Daniels I R, Bekdash B, Scott H J, Marks C G, Donaldson D R
Department of Surgery, St Peter's Hospital, Chertsey, UK.
Colorectal Dis. 2002 Nov;4(6):459-62. doi: 10.1046/j.1463-1318.2002.00370.x.
An enterovesical fistula (EVF) is an uncommon condition requiring careful and sometimes extensive preoperative investigation. Our experience over a 10-year period has been reviewed with emphasis on the diagnostic investigations performed.
Forty-two patients (30 male) have been studied. Presenting symptoms, diagnostic investigations, and subsequent treatment have been reviewed.
The site of the fistulae were; 37 colonic, 2 rectal, and 3 ileal. The commonest presenting symptoms were; pneumaturia 75%, faecaluria 63% and urinary tract infections 57%. The positivity rate of the investigations performed were; cystoscopy 89%, urine cytology 86%, barium enema 65%, computerized tomography (CT) scanning 55%, IVP 35%, and cystography 27.5%. The causes of the fistula were; diverticular disease 71%, carcinoma 20%, Crohn's disease 7%, and radiotherapy 2%.
We recommend cystoscopy and urine cytology for faecal material as the first-line investigations in all patients with a suspected enterovesical fistulae. CT scanning and barium enema should not be first line investigations but may be performed subsequently to help determine the aetiology and planning of surgery.
膀胱结肠瘘（EVF）是一种罕见疾病，需要进行仔细且有时是广泛的术前检查。我们回顾了10年间的经验，重点是所进行的诊断性检查。
研究了42例患者（30例男性）。回顾了其出现的症状、诊断性检查及后续治疗情况。
瘘管部位为：结肠37例，直肠2例，回肠3例。最常见的症状为：气尿75%，粪尿63%，尿路感染57%。所进行检查的阳性率为：膀胱镜检查89%，尿细胞学检查86%，钡剂灌肠65%，计算机断层扫描（CT）55%，静脉肾盂造影（IVP）35%，膀胱造影27.5%。瘘管的病因有：憩室病71%，癌20%，克罗恩病7%，放疗2%。
对于所有疑似膀胱结肠瘘的患者，我们建议将膀胱镜检查及粪便尿细胞学检查作为一线检查。CT扫描和钡剂灌肠不应作为一线检查，但随后可进行以帮助确定病因及手术规划。
