Korean J Gastroenterol.  2011 Nov;58(5):284-287. 10.4166/kjg.2011.58.5.284.

Sigmoidovesical Fistula Caused by Diverticulitis Detected with Sigmoidoscopy

• Jung YW
• Yoo JH
• Lee JS
• Jang BI
• Kim KO
• Jung SH

• KMID: 1026372
• DOI: http://doi.org/10.4166/kjg.2011.58.5.284

Abstract

Enterovesical fistular is an abnormal communication between the intestine and the bladder. It represents a rare complication of intestinal diverticulitis, colorectal malignancy, bladder cancer, inflammatory bowel disease, radiotherapy, and trauma. The most common etiology is diverticular disease. A 70-year-old man came to our hospital due to frequent urinary tract infection, dysuria, pneumaturia and fecaluria. Sigmoidoscopy revealed a large diverticulum with impacted stool at the sigmoid colon. When the scope was inserted into the site, the patient complained of severe urgency and pneumaturia. CT scan was performed. 1.5 cm sized fistular tract between the sigmoid colon and bladder was noted. According to the endoscopy and CT finding, the diagnosis of colovesical fistula was made. The patient underwent surgical intervention. At laparotomy, there were multiple diverticula and fistular tract was noted.

Keyword

Enterovesical fistula; Diverticulitis; Sigmoidoscopy

MeSH Terms

Aged
Colon, Sigmoid/*pathology
Diverticulitis/complications/*surgery
Humans
Intestinal Fistula/*diagnosis/etiology/surgery
Male
Sigmoidoscopy
Tomography, X-Ray Computed

Figure

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  Fig. 1. Cystogram finding. About 300 cc of contrast media was filled in the urinary bladder and no contrast leakage was seen. The margin of the urinary bladder was relatively regular.

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  Fig. 2. Sigmoidoscopic finding. At the sigmoid colon-25 cm from anal verge, a large diverticulum with impacted stool was noted.

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  Fig. 3. CT scan finding. (A) There was about 1.5 cm sized fistular tract between the sigmoid colon and posterior wall of the urinary bladder (white arrow). Perilesional bladder wall thickening and fat infiltrations were also noted. (B) Multiple diverticula were seen in the sigmoid colon (white arrows).

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  Fig. 4. Gross finding of resected specimen. The mucosal surface of the sigmoid colon showed multiple diverticula (black arrow) and fistular opening (white arrow).

Reference

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