Presentation
65 year old man presents with a 14 month history of pneumaturia. Past history included low anterior resection for sigmoid cancer. In addition there is gluteal pain.
Patient Data
A fluid collection within the right ischioanal fossa is seen with external opening within the right natal cleft, likely origination from the blind ending end-to-side anastomosis.
However, an asymmetry is seen within the seminal vesicles, with the left seminal vesicle larger and with lower signal intensity than the right one.
The sagittal images demonstrate a tract between the colon and left seminal vesicle. (series 3-8)
The axial images confirm the presence of a colonic-seminal vesicle fistula.
Case Discussion
Fistulas between the recto-sigmoid and bladder are relatively common, after surgery, in the setting of infectious or inflammatory disease, or as congenital abnormality.
Fistulas between the recto-sigmoid and seminal vesicles however are rare, with only a few case reports in recent literature.
In addition to pneumaturia, patients can present with cystitis and epididymitis.
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