Hudson H M, Millham F H, Dennis R
Department of Surgery, Boston University Medical Center, Massachusetts 02118.
Am Surg. 1992 Dec;58(12):784-6.
Enterovesical fistulas usually result from diverticulitis, Crohn's disease, or colorectal cancer. A perforated Meckel's diverticulum can also result in an vesico-diverticulum fistula, as noted in three previously reported cases. In all three cases, bladder or bowel disease was associated with the fistula. Herein, the authors describe a previously healthy, 23-year-old man who presented with an enterovesical fistula. Exploratory laparotomy revealed a vesico-diverticular fistula resulting from a perforated Meckel's diverticulum. Pathologic examination revealed that the diverticulum did not contain ectopic gastric or pancreatic tissue and that the perforation was secondary to an enterolith. The patient underwent a diverticulectomy and had an uneventful postoperative course. Unlike any of the three previously reported cases, the authors' patient had no coexisting bowel or bladder disease occurring with his vesico-diverticular fistula. To the authors' knowledge, this is only the third reported case of a vesico-diverticular fistula resulting from a perforated Meckel's diverticulum that did not contain ectopic tissue. It represents the first case where the perforation was secondary to an enterolith.
膀胱内瘘通常由憩室炎、克罗恩病或结直肠癌引起。如先前报道的3例病例所示，穿孔的梅克尔憩室也可导致膀胱憩室瘘。在所有这3例病例中，膀胱或肠道疾病均与瘘管相关。在此，作者描述了一名既往健康的23岁男性，他因膀胱内瘘前来就诊。剖腹探查发现膀胱憩室瘘是由穿孔的梅克尔憩室所致。病理检查显示，憩室内不含异位胃或胰腺组织，穿孔是由肠石继发引起的。患者接受了憩室切除术，术后恢复顺利。与先前报道的3例病例不同，作者的患者在膀胱憩室瘘发生时没有并存的肠道或膀胱疾病。据作者所知，这是第三例报道的由穿孔的梅克尔憩室导致的膀胱憩室瘘病例，且憩室内不含异位组织。这是首例穿孔由肠石继发引起的病例。
