AB148. SOH24AB_188. Colonic colander: a complex case of severe colovesical fistula presenting as an inguinal collection

Background: Fistulae are a rare yet dreaded complication of radiotherapy for the treatment of prostate adenocarcinoma. There are no cases reported to date of multiple fistulae secondary to radiotherapy presenting with faeculant inguinal collection.

Methods: We obtained clinicopathological data from electronic and paper-based patient records. We performed a literature review on the management of complex colovesical fistulae and urethrocutaneous fistulae.

Results: A 79-year-old comorbid man presented to the emergency department septic with abdominal pain, faecaluria and a left inguinal collection on a background of a known colovesical fistula secondary to radiotherapy for prostate adenocarcinoma seven years ago. A computed tomography (CT) abdomen pelvis demonstrated a colovesical fistula and an air fluid collection anterior to the bladder with soft tissue fistulation around the base of penis and left inguinal region. He underwent surgery with general surgery and urology teams, with emergency defunctioning ileostomy, drainage of groin collection and flexible cystoscopy. On flexible cystoscopy, there was a complete deficiency of the anterior bladder wall, and urethrocutanous fistula, and a catheter was inserted. The inguinal collection was drained and faeculant material was expressed from the cavity. The procedure was otherwise uncomplicated. The patient subsequently underwent bilateral nephrostomy insertion to defunction his multiple fistula. The patient had a satisfactory result, recovering well and discharged home with outpatient follow up.

Conclusions: The treatment of severe colono-urinary fistulae is multifaceted and requires multi-specialty input.

Keywords: Fistula; radiotherapy; general surgery; urology; prostate cancer