An Uncommon Case of Colovesical Fistula

A colovesical fistula (CVF) is an is an uncommon condition and is an open connection between the colon and urinary bladder. Colovesical fistulas ( CVFs ) can cause significant morbidity, affect quality of life, and may lead to death, usually secondary to urosepsis .The most common cause of colovesicular fistulas is the sequelae of complicated diverticulitis and accounts for over two-thirds of cases .A CVF can be diagnosed clinically, imaging and endoscopy are often required to delineate the extent of a fistula and to elucidate its etiology and in most cases Surgery is usually required to repair a CVF.

A 72-year-old woman presented to the urology clinic with a 2-week history of passing gas in her urine. Three months earlier, she had been treated for acute diverticulitis, and just before the current presentation, she had completed treatment for a urinary tract infection. On physical examination, her abdomen was soft, with no tenderness or distention.

Urinalysis was notable for the presence of leukocytes and bacteria, and urine culture grew Klebsiella pneumoniae. Contrast-enhanced computed tomography of the abdomen and pelvis revealed a pericolonic mass extending from the sigmoid colon to the superior wall of the urinary bladder. Colonoscopy showed diverticulosis of the colon with no tumors or polyps.

Cystoscopic examination of the bladder revealed an area of congested edematous bladder mucosa with a central orifice that extruded gas and feculent material, which confirmed the diagnosis of a colovesical fistula. Causes of colovesical fistulas include diverticulitis, inflammatory bowel disease, and bowel or bladder cancer. The patient underwent robot-assisted colovesical fistula repair with sigmoid colon resection. On follow-up 2 months later, the patient was doing well, with no recurrence of symptoms.