Laparoscopic surgery of an enterovesical fistula of tuberculous origin (terminal ileum and sigmoid colon).

We report a 76-year-old male with enterovesical fistula. Symptoms were abdominal pain with urination, pneumaturia and fecaluria. History of transurethral resection of bladder polyps (benign). Barium and abdominal CT with contrast: intestinal fistula from terminal ileum and sigmoid to the bladder, which was thickened and showed inflammatory changes. We perform laparoscopic surgery. Existence of adherence syndrome and found no granulomas or intra-abdominal collections. After extensive adhesiolysis, we observed a thickened area, with an intense inflammatory plastron in lower hypogastrium, corresponding to the bladder dome, which comprise terminal ileum and sigmoid. Methylene blue was applied by the catheter to confirm the fistula. We found a clear communication between the bladder and terminal ileum and a minor communication with sigmoid colon. Identification and section of the fistulas was performed, as well as removal of the bladder dome, ending with primary closure of the opening and closing the sigmoid (Fig. 1). A right hemicolectomy was performed due to the seriously affectation of the terminal ileum, which poor viability. We reinforced the bladder suture line, and the colonic anastomosis with Tachosil (absorbable collagen sponge with human thrombin). In the pathology were identified several ileal and colonic mucosal ulcerative areas, peroration and abundant granulation tissue. The bladder and the colon show multiple caseating granulo mas. The histological findings suggested tuberculosis granu lomatous disease type. The postoperative course was favorable. Nowadays is monitored by the Department of Urology and Surgery, with no complications related to surgery, receiving appropriate treatment for tuberculosis.