Vesicocolic fistula

　　Vesicocolic fistula is a common colonic fistula disease in daily life. Due to the connection between the bladder and the colon, the urinary system is极易受到感染，which brings great harm to the patients.

　　There are many causes of vesicocolic fistula, such as: the formation of perivesical abscess due to severe bladder injury, colonic injury, inflammation, or tumor, and after colonic repair or intestinal resection anastomosis, the anastomotic dehiscence and leakage occur, which often happens 4 to 5 days after surgery. The pain in the abdomen begins to decrease after surgery, but then it appears again with an increase in persistent pain, often accompanied by sepsis, such as an increase in body temperature, abdominal tenderness, rebound pain, and increased muscle tension in the abdomen. At this time, it should first be considered as peritoneal infection, or there is a possibility of developing an intestinal fistula.

　　Since vesicocolonic fistula is a connection between the colon and the bladder, the feces from the colon enter the bladder, which is very easy to cause urinary tract infection. At the same time, feces will enter the urine, making the urine have a fecal smell, bringing both physical and psychological harm to the patient, and it is necessary to seek medical treatment in a timely manner.

　　Under normal circumstances, the bladder is connected to the urethra, but not to the colon. Vesicocolonic fistula is a pathological connection between the bladder and the colon, forming a fistula tract. Patients are prone to recurrent urinary tract infections. Generally, patients with vesicocolonic fistula may have symptoms such as bladder irritation, fecal leakage, and urethral exhaust, often accompanied by changes in defecation habits caused by primary intestinal diseases, and physical examination may find signs of intestinal obstruction. If it is caused by an inflammatory disease, abdominal muscle tension may be found. Urinalysis often suggests the presence of infection. Inserting contrast medium through the fistula tube can often help in diagnosis.

　　Vesicocolonic fistula is completely preventable. During the process of colon surgery, as long as the wound is properly treated, or the patient pays attention to the postoperative recovery, a colonic fistula will not occur. In summary, to prevent colonic fistula, attention should be paid to the following:

　　1. Establish a normal dietary habit.

　　2. Prevent constipation and diarrhea.

　　3. Develop good defecation habits.

　　Ureterocolonic fistula causes great harm to the human body, and the feces in the colon often enter the bladder through the fistula, causing urinary tract infection. This disease can be diagnosed by combining clinical symptoms with relevant examinations.

　　1. Colonoscopy

　　It can be found that there are abnormal channels in the gastrointestinal tract, and differential diagnosis should be made. After the duodenoscope enters the duodenum, the mucosa appears soft and smooth with annular folds, and the papilla is located on the longitudinal ridge of the folds on the inner side of the descending segment of the duodenum. Generally, the fistula is located above the papilla opening, and the shape is often irregularly star-shaped, without normal papilla shape and opening characteristics. When the fistula is covered by the mucosa, it is not easy to find, but by inserting a catheter from the papilla opening, the catheter can be deflected from the fistula back into the intestinal lumen. By inserting the catheter from above the fistula opening, the abnormal channel is visualized and diagnosed. At this time, the mirror is brought close to the fistula for observation, and bile or other liquids can be seen overflowing. Under endoscopic examination, attention should be paid to differentiate the duodenal fistula from the duodenal diverticulum. The diverticulum can also have an opening near the duodenal papilla, but the edge is relatively even, the opening is often round, and there are often food residues inside the hole. After removing the residues, the bottom of the diverticulum can be seen where the catheter is inserted into the hole and then deflected into the intestinal lumen to inject contrast medium, which can be completely overflowed. At the same time, contrast medium can be seen in the intestinal tract without any abnormal channel. A group of data reports that among 47 cases of choledochojejunal fistula, 5 cases were accompanied by duodenal diverticula, in which 1 case the papilla and fistula were both located in the cavity of the large diverticulum. After endoscopic examination, an immediate barium meal examination was performed, confirming a large diverticulum on the inner side of the descending duodenum. Colonoscopy can accurately locate the duodenocolonic fistula and can observe the size of the fistula, or tissue examination can be performed to determine the nature of the primary lesion, providing a basis for choosing the surgical method.

　　2. Laparoscopic examination

　　It can also be used as a means of diagnosis and treatment for duodenal fistula and has a wide application prospect. Cystoscopy: when there is a suspicion of duodenal renal pelvis (ureter) fistula, this examination can not only find signs of cystitis but also see bubbles or purulent debris excreted from the orifice of the affected ureter; or after injecting contrast agent through the catheter of the affected ureter, the film can show the presence of contrast agent in the duodenum. Currently, the diagnosis mainly relies on retrograde pyelography, with nearly 2/3 of the patients being positive.

