Appearance of a colovesical fistula at cystoscopy

Abstract

Key Clinical MessageColovesical fistulae typically present with pneumaturia and/or fecaluria. Diverticulitis, inflammatory bowel disease, and malignancies of the colon are the commonest causes. The fistulous tract and adjacent organs are best demonstrated by contrast-enhanced CT scan with rectal contrast or MRI. Biopsy at cystoscopy/colonoscopy is necessary for complete evaluation and treatment planning.

An Unexpected Passage: A Complex Enterovesicular Fistula

“…They are estimated to account for one in every 3,000 surgical hospital admissions with the most common etiology being diverticulitis (65%-79% of cases), followed by malignancy (10%-20%), and, much less commonly, long-standing Crohn’s colitis (5%-7%) [1]. Clinically, the classic presenting features of EVFs are pneumaturia, fecaluria, and recurrent polymicrobial urinary tract infections [2]. EVFs are most commonly seen in patients in their fifth to seventh decades of life and predominantly in men with a male-to-female ratio of roughly 2-3:1 [3].…”