Presentation
Pneumaturia, fecaluria.
Patient Data
Colonic diverticulosis.
Extensive irregular wall thickening and hyperenhancement of a short segment of the distal sigmoid colon with pericolonic inflammation.
A thin, fistulous tract can be seen extending from the inflamed sigmoid colon into a round collection abutting and invading into the bladder wall distorting the contour and containing mostly fluid and a few small locules of air. This communicates with a tiny defect in the bladder mucosa, and represents the point of fistulous communication with the bladder lumen (see annotated images).
Inflammatory bladder wall thickening and mucosal hyperenhancement with a small amount of intraluminal air.
Annotated images defining the fistulous tract.
Case Discussion
This patient had a history of colonic diverticulitis in the past, but no recent memory of acute pain symptoms prior to presentation for this study. The colonic wall thickening is worrisome for adenocarcinoma, but pathology was benign in this case.
What makes this case particularly impressive is the well-defined fistulous tract from the colonic lumen into an extraluminal collection, and through a small defect in the bladder mucosa (reference the annotated images). Additionally, the presence of air within the bladder wall strongly suggests the presence of fistula (which was strongly suspected based on the presentation of pneumaturia and fecaluria).
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