Enteropouch fistula is a rare complication after supravesical urinary diversion [5]. Other than surgery, diverticulitis, colorectal malignancy, radiation and Crohn's disease have become the most common aetiology of entero-urinary fistula [7].
In other case reports; fistula was detected three weeks after surgical operation [5, 6], while fistula manifestations were observed 10 days after surgery in our patient. According to the published reports, symptoms are watery diarrhea, mild abdominal symptoms (nausea, vomiting, and dehydration, but normal physical examination), gas in the pouch (diagnosed by KUB) and fecaluria [2, 6]. In our case the only symptom was fecaluria. All the researchers have mentioned that upper GI series, barium enema, and CT scan are not helpful and the best diagnostic modality is pouchogram [2, 6], as it was in our patient. Occasionally, clinical diagnosis in borderline cases is difficult [8]. Some investigators use charchoal [9], methylene blue [8], poppy seed [8], and urine cytology in order to confirm enteropouch fistula diagnosis [10].
The conservative management which is indicated in cases with no sepsis, no obstruction, and no organ impairment and with a normal nutritional status, consists of hyper-alimentation, fasting or low residue diet and continous urinary drainage [7].
Our review results contained cases reported as resistant to conservative management, who were treated surgically [6]. However, the surgical technique used was not elaborated in any of the studies. To our experience, during the operation after releasing all adhesion bands between the pouch and intestinal loops, it's of utmost importance that intestinal opening be defined using intestinal compression in both sides of anastomosis. Otherwise, there is a high probability of inter-loop abscess formation due to the intraperitoneal bowel perforation, which may lead to a high mortality rate.