Yashi M, Muraishi O, Yuzawa M, Tokue A
Department of Urology, Jichi Medical School.
Hinyokika Kiyo. 1998 Jul;44(7):513-5.
A 74-year-old woman was referred to our hospital with the chief complaints of pneumaturia, fecaluria and discharge of feces and urine from vagina. Fistulography on the vaginal side showed the presence of contrast medium both in the sigmoid colon and bladder. Colonoscopy revealed multiple diverticulosis of the sigmoid colon. Under diagnosis of colo-vesico-vaginal fistula due to sigmoid colon diverticulitis, a one-stage operation removing sigmoid colon, uterus-vaginal wall and urinary bladder wall including the fistula and careful reconstruction was performed. Postoperatively, urinary leakage from vagina in large amounts continued due to the recurrence of vesico-vaginal fistula. An attempt to use human fibrin glue in the recurrent fistula was successful, and the patient was asymptomatic at 21 months of follow-up. Colovesical fistula has been reported in about 10-20% of patients undergoing surgery for complicated diverticulitis, but a combined fistula is a rare condition. Furthermore, we recommend the use of human fibrin glue for a recurrent fistula.
一名74岁女性因气尿、粪尿以及粪便和尿液从阴道排出的主要症状被转诊至我院。阴道侧瘘管造影显示乙状结肠和膀胱内均存在造影剂。结肠镜检查发现乙状结肠多发憩室。在诊断为乙状结肠憩室炎导致的结肠-膀胱-阴道瘘后，进行了一期手术，切除乙状结肠、子宫-阴道壁和膀胱壁（包括瘘管）并进行了仔细重建。术后，由于膀胱-阴道瘘复发，阴道大量漏尿持续存在。尝试在复发性瘘管中使用人纤维蛋白胶获得成功，患者在随访21个月时无症状。据报道，在接受复杂憩室炎手术的患者中，结肠膀胱瘘的发生率约为10%-20%，但合并瘘是一种罕见情况。此外，我们建议对复发性瘘管使用人纤维蛋白胶。
