Records of a series of 28 patients with sigmoidal fistulas have been reviewed. Our discussion of the incidence and pathogenesis of sigmoidal fistulas is based on a review of the literature and a study of a collected series of cases. The value of various diagnostic features (symptomatology, physical examination, sigmoidoscopy, roentgenography, urologic studies, Papanicolau staining methods, direct biopsy and needle biopsy) have been discussed. The historical background of the surgical management of sigmoidal fistulas has been presented. The results of treatment in the present series have been summarized. A general discussion of the surgical management of sigmoidal fistulas is based on personal observation and a study of a collected series of cases.