Diagnosis and treatment of diverticular colon disease complicated by fistula formation

Levchuk A.L.¹, Abdullaev A.E.²

Objective. To improve the results of surgical treatment of patients with urogenital-colonic, small-colonic and large-intestinal-vaginal fistulas of diverticular origin by improving the diagnostic program and surgical tactics.

Materials and methods. A study was conducted with the participation of 82 patients treated at the State Clinical Hospital in Vladimir from 2012-2022 with DPC complicated by the formation of fistulas. There were 38 (46.3%) patients with internal intestinal fistulas, of which 22 (57.9%) were men and 16 (42.1%) were women. The mandatory diagnostic program included: general clinical studies, ultrasound of the abdominal cavity, pelvis, in women transvaginal ultrasound, CT of the abdominal cavity with intravenous contrast enhancement and MRI of the pelvis, cystoscopy, FCS, irrigography, including simultaneous fistulography through an external fistula opening.

Results. The clinical picture of a colovesical fistula was found in 19 (50%) cases, sigmo-vaginal in 14 (36.8%), and ileo-sigmoid in 5 (13.2%) cases. Abdominal ultrasound was performed in all patients (n-82), transvaginal ultrasound in 23 (28%), and ultrasound in 38 (46.3). Irrigoscopy was performed in 68 (82.9%) patients. Cystoscopy was performed in 19 (23.2%) cases. FCS was performed in 68 (82.9%) patients. MSCT in 77 (93.9%) cases. Dissection of the fistula, resection of the sigmoid colon according to Hartmann with the removal of a single-stem colostomy with planar resection and suturing of the bladder wall was performed in 6 (7.3%) patients. LGE was performed in 28 (34.1%) patients. Sigmoid colon resection with primary colonic anastomosis and the imposition of an interventional colostomy was performed in 9 (11%) patients. In 23 (28%) cases, sigmoid colon resection was performed with primary anastomosis without removal of the interventional stoma, in 10 (12.2%) patients with external intestinal fistulas, and 13 (15.9%) with sigmovesical fistula. In 5 (6.1%) cases, resection of the sigmoid colon was performed with resection of the small intestine bearing the fistula, with the imposition of small and large intestinal anastomoses. Complications occurred in 6 (7.3%) cases (Table 5).

Conclusion: The treatment of diverticular colon disease complicated by the formation of fistulas is one of the most urgent and time-consuming tasks. The incidence of this complication is 15.7%. The most severe category of patients are patients with external colon fistulas, since their occurrence was facilitated by previous surgical interventions for complications of DBTC. The only radical method of treatment for this category of patients is only surgical intervention. Given the need to involve related specialists in the treatment of internal DBTC fistulas, the strategy for the diagnosis and treatment of this difficult category of patients should be multidisciplinary. And the method of performing surgical intervention in this case should be strictly personalized.

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