Presentation
Fecaluria and pneumaturia with refractory urinary tract Infection.
Patient Data
Thickened loop of sigmoid colon with diverticulosis adherent to the bladder, with gas and stool (yellow circle) inside the urinary bladder. There's also segmental colonic inflammation and pericolic fat stranding within an area of diverticulosis. Thickened bladder wall with enhancement by inflammation. Fatty liver infiltration with a cyst in the right lobe. The kidneys are normal with two stones in the right kidney. Simple cortical cysts are present bilaterally. There is no hydronephrosis.
Sagittal CT shows a fistulous tract containing fluid, stool and air (yellow arrow) extending from the sigmoid colon into the bladder wall.
Case Discussion
In the presence of a colovesical fistula, the patient may have irritative urinary symptoms or even pneumaturia or fecaluria, and there may be air or enteral contrast visible in the bladder. Passage of urine per rectum is not common with colovesical fistulae from diverticulitis.