Presentation
Pneumaturia and passage of urine rectally. No prior surgery.
Patient Data
An air-fluid level is present within the urinary bladder.
The anterior wall of the upper rectum touched the posterior wall of the urinary bladder, and a suspected fistula is seen between the rectum and bladder, better seen in post-contrast T1W fat sat images.
A gastrografin enema was performed to confirm the rectovesical fistulous formation diagnosis.
By injecting contrast medium through the anus, the rectum is visualized, and a frank rectovesical fistula causes contrast passage into the small trabeculated urinary bladder.
A left-sided vesicoureteric reflux is also seen.
Several stones are seen in the right renal lodge in a non-contrast image.
Case Discussion
This case typically demonstrates a rectovesical fistula in an elderly male patient with pneumaturia and passage of urine rectally, probably due to prior diverticulitis.
Diverticulitis (60%), colorectal cancer (20%), and Crohn disease (10%) are the main causes of colovesical fistula that usually occur through the dome of the bladder.
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