For the patient in the preceding question, a colovesical fistula originating from the sigmoid colon is demonstrated. Colonoscopy reveals diverticula and excludes carcinoma. During laparotomy, a thickened sigmoid colon is found to be adherent to the dome of the bladder. A definite fistula is not observed. Appropriate operative management includes which of the following?
A. Sigmoid resection, primary colonic anastomosis, catheter drainage of bladder
B. En-bloc resection of sigmoid colon and adjacent bladder wall, primary colonic anastomosis, suprapubic cystostomy
C. En-bloc resection of sigmoid colon and adjacent bladder wall, formation of descending colostomy and Hartmann’s pouch, suprapubic cystostomy
D. Sigmoid resection, primary colonic anastomosis, bilateral percutaneous nephrostomies
Answer:A
For the patient in the preceding question, a colovesical fistula originating from the sigmoid colon is demonstrated. Colonoscopy reveals diverticula and excludes carcinoma. During laparotomy, a thickened sigmoid colon is found to be adherent to the dome of the bladder. A definite fistula is not observed. Appropriate operative management includes which of the following?
A. Sigmoid resection, primary colonic anastomosis, catheter drainage of bladder B. En-bloc resection of sigmoid colon and adjacent bladder wall, primary colonic anastomosis, suprapubic cystostomy C. En-bloc resection of sigmoid colon and adjacent bladder wall, formation of descending colostomy and Hartmann’s pouch, suprapubic cystostomy D. Sigmoid resection, primary colonic anastomosis, bilateral percutaneous nephrostomies