Vesico‐colic Fistula Complicating Diverticular Disease

SUMMARY Eleven cases of vesico‐colic fistula secondary to diverticular disease of the colon are described. Pneumaturia was noted in every male patient. In women it is possible that pneumaturia is overlooked and that some cases of fistula are dismissed as chronic cystitis. Cystoscopy and barium enema seldom disclose a previously unsuspected fistula, and often raise the suspicion of carcinoma. Laparotomy is necessary to establish the nature of the primary disease. At operation extensive inflammation or abscess formation is rare, so that one‐stage resection is usually feasible. It is suggested that the development of vesico‐colic fistula demands the presence of a particular form of diverticular disease and that this may determine its incidence. There is a striking absence of acute urinary tract infection in spite of prolonged fascal contamination.