Commentary

Abstract

Colovesical fistula is a well-known complication of pelvic radiation, especially when the latter is combined with surgery [1]. Interventional management is usually necessary but difficult, with surgery preferably avoided as these patients are poor surgical candidates and the irradiated field is an unfriendly surgical environment [1,2]. In this e-Video, the authors elegantly demonstrate how a patient with sepsis due to a fistula between a neobladder and the rectum was successfully treated with placement of an atrial septal defect closure device. These devices have been used for treatment of tracheoesophageal fistulas [3] but seem to be effective in the lower gastrointestinal (GI) tract as well. Among the highlights of the case, one should point out the interdisciplinary approach, with cooperation between GI endoscopists and urologists for effective device placement, and the trend of modern GI endoscopy to expand into spaces adjacent to but outside of the GI tract.Competing interests I.S.P. has provided consultancy for and received honoraria from Boston Scientific, and has received travel grants from Takeda Hellas.