Diverticulitis with colovesical fistula

Case contributed by Jack Ren

Presentation

Recurrent UTI. Cystoscopy revealed pus coming from opening left wall bladder. ? abscess ? fistula

Patient Data

Age: 70-75
Gender: Female
Modality: CT

The proximal sigmoid colon diffusely thickened and with serosal stranding, an appearance typical of chronic diverticulitis.

There is a focal perforation, which abuts the bladder forming a thick serosal/mural reaction encompassing a 2.4 cm cavity.

This presumably communicates via a tiny punctum with the bladder cavity, as a tiny gas locule is present, but no rectal contrast has passed through.

Although unlikely, it is impossible to exclude a coexisting tumour within this segment.

The process does not involve the adjacent left ovary but there is minor thickening of the left broad ligament.

The ovaries and uterus are otherwise unremarkable.

Rest of bowel is unremarkable.

The liver, gallbladder, pancreas, spleen, adrenal glands and kidneys are unremarkable.

In particular, the left ureter is not involved in this inflammatory process.

CONCLUSION

8 cm long segment of an inflamed proximal sigmoid colon (likely diverticular disease), with focal perforation onto the anterolateral wall of the adjacent bladder, forming a chronic fistula with a cavity that measures 2.4 cm in size.

PlayAdd to Share

Case Information

rID: 30391
Case created: 7th Aug 2014
Last edited: 4th Oct 2015
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.