Presentation
One week of abdominal pain, fever and rigors.
Patient Data
Rectal contrast via a rectal tube. Oral contrast also given.
A 10 cm segment of sigmoid colon is abnormal, with stricturing and circumferential wall thickening. There are a few diverticuli in this segment and elsewhere. A moderate degree of paracolic fat stranding is present, particularly extending to the bladder where the intervening fat plane between the bladder and colon is absent. There is marked bladder wall thickening and a gas locule in the inflamed tissue between the colon and bladder in keeping with a fistula. Gas also noted in the bladder, although no rectal contrast is seen in the bladder. The large bowel is not distended.
A few cortical cysts noted in the kidneys. The remainder of the solid organs are normal. No free fluid or gas. Minor dependent changes noted at the lung bases. No focal or destructive bone lesion.
Conclusion
Sigmoid colitis and colovesical fistula secondary to sigmoid diverticulosis.
Outpatient colonoscopy is advised to ensure there is no underlying sigmoid malignancy.
Case Discussion
The patient had the sigmoid colon resected and bladder repaired.
Colonoscopy biopsy = normal colonic mucosa.
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