Conservative management of colo-vesical fistula

A 55 year old lady presented with history of pneumaturia and occasional passage of fecal matter per urethra since 8 days.She was a known case of carcinoma endometrium operated 18 years back with Total Abdominal Hysterectomy followed by chemotherapy and radiotherapy.She was asymptomatic for 10 years then she started leaking ? fecal matter per urethra.She was taken up for endoscopic intervention after which the fecal leakage stopped. She is a known case of diabetic-fairly controlled,hypertension on medications.She was investigated for cystoscopy(diagnostic) which revealed a fistula 2 cm away from the left ureteric orifice cranially and laterally.The fistulogram showed leakage of the contrast into the sigmoid colon. She was given option of open repair of colo-vesical fistula but she preferred an endoscopic approach over open repair.The patient was explained the chances of success and failure and then was taken up for endoscopic repair. She was kept on liquid diet before the planned surgery and also given Peglec for bowel preparation. On the day of surgery , the prophylactic antibiotics were administered and the cystoscopy was started. The fistula was identified in the same position.It was cauterised on all sides with ball electrode with resectoscope instrument. After cauterising the ureteric orifices were cannulated with ureteric catheters and the cauterised mucosa was re-inforced with Fibrin Glue(Mixture of Fibrinogen and thrombin-Tisseel by Baxter).A total of 4 ml quantity was required.The bladder was kept deflated after the injection. The sealing of the fistula tract was confirmed endoscopically and then Foleys catheter was introduced. The plan is to keep patient on NBM for 24 hours and further 24 hours on liquids and then ensure she will not suffer from constipation further.The bladder will be kept deflated for a period of 4 weeks.