Abdominal pain and UTI
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Diffuse sigmoid colon mural thickening is noted, this is associated with multiple intramural gas 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 gas foci. Concentric mural thickening of the urinary bladder in addition is also seen associated with intraluminal gas attenuation forming gas-fluid levels.
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 portosystemic collaterals. Multiple gallbladder stones.
Diverticulitis is the most 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 catheter insertion or instrumentation and positive presentation of one of the aforementioned 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 fluoroscopy.