Enterovesical

Enterovesical describes a relationship or abnormal connection between the intestine and the urinary bladder. In medical use it most often refers to an enterovesical fistula, an abnormal tract that permits intestinal contents to enter the bladder and urine to enter the bowel. This condition is a type of fistulous disease and typically presents with urinary symptoms and signs of intestinal disease.

Causes and risk factors include diverticular disease of the colon (especially the sigmoid colon) and Crohn disease. Other etiologies are colorectal cancer, pelvic or abdominal trauma, prior pelvic surgery, radiation therapy, and, less commonly, infections or inflammatory disorders that involve both the bowel and bladder. The underlying disease generally drives the fistula formation.

Signs and symptoms commonly include pneumaturia (air in the urine) and fecaluria (feces in the urine), along with recurrent urinary tract infections, dysuria, frequency, pelvic or abdominal pain, and occasionally passage of stool via the urethra. The presentation may vary with the location and etiology of the fistula and with the patient’s overall condition.

Diagnosis relies on a combination of clinical suspicion, urine analysis and culture, and imaging. CT scans with contrast or CT cystography can reveal a fistulous tract or gas within the bladder. MRI may be used for detailed anatomy. Endoscopic procedures, such as cystoscopy and colonoscopy, help localize the fistula and assess the extent of disease.

Treatment and prognosis depend on the underlying cause and fistula severity. Initial management often includes antibiotics and stabilization. Definitive treatment typically involves surgical repair to separate the bowel and bladder, frequently with resection of the diseased bowel segment and repair of the bladder; the approach may be staged or combined and tailored to the individual patient. Overall prognosis improves with treatment but may be influenced by the primary disease.