Challenging treatment of enterovesical fistula: a scoping review of pros and cons

Abstract

Enterovesical fistula (EVF) is rare, morbid conditions primarily caused by diverticulitis. However, Crohn’s disease and pelvic malignancies present distinct operative challenges. Objectives were to evaluate current EVF management strategies, highlighting clinical benefits, limitations, and evidence gaps. We performed a PRISMA-ScR-guided scoping review of PubMed and Scopus (January 2000-February 2026), including English-language clinical studies. We analyzed data on etiology, surgical approach [open vs. minimally invasive surgery (MIS)], bladder management, and patient outcomes. Elective colorectal resection with primary anastomosis is the preferred approach for benign EVF, achieving high closure rates with acceptable morbidity. MIS is increasingly adopted in experienced centers, decreasing length of stay and wound complications. However, conversion to open surgery remains common in hostile pelves (e.g., dense phlegmon, prior surgery). Bladder management favors a selective, organ-preserving approach using intraoperative leak testing, often safely omitting formal cystotomy and routine postoperative cystography. Regarding specific etiologies: Crohn’s-related EVF may initially respond to biologics but typically requires definitive surgery; malignant EVF necessitates en bloc resection, with prognosis driven by oncologic stage and patient frailty. Current management converges on elective one-stage resection, selective bladder preservation, and judicious use of MIS. The persistent heterogeneity in perioperative care underscores the need for prospective, multicenter trials to standardize pathways and optimize outcomes.