Most vesicorectal fistulas are caused by intestinal diseases, including diverticulitis, intestinal tumors, and Crohn’s disease . However, obstruction/high internal pressure in the adjacent lumen (e.g., biliary tract) of the intestine is also one of the causes of spontaneous intestinal fistula . The patient had neurogenic bowel and neurogenic bladder. We hypothesized that infection and intravesical and intrarectal distension caused her vesicorectal fistula.
A vesicorectal fistula may induce many complications, including recurrent urinary tract infection, pelvic abscess, peritonitis, and intestinal obstruction. Surgical intervention is usually required, and choosing a single- or two-stage repair depends on the location of the fistula and general health . Non-operative management is a viable option only in selected patients with intravenous total parenteral nutrition, bowel rest, and antibiotics .
Therefore, surgical closure of the fistula is undoubtedly necessary. The goal of operative management is to separate and close the involved organs with minimal anatomic disruption and normal long-term function of both systems. However, the greatest problem will be the management of the patient’s bladder after the operation since high intravesical pressure and hydronephrosis will most likely reappear. A mixture of medication/botulinum toxin/surgery will be necessary to achieve a low-pressure storage system. Fistula repair combined with bladder enlargement may be a good option if the patient is willing to start CIC again.
Despite the disadvantages of being expensive and requiring expertise, the advantages of video urodynamic studies in the diagnosis of complex urinary dysfunction are still irreplaceable. In this case, it can be predicted that if we choose to initially give patients a conventional urodynamic study, the final diagnosis will greatly altered.
We believe that this is the first report of spontaneous vesicorectal fistula due to neurogenic bladder and neurogenic bowel. Although it resulted in the patient’s firm rejection of the operation, the delicate balance of the patient at present is also worth discussing. Early repair of the fistula is still necessary. The treatment of neurogenic bladder after fistula repair will be difficult and deserves further observation and follow-up.