Refractory urinary tract infection in a male with colovesical fistula

Abstract

A colovesical fistula is a communication between the lumen of the colon and the bladder, which sometimes results from diverticulitis. The left or sigmoid colon is the most commonly involved segment. The most usual presenting symptoms are pneumaturia and fecaluria, followed by dysuria, abdominal pain and, rarely, hematuria; these patients also often present with symptoms of recurrent/chronic urinary tract infection.We present here the case of a 57-year-old man complaining of recurrent lower urinary tract symptoms followed by pneumaturia and fecaluria. Computed tomography of the abdomen and pelvis revealed a colovesical fistula due to sigmoid diverticulitis. After locating the fistula, the lesion was totally removed, including the segmental sigmoid colon and partial bladder. The anastomosis was completed with a circular stapler and the bladder defect wall was repaired with double suture. The patient was doing well 3 months post-operatively and showed no evidence of urinary tract infection. Patients with repeated and refractory urinary tract infections should be considered for anatomical disorders such as colovesical fistula.