　　3. Bone charcoal powder test

　　Oral bone charcoal powder, after 15-40 minutes, black charcoal powder will be excreted from the urine. This examination can only confirm the existence of an internal fistula between the digestive tract and the urinary tract, but cannot determine the location of the fistula.

　　Bladder-colon fistula causes great harm to the human body. The feces in the colon often pass through the fistula into the bladder, causing urinary system infection. The treatment of this disease often requires surgery to cure it, and at the same time, attention should be paid to dietary adjustment in diet, which can effectively alleviate the symptoms of the disease.

　　Appropriate control of fat:Do not use foods with high oil content and fried foods in the diet. Use less oil in cooking and adopt methods such as steaming, blanching, braising, and stewing. It is forbidden to eat foods with high fat content such as lard, mutton fat, butter, cow fat, and walnuts, as these may worsen diarrhea.

　　Avoid gas-producing foods:Due to repeated attacks, ulcers and scar fibers alternate in the colon mucosa, thereby reducing the elasticity of the inner wall of the colon. If you eat more gas-forming foods such as soybeans, soy products, fried broad beans, sweet potatoes, etc., it may lead to intestinal gas accumulation and complications such as acute intestinal dilatation or ulcer perforation; it is forbidden to eat cold fruits and vegetables.

　　Most patients with this disease have weakened spleen and stomach, and kidney yang deficiency. If they eat more cold and cold foods, such as various cold drinks, iced foods, pears, watermelons, oranges, tangerines, bananas, tomatoes, clam meat, sea cucumber, lily soup, etc., it will further damage the spleen and kidney yang, weaken the movement of the spleen and stomach, and accumulate cold and dampness inside. At the same time, these foods themselves are slippery, which will aggravate diarrhea and abdominal pain; it is forbidden to eat milk and seafood. Eating milk, condensed milk, shrimps, sea fish, and other foods after diarrhea can easily cause colonic allergy, leading to exacerbation of diarrhea.

　　In addition, honey and its products have the effect of moistening intestines and defecation, so they cannot be eaten; vegetables with high fiber content such as chive, celery, bamboo shoots, etc., should be eaten less, and leafy vegetables should also be appropriately controlled. If necessary, the method of chewing and drinking the juice while spitting out the residue can be adopted; appropriate amounts of lean meat, fish, eggs, mushrooms, etc., should be added to the diet, as long as they are not excessive and not too greasy, and the amount of non-vegetarian food should be gradually increased.

　　Ureterocolonic fistula causes great harm to the human body, and the feces in the colon often enter the bladder through the fistula, causing urinary tract infection. This disease can be diagnosed by combining clinical symptoms with relevant examinations.

　　In the treatment of this disease, if the lesion is located at the rectum or sigmoid colon, the proximal segmental enterostomy can be performed first, and then the resection of the diseased intestinal segment can be performed after the inflammation subsides, and the fistula mouth can be closed, and then the colostomy mouth can be closed. Some scholars propose that the entire operation should be completed in one stage, and partial intestinal resection or appendectomy may be required for small intestinal or ileal bladder fistula, and the bladder fistula mouth can be closed. For those with malignant internal fistula caused by colon cancer infiltration into the duodenum, radical or palliative surgery should be chosen according to the specific situation.

　　①Radical Surgery:It has been introduced that an extended right hemicolectomy is used to treat duodenal colonic fistula caused by malignant tumors located at the hepatic flexure of the colon. The so-called extended right hemicolectomy refers to the standard right hemicolectomy plus partial pancreaticoduodenectomy and then reconstructing the digestive tract. This includes anastomosis between the common bile duct (or gallbladder) and jejunum, anastomosis between the pancreas and jejunum (all require separate rubber or plastic tube catheter drainage), and anastomosis between the stomach and jejunum, ileum and transverse colon.

　　②Palliative Surgery:For those who cannot be removed, palliative surgery can be performed. This is to cut off the pylorus, transverse colon, and distal ileum separately, and then close the distal ends of the stomach and ileum separately, and then perform anastomosis between the stomach and jejunum, ileum and transverse colon, and jejunum output loop and proximal transverse colon. Whether it is radical or palliative surgery, abdominal drainage must be placed during the operation.