Internal fistulas in diverticular disease

Q: Which of the following is the most common fistula formation as one of the complications of diverticulitis? (select one)

A) colovesical 

B) colovaginal  

C) coloenteric 

D) colocutaneous 

Answer: A 

Fistula formation is one of the dreaded complications of diverticulitis, which usually requires surgical management. In about a quarter of the patients who require surgery for diverticular disease, fistulas are found.  Most of the fistulas are formed from diverticulitis in the sigmoid colon. 65% of the time, it is colovesical fistulas, followed by colovaginal. Other fistulas are coloenteric, colouterine, and colocutaneous. In rare cases, it can be multiple.

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References:

1. Woods RJ, Lavery IC, Fazio VW, et al. Internal fistulas in diverticular disease. Dis Colon Rectum 1988; 31:591.

2. Di Buono G, Bonventre G, Buscemi S, Randisi B, Romano G, Agrusa A. The colovescical fistula in diverticular disease: Laparoscopic approach in two different cases. Int J Surg Case Rep. 2020;77S(Suppl):S112-S115. doi: 10.1016/j.ijscr.2020.09.044. Epub 2020 Sep 11. PMID: 32972892; PMCID: PMC7876919.

3. Wassef R, Morgan S, Tassé D, Bernard D. Les fistules dans la maladie diverticulaire du côlon: étude de 29 cas [Fistulas in diverticular disease of the colon: study of 29 cases]. Can J Surg. 1983 Nov;26(6):546-9. French. PMID: 6627148.