Colovesical fistula complicating diverticular disease: diagnosis and surgical management in elderly.

described including: the “pinch off” technique followed by simple; use of an omental patch to close the bladder defect; or wedge resection of the affected bladder area with closure using sutures or an omental patch. Simple decompression with an indwelling catheter alone may be sufficient for small defects. However, the bladder has to be drained with a Foley catheter for 7-10 post- operative days. We have recently treated four cases of colovescale fistula. In an urgency setting for complicated diverticulitis in hinchey iii (one case), patient underwent to two-stage open surgery, primary anastomosis with loop ileostomy. in the remaining cases, patients underwent to single stage surgery (laparoscopic), with primary anas-tomosis.in conclusion, in our series, CT was the most sensi-tive and accurate exam to diagnose CVF in the cases. Then, we suggest CT as a first line investigation in all patients with suspected CVF. CT detected air within the bladder earlier and without equivocation when com-pared with other imaging techniques. It is useful in the evaluation of pericolonic inflammation, thus perform-ing an important role in surgical planning. Since 10% to 15% of CVF are due to malignancies, we recommend colonoscopy following the CT. Our outcomes were comparable with those reported for laparoscopic management of CVF and complicated DD, laparoscopic resection and primary anastomosis should be considered a safe and feasible option.