One-Stage, en Bloc Resection for Colonic-Uterine Fistula Caused by Diverticulitis

Clay, Richard C.; Tierney, Nicholas A.

doi:10.1001/jama.1969.03150160067018

Cited by 12 publications

(3 citation statements)

References 4 publications

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“…Colouterine fistulas are extremely rare, but the few cases reported in the literature have all been the results of complicated diverticular disease [1][2][3][4]. To the best of our knowledge, a malignant colouterine fistula has not been reported previously and, as a result, no surgical technique has been described.…”

Section: Discussionmentioning

confidence: 99%

“…However, following the performance of these 2 ''en bloc'' resections, we came across a case report published by Clay and Tiernay [1] in 1969 that reported on a technique that is similar in some aspects, except for the fact that we went down to the level of the upper half of the vagina anteriorly and used the TME technique posteriorly, employing a staple device for colonic reconstruction.…”

Section: Discussionmentioning

confidence: 99%

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En bloc resection for malignant colouterine fistula

et al. 2010

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Colouterine fistula is a rare clinical entity. A literature search revealed only a few reports dealing with this complex problem, mostly resulting as a complication of diverticular disease of the colon. During a 4-month period, we diagnosed and successfully treated 2 women with a malignant colouterine fistula originating from a primary colorectal carcinoma invading the uterus. We herein report on our experience dealing with this kind of pathology, with special emphasis on the surgical technique used to resect the tumoral mass "en bloc".

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

En bloc resection for malignant colouterine fistula

et al. 2010

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“…If it is secondary to diverticulitis, the prognosis is usually excellent following surgical treatment 20 . Clay and Tiernay were the first to recommend a one‐stage procedure en block resection of the uterus and adherent colon, 21 but in an emergency a Hartman procedure can be suitable to avoid septic complications and anastomotic dehiscence 3…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging and hysteroscopy to diagnose colo‐uterine fistula: A rare complication of diverticulitis

Kassab

El-Bialy

Hashesh

et al. 2008

J of Obstet and Gynaecol

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Colo-uterine fistula of diverticular origin is an extremely rare disease due to the resistance of uterine tissue. Methods for diagnosis remain to be established. Non-invasive imaging like magnetic resonance imaging (MRI) may help to establish a proper diagnosis, but confirmation may be reached by diagnostic hysteroscopy or even surgical exploration. We report a 78-year-old female who presented with continuous dull aching pain associated with increasing constipation. MRI suspected a fistula between the posterior aspect of the uterine body and the sigmoid colon which contained extensive diverticulosis. Hysteroscopy confirmed the fistulous opening, but colonoscopy confirmed diverticular disease with no evidence of malignancy. The patient had en block surgical treatment of the uterus and the adjacent colon, followed by an uneventful recovery. The sensitivity and specificity of non-invasive imaging procedures to diagnose such cases remain to be established. As imaging procedures cannot rule out neoplasia, endoscopic procedures need to be added.

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A case of sigmoidouterine fistula detected by transvaginal ultrasonography

Kiyokawa

2001

J Med Ultrasonics

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An 80-year-old woman, 2 G 2 P, with macrohematuria came to this institution for treatment. On pelvic examination, the uterus was palpated slightly large for her age, slight tenderness and resistance were noted at the uterine corpus, and the adnexa and parametrium were soft. The entire abdomen, including the Douglas pouch and pelvic bottom, were also soft. Examination a the speculum revealed swelling of the vulva and vagina and blood oozing from the entire vaginal wall. There was also a small amount of purulent discharge at the cervical canal. Transvaginal ultrasonography (TVUS) showed the uterine corpus to be small and found no adnexal or pelvic mass. However, the entire uterine cavity was hyperechoic, and these signals were passing through the myometrium near the fundus and ended in a cup-shaped configuration. These features were consistently confirmed on later repeated TVUS examinations. On further interview, the patient disclosed that she had had continual diarrhea and fecal discharges from the vagina for close to one month. The cytology of the smears from both the uterine cervix and cavity were negative, but purulent content was found in the endometrial biopsy specimen. Computed tomography and magnetic resonance imaging revealed no pathologic findings, but a colonic mass lesion adjacent to the uterus was observed although the fistula could not be identified. Innumerable diverticula in the colon and the outlines of barium spillage from the colon were demonstrated on barium enema examination. Colonic fiberscopic examination confirmed the intact colonic mucosa. Of the tumor markers, CA 19-9 and SCC values were normal, while CEA level was elevated (9.8 ng/ml). Surgery revealed a fistula that was perforated from the bottom of the sigmoid diverticulum through the uterine myometrium, and into the uterine cavity. The features of fistulas delineated by the continuous high-echoic signals on TVUS were identical with these pathological findings. The microbubbles of bowel gas in fecal discharges were deemed to be the cause of high echogenicity. These TVUS findings were repeatedly confirmed on later evaluations. A diagnosis of a sigmoidouterine fistula on TVUS should, therefore, be considered when there is fecal discharge. TVUS thus provided crucial and reliable findings of uterine fistula and should warrant use in managing colonic-uterine fistula. The postoperative course was uneventful. CEA concentration decreased to 3.4 ng/ml; cut-off value was 5 ng/ml. J Med Ultrasonics 2001 ; 28 (Summer) : 71-75.

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One-Stage, en Bloc Resection for Colonic-Uterine Fistula Caused by Diverticulitis

Cited by 12 publications

References 4 publications

En bloc resection for malignant colouterine fistula

En bloc resection for malignant colouterine fistula

Magnetic resonance imaging and hysteroscopy to diagnose colo‐uterine fistula: A rare complication of diverticulitis

A case of sigmoidouterine fistula detected by transvaginal ultrasonography

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