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Abstract：
BACKGROUND: A colosplenic fistula (CsF) is an extremely rare complication. Its diagnosis and management remain poorly understood, owing to its infrequent incidence. Our objective was to systematically review the etiology, clinical features, diagnosis, management, and prognosis to help clinicians gain a better understanding of this unusual complication and provide aid if it is to be encountered.
METHODS: A systematic review of studies reporting CsF diagnosis in Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, and Wiley Cochrane Library from 1946 to June 2022. Additionally, a retrospective review of four cases at our institution were included. Cases were evaluated for patient characteristics (age, sex, and comorbidities), CsF characteristics including causes, symptoms at presentation, diagnosis approach, management approach, pathology findings, intraoperative complications, postoperative complications, 30-day mortality, and prognosis were collected.
RESULTS: Thirty patients with CsFs were analyzed, including four cases at our institution and 26 single-case reports. Most of the patients were male (70%), with a median age of 56 years. The most common etiologies were colonic lymphoma (30%) and colorectal carcinoma (17%). Computed tomography (CT) was commonly used for diagnosis (90%). Approximately 87% of patients underwent a surgical intervention, most commonly segmental resection (81%) of the affected colon and splenectomy (77%). Nineteen patients were initially managed surgically, and 12 patients were initially managed nonoperatively. However, 11 of the nonoperative patients ultimately required surgery due to unresolved symptoms. The rate of postoperative complications was (17%). Symptoms resolved with surgical intervention in 25 (83%) patients. Only one patient (3%) had had postoperative mortality.
CONCLUSIONS: Our review of 30 cases worldwide is the largest in literature. CsFs are predominantly complications of neoplastic processes. CsF may be successfully and safely treated with splenectomy and resection of the affected colon, with a low rate of postoperative complications.
METHODS: A systematic review of studies reporting CsF diagnosis in Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, and Wiley Cochrane Library from 1946 to June 2022. Additionally, a retrospective review of four cases at our institution were included. Cases were evaluated for patient characteristics (age, sex, and comorbidities), CsF characteristics including causes, symptoms at presentation, diagnosis approach, management approach, pathology findings, intraoperative complications, postoperative complications, 30-day mortality, and prognosis were collected.
RESULTS: Thirty patients with CsFs were analyzed, including four cases at our institution and 26 single-case reports. Most of the patients were male (70%), with a median age of 56 years. The most common etiologies were colonic lymphoma (30%) and colorectal carcinoma (17%). Computed tomography (CT) was commonly used for diagnosis (90%). Approximately 87% of patients underwent a surgical intervention, most commonly segmental resection (81%) of the affected colon and splenectomy (77%). Nineteen patients were initially managed surgically, and 12 patients were initially managed nonoperatively. However, 11 of the nonoperative patients ultimately required surgery due to unresolved symptoms. The rate of postoperative complications was (17%). Symptoms resolved with surgical intervention in 25 (83%) patients. Only one patient (3%) had had postoperative mortality.
CONCLUSIONS: Our review of 30 cases worldwide is the largest in literature. CsFs are predominantly complications of neoplastic processes. CsF may be successfully and safely treated with splenectomy and resection of the affected colon, with a low rate of postoperative complications.
摘要：
背景：脾瘘（CsF）是一种极为罕见的并发症。它的诊断和管理仍然知之甚少，由于其罕见的发生率。我们的目的是系统地回顾病因，临床特征,诊断,管理,和预后，以帮助临床医生更好地了解这种不寻常的并发症，并在遇到时提供帮助。
方法：对OvidMEDLINE中CsF诊断的研究进行系统评价，OvidEmbase,Scopus,WebofScience,和WileyCochrane图书馆从1946年到2022年6月。此外,纳入了我们机构4例病例的回顾性研究.评估病例的患者特征(年龄，性别,和合并症)，CsF特征包括原因，出现时的症状，诊断方法，管理方法，病理结果，术中并发症,术后并发症,30天死亡率，并收集预后。
结果：分析了30例CsFs患者，包括我们机构的4例病例和26例单病例报告。大多数患者是男性（70％），平均年龄为56岁。最常见的病因是结肠淋巴瘤（30％）和结直肠癌（17％）。计算机断层扫描（CT）通常用于诊断（90％）。大约87%的患者接受了手术干预，最常见的部分切除（81％）的影响结肠和脾切除术（77％）。19名患者最初接受了手术治疗，12例患者最初接受非手术治疗。然而,11名非手术患者由于未解决的症状最终需要手术。术后并发症发生率为17%。25例（83％）患者通过手术干预缓解了症状。只有一名患者（3％）有术后死亡。
结论：我们对全球30例病例的回顾是文献中最大的。CsF主要是肿瘤过程的并发症。CsF可以通过脾切除术和受影响的结肠切除术来成功和安全地治疗。术后并发症发生率低。
方法：对OvidMEDLINE中CsF诊断的研究进行系统评价，OvidEmbase,Scopus,WebofScience,和WileyCochrane图书馆从1946年到2022年6月。此外,纳入了我们机构4例病例的回顾性研究.评估病例的患者特征(年龄，性别,和合并症)，CsF特征包括原因，出现时的症状，诊断方法，管理方法，病理结果，术中并发症,术后并发症,30天死亡率，并收集预后。
结果：分析了30例CsFs患者，包括我们机构的4例病例和26例单病例报告。大多数患者是男性（70％），平均年龄为56岁。最常见的病因是结肠淋巴瘤（30％）和结直肠癌（17％）。计算机断层扫描（CT）通常用于诊断（90％）。大约87%的患者接受了手术干预，最常见的部分切除（81％）的影响结肠和脾切除术（77％）。19名患者最初接受了手术治疗，12例患者最初接受非手术治疗。然而,11名非手术患者由于未解决的症状最终需要手术。术后并发症发生率为17%。25例（83％）患者通过手术干预缓解了症状。只有一名患者（3％）有术后死亡。
结论：我们对全球30例病例的回顾是文献中最大的。CsF主要是肿瘤过程的并发症。CsF可以通过脾切除术和受影响的结肠切除术来成功和安全地治疗。术后并发症发生率低。
