Palumbo Vito, Giannarini Gianluca, Subba Enrica, Inferrera Antonino, Ficarra Vincenzo
1 Department of Human Pathology in Adult and Developmental Age 'Gaetano Barresi', Urologic Section, University of Messina, Messina, Italy.
2 Urology Unit, Academic Medical Centre 'Santa Maria della Misericordia', Udine, Italy.
Urologia. 2019 Feb;86(1):39-42. doi: 10.1177/0391560318758939. Epub 2018 Mar 23.
: Entero-neovesical fistula is a rare complication after radical cystectomy and orthotopic ileal bladder substitution. Typical presenting symptoms are faecaluria, pneumaturia, recurrent urinary tract infections and abdominal pain. Risk factors include history of pelvic radiation, chemotherapy and abdominal surgery, as well as diverticular colonic disease, inflammatory bowel disease and traumatic pelvic injury. The paucity of cases reported in the literature makes the management of this threatening complication very challenging. Conservative treatment has only anecdotally been reported.
: We describe two cases of entero-neovesical fistula with different presentation, which both required an immediate surgical treatment. The former patient was admitted to the emergency room with faecaluria, complete urinary incontinence and fever 2 years after radical cystectomy, and a fistula between the Y-shaped neobladder and the bowel anastomosis was detected. He had previously undergone chemotherapy because of tumour progression. Undiversion into an ileal conduit was required. The latter patient presented with faecaluria 20 days after an uneventful radical cystectomy, and a fistula between the Vescica Ileale Padovana neobladder and the sigmoid was documented. Treatment included resection of the sigmoid with several small diverticula, temporary ileostomy and closure of the neobladder fistula.
: Conservative treatment of entero-neovesical fistula can be attempted only in patients with small openings in the small bowel and no systemic symptoms. In all other cases, surgical treatment with bowel resection and either closure of the neobladder opening or undiversion should be the preferred option.
肠膀胱瘘是根治性膀胱切除术后原位回肠膀胱替代术罕见的并发症。典型的症状表现为粪尿、气尿、反复尿路感染和腹痛。危险因素包括盆腔放疗、化疗和腹部手术史，以及结肠憩室病、炎症性肠病和骨盆外伤。文献报道的病例较少，使得这种严重并发症的治疗极具挑战性。保守治疗仅有零星报道。
我们描述了两例表现不同的肠膀胱瘘病例，均需立即进行手术治疗。前一例患者在根治性膀胱切除术后2年因粪尿、完全性尿失禁和发热入住急诊室，检查发现Y形新膀胱与肠吻合口之间存在瘘管。他此前因肿瘤进展接受过化疗。需要改道为回肠膀胱造瘘。后一例患者在根治性膀胱切除术后20天出现粪尿，经记录发现帕多瓦回肠膀胱新膀胱与乙状结肠之间存在瘘管。治疗包括切除有多个小憩室的乙状结肠、临时回肠造瘘和关闭新膀胱瘘口。
仅在小肠开口小且无全身症状的患者中可尝试保守治疗肠膀胱瘘。在所有其他情况下，手术切除肠段并关闭新膀胱开口或改道应是首选方案。
