Twenty‐four geriatric patients with colovesical fistula were admitted to St. Vincent's Hospital, New York, between January 1961 and December 1970. A review of these cases showed that only 42 per cent were correctly diagnosed upon admission. Diverticulitis was the leading etiologic factor, and in most cases the fistula was located between the sigmoid and the bladder. The most valuable diagnostic procedures were cystoscopy and barium‐enema x‐ray examination. Pneumaturia (present in 75 per cent of the cases) and fecaluria were significant physical findings, as was abdominal pain. A three‐stage operation — preliminary colostomy, then colonic resection and fistulectomy, and finally closure of the colostomy — is the safest surgical procedure.
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