Multidisciplinary management of a patient with vesicosigmoid fistula and multisystem diseases undergoing stoma reversal: a case report

BACKGROUND: Vesicosigmoid fistula is a rare and complex pathological connection between the urinary and digestive systems, most often caused by calculi, diverticulitis, or malignancy. In elderly patients, surgical repair of the fistula and stoma reversal carry high risks, particularly when complicated by dysfunction of multiple organ systems such as the heart, lungs, and kidneys. This case aims to summarize the perioperative risk assessment and comprehensive management strategies for an elderly patient undergoing stoma reversal after vesicosigmoid fistula repair. CASE PRESENTATION: A 73-year-old man was admitted for planned reversal of ileal and bladder stomas four months after initial diversion surgery. His medical history included hypertension for 10 years. Preoperative evaluation revealed severe urinary tract infection, bilateral hydronephrosis, severe aortic valve stenosis, and emphysema. After multidisciplinary consultation and optimization of infection control and cardiopulmonary function, the patient underwent sigmoid colon resection, excision and repair of the bladder fistula, and bilateral ureteral stent placement. Postoperatively, transient infection exacerbation, hypoxemia, and elevated cardiac enzymes were observed. The patient improved after targeted antibiotic therapy, respiratory support, cardioprotective treatment, and nutritional intervention, and was discharged uneventfully. CONCLUSION: This case highlights that in elderly patients with complex stoma reversal, comprehensive preoperative multisystem risk assessment and multidisciplinary team (MDT) collaboration are essential. Intraoperative attention to adequate fistula excision and watertight repair, together with intensified postoperative monitoring and dynamic management of infection, respiratory, and cardiac status, can substantially improve clinical outcomes.