Endoscopy 2021; 53(10): 1090
DOI: 10.1055/a-1298-3906
E-Videos

Management of fistula between neobladder and rectum using an atrial septal defect closure device

Ashlee Sidhu
Aryavart Hospital, Daurala Sugar Mills, Meerut, Uttar Pradesh, India
,
Nagoor Basha Shaik
Aryavart Hospital, Daurala Sugar Mills, Meerut, Uttar Pradesh, India
,
Malay Sharma
Aryavart Hospital, Daurala Sugar Mills, Meerut, Uttar Pradesh, India
› Author Affiliations

Radiation therapy is widely used to treat malignancies in the pelvic cavity such as cancers of the colorectum, urinary tract, uterus, adnexa, and prostate. Studies have reported pelvic radiotherapy to have been closely associated with gastrointestinal complications such as mucosal ulcers, stenosis, perforation, and fistula formation [1].

These fistulous tracts are life-threatening since the patient is in a perpetual state of urosepsis. Surgical interventions are risky due to underlying advanced disease. Therefore, the management of an enterovesical fistula between a surgical neobladder and the rectum in patients previously operated on for bladder malignancy is challenging [2]. We present the case of a 58-year-old man who underwent surgery for bladder carcinoma with construction of a neobladder. The surgery was followed by chemoradiation therapy.

The patient presented in the emergency department with a 15-day history of fever, hypotension, pneumaturia, and fecaluria. Contrast-enhanced computed tomography of the abdomen revealed a fistulous opening measuring 1.4 cm × 1.9 cm between neobladder and rectum ([Fig. 1]). Successful endoscopic closure of the rectovesical fistula was achieved using an atrial septal defect closure device ([Video 1]). Following the procedure, the urosepsis and hypotension improved and the patient was catheterized for 3 days. The patient had clear urine on the 3 rd day and a culture after 72 hours was sterile. He was discharged on the 7th day. He remained well for one and a half months before succumbing to his underlying advanced malignancy.

Zoom Image
Fig. 1 Contrast-enhanced computed tomography of the abdomen showing a fistulous opening measuring 1.4 cm × 1.9 cm between neobladder and rectum.

Video 1 Management of fistula between neobladder and rectum using an atrial septal defect closure device.


Quality:

Endoscopy_UCTN_Code_TTT_1AQ_2AJ

Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.

This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos



Publication History

Publication Date:
26 November 2020 (online)

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany