SSAT - Does Colovesical Fistula Secondary to Diverticulitis Have Similar Outcomes Under the 50-Age-Group?

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Does Colovesical Fistula Secondary to Diverticulitis Have Similar Outcomes Under the 50-Age-Group?
Huriye Hande Aydinli^*, Cigdem Benlice, Gokhan Ozuner, Emre Gorgun, Luca Stocchi
Cleveland Clinic, Cleveland, OH

Background: Diverticulitis traditionally has been described as being more virulent in young patients. The aim of this study was to analyze risk factors, surgical approach and compare 30-day postoperative morbidity and mortality in patients under 50-year-old who underwent colorectal surgery for diverticular disease complicated with colovesical fistula (CVF).
Methods: All patients who underwent colorectal surgery for diverticulitis complicated with CVF between 01/1993 and 11/2015 were identified from an IRB-approved, prospectively maintained institutional database and reviewed. Patients were divided according to their age at the time of surgery: Group-A (≤50 years) and Group-B (>50 years). Demographics, preoperative comorbidities, operative factors and 30-day major morbidity (ileus, anastomotic leak, wound infection, organ-space surgical site infection (SSI), deep vein thrombosis, pulmonary embolism, reoperation, reintubation, fascial dehiscence, transfusion, and acute renal failure) were compared between the two groups.
Results: A total of 237 patients were identified with CVF secondary to diverticular disease. Among this group, 36 patients were 50 years of age (Group-A) and 201 patients were over 50 years (Group-B). The most common presenting symptoms in both groups were pain (67%), pneumaturia (50%), fecaluria (33%) and fever (20%). CT scan was the most frequently performed investigation (92%) followed by colonoscopy (40%) and cystoscopy (23%). Both groups (A and B) were comparable in BMI (28.93 +/-11.61 vs 29.48 +/- 7.14, p=0.93), number of previous diverticular attacks (p=0.06), presentation, steroid use (p=0.75), type of surgical procedures (p=0.13) and approaches (p=0.08) performed (Table). A male dominance was observed in the under 50-age-group (83% vs. 53%, p=0.002). Coronary artery disease, hypertension, transfusion requirement were higher and length of stay was longer (5.9 +/- 2.9 vs 9.3 +/- 8.2, p=0.004) in Group B. Perioperative morbidity and mortality were similar in both groups (Table).
Conclusion: Colovesical fistula secondary to diverticulitis has a similar presentation and outcome in different age groups. Patients under 50 predominantly are male. 33% in this group had previous attacks of diverticulitis. We did not find a difference in BMI among the groups. Laparoscopic approach was feasible in 40% of all cases.
Comparison of demographics, patient characteristics and operative outcomes between the groups
Group-A, N=36 Group-B, N=201 P value
Age, year¹ 44.7 +/- 5.5 68.1 +/- 9.2 <0.001
Gender* (Female) 6 (16.7%) 94 (46.8%) 0.002
BMI, kg/m² ¹ 28.9 +/- 11.6 29.5 +/- 7.1 0.93
DM* 6 (16.7%) 30 (14.9%) 0.79
HTN* 14 (38.9%) 125 (62.2%) 0.01
Cardiac comorbidities* 12 (37.5%) 108 (58.7%) 0.02
Previous diverticulitis attacks* 12 (33%) 54 (27%) 0.06
Pneumaturia 20 (55.6%) 116 (58.9%) 0.71
Pain 25 (69.4%) 131 (66.8%) 0.92
Fecaluria 11 (31.4%) 67 (33.8%) 0.78
Fever 8 (22.2%) 39 (19.8%) 0.74
CT scan* 28 (80.0%) 153 (78.9%) 0.88
Colonoscopy* 20 (58.8%) 89 (46.4%) 0.18
Cystoscopy* 7 (20.6%) 45 (23.6%) 0.71
ASA classification* <0.001
No disturb (Class-I) 1 (2.9%) 1 (0.51%)
Mild disturb (Class II) 26 (74.3%) 51 (26.2%)
Severe disturb (Class III) 8 (22.9%) 124 (63.6%)
Life threat (Class IV) 0 (0%) 19 (9.7%)
Procedure type* 0.13
Sigmoidectomy 28 (77.8%) 155 (77.1%)
Anterior proctosigmoidectomy 5 (13.9%) 16 (8.0%)
Hartmann 2 (5.6%) 25 (12.4%)
Left colectomy 1 (2.8%) 0 (0%)
Other 0 (0%) 5 (2.5%)
Major morbidity* 9 (25.0%) 79 (39.3%) 0.11
Mortality* 0 (0%) 6 (3.0%) 0.59
Anastomotic leak* 0 (0%) 7 (3.5%) 0.6
Ileus* 5 (13.9%) 36 (17.9%) 0.56

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