A colovesical fistula is a recognized complication of diverticulitis. Although the underlying pathology is usually of colonic origin, the majority of patients present with urological symptoms, classically pneumaturia, and urinary tract infection. Epididymo-orchitis is a rare presentation. It is important to identify elderly males who present with recurrent urosepsis and/or epididymo-orchitis refractory to medical treatment as they may have an underlying benign or malignant etiology. The diagnostic challenge in these cases is to confirm the presence of a fistula, exclude malignancy, and determine the underlying pathology.We present a case of diverticular colovesical fistula in an elderly male who presented with symptoms of epididymo-orchitis on a background of recurrent urinary tract infections. The presence of intravesical gas within the left posterolateral bladder wall and soft tissue thickening continuous with the mid-sigmoid colon was consistent with a colovesical fistula. This patient underwent elective laparoscopic anterior resection and repair of colovesical fistula.

Gallbladder volvulus is a very rare complication of a congenital defect in gallbladder development also known as a "floating" gallbladder and often presents in the elderly. Proposed aetiologies include loss of abdominal fat and kyphoscoliosis. We present a patient with severe lumbar scoliosis centred on L2, producing a lumbar vertebral distortion of about 30 degrees concave to the right, resulting in right hemiabdomen volume loss. The mechanical interaction between the gallbladder fundus and compressed viscera transmits abnormal ambulatory forces from the distorted right pelvic brim into the abdomen predisposing to gallbladder torsion. Laparoscopic cholecystectomy was performed without complication and the patient had an uneventful recovery.This case demonstrates the challenges of diagnosing gallbladder torsion preoperatively. A high level of clinical suspicion is vital especially in elderly patients to enable timely surgical intervention to reduce morbidity and mortality.