Keywords
Urology
Rectovesical Fistula
Trauma
Treatment
How to Cite
Abstract
Background: A rectovesical fistula corresponds to the formation of a pathological communication between the rectum and the urinary bladder, resulting in an abnormal connection that allows the direct passage of fecal content or intestinal gas into the urinary system and or urine into the rectum. This condition disrupts the usual anatomical separation between the digestive tract and the lower urinary tract, may occur at different points of the rectal and bladder walls, and frequently involves inflamed or injured tissue. In this context, a clear understanding of this communication is crucial for appropriate therapeutic planning.
Aim: To report a unique case of rectovesical fistula caused by complex penetrating trauma. Method: This is a case report of an adolescent patient who sustained complex penetrating pelvic trauma and was treated by the Urology Service of Hospital Universitário São Francisco, in Bragança Paulista, Sao Paulo, Brazil, with data obtained exclusively from the medical records. The study was conducted with formal informed consent and assent from the patient and his legal guardian, ensuring confidentiality, and was approved by the Institutional Research Ethics Committee, in accordance with Resolution No. 466/2012 of the Brazilian National Health Council.
Case Report: A 16 year old male patient sustained penetrating anal trauma caused by an iron rod and subsequently developed a traumatic rectovesical fistula confirmed by computed tomography. He was treated with a multidisciplinary surgical approach including transanal rectal repair, bladder bivalving, omental interposition, temporary colostomy, and urinary diversion, with favorable postoperative evolution and no fistula recurrence.
Conclusion: Bladder bivalving is a safe and effective technique for the treatment of complex traumatic urogenital fistulas, as it provides wide anatomical exposure, allows precise repair with tissue interposition, and reduces the risk of recurrence, being especially indicated in severe cases that require a multidisciplinary surgical approach and are associated with high functional success rates.
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