Colovesical fistula due to acute sigmoid diverticulitis

There is circumferential colonic wall thickening of the sigmoid colon secondary to acute diverticulitis. Medially a fistula extends to the urinary bladder where there is a thickened left lateral wall (18 mm thick) and gas within the bladder lumen. The fistula measures 16 mm AP and 18 mm transversely. The colon demonstrates moderate faecalfecal loading throughout. No large or small bowel dilatation. No free fluid or free gas.

The liver is unremarkable apart from mild intra fatty-fatty bile duct dilatation which is within normal limits given previous cholecystectomy. The CBD measures 13 mm. The kidneys, adrenal glands, pancreas, and spleen are unremarkable.

The major vessels are unremarkable. No lymphadenopathy.

The lung bases are clear. Mild multilevel degenerative disease of the lumbar spine.

Impression

Acute sigmoid diverticulosis complicated by a colovesical fistula. No free intraperitoneal gas or fluid.