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Colovesical & Enterovesical Fistula — Management

Surgical resection remains the definitive treatment for colovesical (CVF) and enterovesical (EVF) fistulas. See clinical page: Colovesical & Small-Bowel Fistulas.

One-Stage Sigmoidectomy + Primary Anastomosis​

The most common and preferred approach for diverticular-related CVF, with or without diverting loop ileostomy. Minimally invasive surgery (laparoscopic or robotic) is associated with shorter hospital stays compared to open, with no significant difference in major complications.[1][2][3]

Bladder Management​

Formal bladder repair is often unnecessary. In a series of 74 patients, 68% were managed with Foley catheter drainage alone on the bladder side, with successful healing within one week. Formal bladder repair was reserved for overt defects.[4]

Staged Procedures​

Two-stage (resection with diverting colostomy, then reversal) or three-stage procedures for emergent or complex presentations.[5]

Endoscopic OTS Clip​

Over-the-scope (OTS) clip placement is an emerging option for poor surgical candidates — initial technical success 80%, long-term success ~50%.[6]

Recurrent symptomatic UTI (especially with pyelonephritis) is an indication for surgery, which involves resection of inflamed bowel and bladder defect closure.[7][8]

References​

1. Froiio C, Bernardi D, Asti E, et al. Burden of colovesical fistula and changing treatment pathways: a systematic literature review. Surg Laparosc Endosc Percutan Tech. 2022;32(5):577–585. doi:10.1097/SLE.0000000000001099

2. Brown RF, Lopez K, Smith CB, Charles A. Diverticulitis. JAMA. 2025. doi:10.1001/jama.2025.10234

3. Volkert A, Nigam A, Stover D, et al. Comparison of open versus minimally invasive repair of colovesical fistula. J Clin Med. 2025;14(17):6065. doi:10.3390/jcm14176065

4. Ferguson GG, Lee EW, Hunt SR, Ridley CH, Brandes SB. Management of the bladder during surgical treatment of enterovesical fistulas from benign bowel disease. J Am Coll Surg. 2008;207(4):569–72. doi:10.1016/j.jamcollsurg.2008.05.006

5. El-Haddad HM, Kassem MI, Sabry AA, Abouelfotouh A. Surgical protocol and outcome for sigmoidovesical fistula secondary to diverticular disease of the left colon. Int J Surg. 2018;56:115–123. doi:10.1016/j.ijsu.2018.05.742

6. DeLong CG, Scow JS, Morrell DJ, et al. Endoscopic management of colovesical and colovaginal fistulas with over-the-scope clips. Colorectal Dis. 2022;24(3):314–321. doi:10.1111/codi.15987

7. Lichtenstein GR, Loftus EV, Isaacs KL, et al. ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol. 2018;113(4):481–517. doi:10.1038/ajg.2018.27

8. Lichtenstein GR, Loftus EV, Afzali A, et al. ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol. 2025;120(6):1225–1264. doi:10.14309/ajg.0000000000003465