[Crossref]
• [29] Shikata J, Shida T, Satoh S, Furuya K, Kamiyama A. The effect of local blood flow on the healing of experimental intestinal anastomoses. Surg Gynecol Obstet. 1982;154(5):657–661
• [30] Foster ME, Lancaster JB, Leaper DJ. Leakage of low rectal anastomosis. An anatomic explanation? Dis Colon Rectum. 1984;27(3):157–158 http://dx.doi.org/10.1007/BF02555661[Crossref]
• [31] Foster ME, Lancaster JF, Leaper DJ. Functional aspects of ano-rectal vascularity. Acta Anat (Basel). 1985;123(1):30–33 http://dx.doi.org/10.1159/000146034[Crossref]
• [32] Napolitano AM, Napolitano L, Costantini R, Ucchino S, Innocenti P. [Skeletization of the inferior mesenteric artery in colorectal surgery. Current considerations]. G Chir. 1996;17(4):185–189
• [33] Patricio J, Bernades A, Nuno D, Falcao F, Silveira L. Surgical anatomy of the arterial blood-supply of the human rectum. Surg Radiol Anat. 1988;10(1):71–75 http://dx.doi.org/10.1007/BF02094074[Crossref]
• [34] Fegiz G, Tonelli F, Rossi P, Di Paola M, De Masi E, Simonetti G. Preservation of the superior hemorrhoidal artery in resection of the colon and rectum. Surg Gynecol Obstet. 1976;143(6):919–925
• [35] Ghavami B. Doit-on préserver l’Artère Mésentérique Inférieure lors d’une sigmoïdectomie pour maladie bénigne? Le Journal de coelio-chirurgie. 2008;65:11–14
• [36] Caldana G, Caron R, Florianello F, Musazzi M, Morbidelli A. [Perforated colonic diverticulitis. Surgical technique]. Minerva Chir. 1994;49(7–8):647–651
• [37] Biondo S, Borao JL, Millan M, Kreisler E, Jaurrieta E. Current status of the treatment of acute colonic diverticulitis: a systematic review. Colorectal Dis. 2011. doi:10.1111/j.1463-1318.2011.02766.x [Crossref]

Identifiers

DOI

10.2478/s11536-012-0036-6