Presentation
Left lower quadrant pain, frequent urine infections, passing frothy urine.
Patient Data
Diverticulosis of the sigmoid colon with numerous diverticula and smooth circumferential muscle thickening. Focal thickening of mid-sigmoid with anterior soft tissue extension to the left anterolateral bladder wall, with gas within a pocket in the bladder wall and gas within the lumen too. Adjacent peritoneal thickening. No signs of free perforation. No signs of ascending urinary tract infection. Findings consistent with colovesical fistula.
Case Discussion
The main complications of diverticulosis are acute inflammation, which may be associated with abscess formation, perforation, venous thrombophlebitis, and fistula formation - in this case, a colovesical fistula. This accounts for the history of frequent urinary tract infections and pneumaturia.
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