Published in:
01-04-2014 | The Last Image
Post-anastomotic rectovesical fistula: endoscopic treatment by OTSC ®
Published in: Techniques in Coloproctology | Issue 4/2014
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Endoscopy offers a valid alternative to surgery in case of colorectal postsurgical fistula. The over-the-scope clip system (OTSC®) (Ovesco Endoscopy AG, Tübingen, Germany) expands the indications for endoscopic clipping [1]. We report a case of anastomotic rectovesical fistula (Figs. 1, 2 and 3) occurring 6 months after surgery for complicated diverticular disease, effectively treated by OTSC (Figs. 4, 5, 6 and 7). Two outpatient sessions (6 months apart) were required for clinical resolution. This solution was effective and well tolerated by the patient, who refused surgical treatment.
Fig. 1
Anastomotic rectovesical fistula: endoscopic view of the internal orifice
Fig. 2
The axial image MRI shows good bladder distension with a focal linear image (blue arrow) at the level of the bladder dome with possible communication with the intestinal loop (yellow arrow) compatible with fistula
Fig. 3
The axial contrast media MRI image shows increased vascularization at the level of the fistula (red arrow) with thickening of mesentery (yellow arrow) suggesting an inflammatory process
Fig. 4
Endoscopic curettage of the internal orifice (left) before the fibrotic tissue retraction by the anchor device (right). These two endoscopic steps, together with the use of the Foley catheter, in order to reduce the pressure gradient, were the basis of successful treatment
Fig. 5
OTSC® placement at the end of the first endoscopic session. A series of OTSC®s (double OTSC®s) were required in order to close the primary orifice and a minor secondary orifice upstream to the first one
Fig. 6
OTSC® placement at the end of the second endoscopic session
Fig. 7
The axial contrast media CT image shows the fistula (red arrow) with no contrast enhancement, no increased vascularisation or thickening of mesenteric adipose tissue. These findings are compatible with treated fistula
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