Abdominal pain and UTI.
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Diffuse sigmoid colon mural thickening is noted, this is associated with multiple intra-mural air pockets, marked permeation of the pericolic fat, showing dirty fat pattern with linear stranding.
Adherence between the pathological sigmoid colon wall and the anterior aspect of the left side of the urinary bladder vault which showed mild enhancement and a connecting linear tract containing air foci. Concentric mural thickening of the urinary bladder wall in addition is also seen associated with intra-luminal air attenuation forming air fluid leveling.
The liver showed cirrhotic changes manifested as hypertrophied lateral segment left lobe, enlarged caudate lobe, relatively shrunken right lobe and Irregular hepatic outlines. Enlarged spleen. Dilated portal vein and multiple porto-systemic collaterals. Multiple gall bladder stones.
Diverticulitis is the lost common cause of Colovesical fistula accounting for about 60% of cases. Other causes includes malignancy Crohn disease, trauma, irradiation and appendicitis. The presence of gas in the urinary bladder in absence of history of Foley's catheter insertion or instrumentation and positive presentation of one of the fore-mentioned causes, the diagnosis of colovesical fistula should be considered. Contrast enhanced scan is needed for diagnosis either through the bladder (cystogram) or through the rectum (contrast enema) and the fistula can be demonstrated by CT or Floroscopy.