Presentation
Abdominal pain and dysuria from a week ago. History of appendicectomy 6 months ago.
Patient Data
There is a fistulous connection between an inflamed loop of the small bowel and the bladder dome in this patient with Crohn's disease, compatible with an enterovesical fistula.
Marked thickening of urinary bladder dome.
Thickened terminal ileal loop is associated with perienteric inflammatory changes and reactive lymph nodes.
Extension of inflammatory changes to the retroperitoneal region causing the narrowing of the right middle ureter and upstream moderate hydroureteronephrosis.
There is a fistulous connection (arrow) between an inflamed loop of the small bowel and the bladder dome in this patient with Crohn's disease, compatible with an enterovesical fistula.
Case Discussion
The patient's symptoms primarily started 6 months ago with vague abdominal pain and nausea. Abdominal sonography revealed an inflamed appendiceal loop and the patient underwent surgery based on clinical, imaging, and laboratory findings. But the patient's abdominal pain and nausea continued despite surgery. Subsequent abdominopelvic CT and colonoscopy with biopsy revealed inflammatory bowel disease (Crohn disease) a month later after appendicectomy. The patient was under short-term follow-up. The patient has been referred again with a complainant of dysuria and the inability to deflate the urinary bladder from a week ago besides abdominal pain. Abdominopelvic CT revealed an enterovesical fistula with reactive thickening of the urinary bladder dome.