Rectovesical Fistula

Rectovesical fistula is a recognized complication after penetrating trauma to the rectum and bladder.  It occurs in less than 5% of patients with combined injury.

It may present as urine per rectum, pneumaturia, fecaluria, or as persistent UTI.

Diagnosis is made by cystography, barium enema, or CT scan.  Cystoscopy and proctoscopy may be useful in planning the operative approach.

Treatment begins by diverting both the fecal stream with colostomy and the urine with foley drainage.  If simple diversion is not enough, operative repair may be necessary.