Colovesical fistula — an abnormal communication between the colon and bladder — characteristically presents with pneumaturia and fecaluria. When initial medical and supportive measures fail to resolve the underlying infection, abscess, anaemia, and nutritional deficits, a structured surgical protocol is the recognised next step.
The first-line approach — antimicrobial therapy for urosepsis, percutaneous drainage of pelvic abscess, and correction of anaemia and malnutrition — aims to stabilise the patient before definitive intervention. Escalation to the surgical protocol is indicated when urosepsis has not resolved, the pelvic abscess has not cleared, or anaemia and malnutrition remain uncorrected.
Surgical intervention is the established definitive treatment, as medical therapy typically temporises symptoms without achieving cure. The operative approach is laparoscopic and addresses both the colonic and bladder components of the fistula — the specific steps, sequence, and technical details are contained in the full protocol.
Treatment aims for healing of the colovesical fistula, resolution of pneumaturia, and resolution of fecaluria. The primary goal is removal of the diseased colonic segment.
DOI: 10.4274/tjcd.galenos.2022.2022-9-1