Rectovesical fistula treated by glue injection plus endoclipping technique

P. Katsinelos, S. Gkagkalis, G. Chatzimavroudis, C. Zavos, J. Kountouras
2013 Endoscopy  
A 74-year-old man was referred to our department for endoscopic evaluation and treatment of a rectovesical fistula. He had undergone prostatectomy for early prostate cancer 2 weeks previously. Postoperatively, he had developed pneumaturia and dysuria; computed tomography (CT) had revealed a rectovesical fistula. At colonoscopy, a well-circumscribed opening of a fistula tract was seen in the anterior rectal wall, located 2 cm beyond the linea dentata (• " Fig. 1 ). The edges of the fistula were
more » ... f the fistula were cauterized with argon plasma coagulation to stimulate an inflammatory reaction and local collagen synthesis. A 2-mL syringe containing 1 mL n-2-butyl cyanoacrylate (Histoacryl; B. Braun, Melsungen, Germany) and 1 mL Lipiodol was prepared and the glue/Lipiodol mix was injected via a 23-G variceal needle in aliquots of 0.5 mL at four sites of the wall of the fistula, followed by a flush of Lipiodol equivalent in volume to the dead space of the needle. The margins of the fistula orifice were brought into contact and closed with endoclips (HX-600-900; Olympus, Athens, Greece; • " Fig. 2) . After endoscopic intervention, the patient was treated with parenteral nutrition and antibiotics. His symptoms completely resolved and he was discharged 7 days after the procedure. A follow-up endoscopy performed 1 month later revealed that the lesion was well healed (• " Fig. 3) . He remains asymptomatic 6 months post-procedure. Rectal injury after radical prostatectomy with subsequent formation of rectovesical fistula has an incidence of 1 -11 % [1]. York-Mason, modified York-Mason and less invasive repair methods, which include laparoscopic and robotic-assisted techniques, have been reported as successful treatment modalities for rectovesical fistulas [2, 3]. We wish to emphasize the use of the combination of endoclips plus n-2-butyl cyanoacrylate injection in the treatment of gastrointestinal fistulas. To our knowledge, the present case is the first report of a rectovesical fistula that was success-fully treated with injection of glue plus endoclipping. References 1 Harpster LE, Rommel FM, Sieber PR et al. The incidence and management of rectal injury associated with radical prostatectomy in a community urology practice. J Urol 1995; 154: 1435 -1438 2 Kasraeian A, Rozet F, Cathelineau X et al. Modified York-Mason technique for repair of iatrogenic rectourinary fistula: the Montsouris experience. J Urol 2009; 181: 1178 -1183 3 Sotelo R, de Andrade R, Carmona O et al. Robotic repair of rectovesical fistula resulting from open radical prostatectomy.
doi:10.1055/s-0032-1308945 pmid:24008443 fatcat:szeq7nvcafaxpf23lplzxp5j3u