Diverticulitis, renal obstruction and fistula
Outpatient. Generally feeling unwell with long standing left iliac fossa pain. Left sided tenderness, but no guarding. Colonscopy is normal.
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A moderately long segment of abnormal sigmoid colon with numerous diverticula and significant surrounding inflammatory change. Numerous locules of gas that sit outwith the colon are suspicious for fistula.
The uterus is directly oposed to the mass and there is concern for a uterocolic fistula although there is no gas within the uterus or tubes. Bladder wall thickening, but no intra-vesicular gas.
Note is also made of a hiatus hernia.
This patient was scanned as an outpatient. The concern for impending failure of the left kidney and possibility of further complications related to diverticular disease promped the referring clinician (a gastroenterologist) to arrange admission as well as urological and surgical reviews.
The kidney was decompressed and a defunctining stoma considered. No evidence of uterocolic fistula was demonstrated.