CPT® Code 45800

A rectovesical fistula is defined as an abnormal connection between the rectum and the urinary bladder, which can lead to significant clinical complications. This condition may arise as a postoperative complication or as a result of chronic infections or inflammation affecting the pelvic structures. The procedure coded as CPT® 45800 involves the surgical closure of this type of fistula. During the operation, the abdomen is surgically opened to access the affected area, where the fistula is identified. The surgeon carefully lyses any adhesions that may exist between the rectum and the bladder, allowing for the separation of these two structures. Following this, the opening in the bladder is located and meticulously repaired using sutures to ensure a proper seal. The rectum is also inspected, and if necessary, it is closed with sutures to restore its integrity. To further reduce the risk of recurrence of the fistula, omentum—a fold of peritoneum—may be interposed between the bladder and rectum. In some cases, a colostomy may be performed to temporarily divert stool away from the rectum, with the procedure typically involving the sigmoid colon. Various types of colostomies can be created, including loop colostomy, loop with distal closure, or an end colostomy with a mucous fistula. Additionally, drains may be placed in the abdominal cavity as needed, and the abdominal incision is subsequently closed. It is important to note that CPT® 45800 is specifically used for the closure of a rectovesical fistula without the performance of a colostomy, while CPT® 45805 is designated for cases where a colostomy is included in the procedure.