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Introduction: A 51-year-old male was seen complaining of pneumaturia and bowel complaints, including blood per rectum. The patient related a history of an open left inguinal hernia repair utilizing a Kugel mesh ten years before. Case Presentation: Cystoscopy and colonoscopy demonstrated a hemorrhagic mass due to a prosthetic mesh protruding into the bladder and colon. Following colonoscopy and cystoscopy, a large inflammatory mass involving both the colon and urinary bladder was resected, which contained a rolled-up "tubular" mesh structure. After primary repair of the urinary bladder and placement of a Foley catheter, the sigmoid colon and mesh were resected, and the colonic anastomosis was completed. Outcome: Postoperatively, the patient progressed well with normal colon and bladder function after the removal of the Foley catheter. Discussion: Historically, the patient demonstrated the risk of major multiorgan surgical complications of a newer inguinal hernia repair technique, which may occur even a decade or more after the initial surgical correction and is, therefore, presented. [ABSTRACT FROM AUTHOR]

Purpose of review: Vesico-enteric fistulas (VEF) have a tremendous effect on patient quality of life. Unfortunately, clear diagnostic and management guidelines do not exist. In this article, we review the current evidence for workup and treatment of these fistulas. Additionally, new treatments are presented. Recent findings: Technological advancements in imaging modalities have shifted diagnosis from simply demonstrating the fistula to providing anatomic and pathologic information. Furthermore, continued improvement in endoscopic and laparoscopic tools may allow for treatment of fistulas with durable results. Summary: Management of the underlying disease process is key to management of VEF. Enhanced imaging techniques and improved medical therapies have allowed for better optimization prior to surgical therapy improving success rates. Additionally, endoscopic and laparoscopic treatments have allowed for more minimally invasive treatments, challenging the accepted practice of excision and repair of VEF. In the future, continued technological and medical developments will allow for better management of the underlying cause of VEF and decrease comorbidity associated with repair. [ABSTRACT FROM AUTHOR]

Aim: To describe the problems and management of rectourethral fistulas. Background: Rectourethral fistula constitutes a rare entity that poses a challenging management problem. The condition is either congenital or acquired. The clinical findings suggestive of RUF include pneumaturia, faecaluria, and urine leakage per rectum. Methods: This study was based on English research literature, mainly by searching PubMed bibliographic database. Results: Diagnosis of a rectourethral fistula is difficult and often based on history alone. In rare cases, non-operative management has been successful, but the majority of patients require surgical intervention. A wide variety of procedures have been described for RUF repair. Conclusion: Rectourethral fistula represents a complex management problem for any surgeon. Surgical treatment of RUF is technically demanding and requires collaboration with rectal surgeons. [ABSTRACT FROM AUTHOR]

Introduction: Emphysematous cystitis is a very rare complicated urinary tract infection characterized by air in the bladder wall. Case presentation: We report two clinical cases of emphysematous cystitis of an 83-year-old Caucasian woman with diabetes mellitus and a 78-year-old Caucasian man with no past medical history. They presented with severe confusion and abdominal distension. Emphysematous cystitis was diagnosed in time with a thorough physical examination, urine analysis and computed tomography. The patients were successfully treated with antibiotic therapy and bladder drainage. Conclusion: This rare disorder should be recognized in time and treated properly to guarantee survival. [ABSTRACT FROM AUTHOR]

Emphysematous cystitis is a rare disease with a high mortality rate. Generally elderly women with diabetes mellitus are affected. Diagnosis is made radiologically using plain abdominal X‑ray or computed tomography. The therapy includes urine drainage, antibiotic treatment and hyperglycaemic control to avoid progress of the infection and the development of complications. In the current report we present a case of a 79-year-old woman with uncontrolled diabetes mellitus and an incidental diagnosis of emphysematous cystitis. [ABSTRACT FROM AUTHOR]

Enterovesical fistulae are a recognized complication of a variety of inflammatory and neoplastic conditions. Despite advances in imaging and treatment the diagnosis may be delayed and the management remains diverse. We describe our experience with their diagnosis and management.This retrospective study encompassed all patients referred over a 10-year period with clinical suspicion of or confirmed enterovesical fistula. Demographics, clinical presentation, aetiology and clinical outcome were evaluated. Mean follow-up was 18 months (range 6–50 months).Thirty patients were studied.The mean age was 63.5 years (range 23–92 years). Fifteen (50%) patients presented with classical urinary symptoms (pneumaturia, faecaluria and recurrent urinary tract infections). The commonest investigations (n, % positive) included CT (15, 80), cystoscopy (16, 87.5), endoscopy (11, 54.5) and barium enema (8, 50). There were 20 inflammatory and 10 neoplastic aetiologies. Five patients were treated conservatively and 25 patients underwent surgery. Surgery resulted in symptomatic cure in the majority of cases (22/25).Classical urinary symptoms were only evident in 50% of patients with confirmed fistulae. We advocate CT scanning as the optimum imaging modality before surgical intervention. Surgical treatment in a specialized unit remains the most effective treatment of enterovesical fistulae. [ABSTRACT FROM AUTHOR]

Background: Emphysematous cystitis is defined by the presence of gas in the urinary bladder wall. It complicates urinary tract infections especially in diabetic patients. Aims: We present a case of emphysematous cystitis in a diabetic patient with a poor glycemia control and we discuss diagnostics and treatment items of this uncommon and serious infection. Methods and Results: A 45-year-old man was admitted to the emergency department with confusion and abdominal pain. The clinical examination found a septic shock the Ultra-sonography (US) showed a cholecystitis the patient was operated without amelioration. A post operative pelvic computed tomography (CT) demonstrated intramural gas in the urinary bladder, which suggested a diagnosis of emphysematous cystitis. The treatment was based on an antibiotics associated with a bladder drainage. The evolution was in favor. Conclusion: Every diabetic patient with a urinary tract infection who seems to be severely ill should have an abdominal X-ray as a minimal screening tool to detect emphysematous complications. [ABSTRACT FROM AUTHOR]

This paper presents two unusual fistulae between the rectum and the lower urinary tract in adults, one a posttraumatic fistula following dilatation of a sigmoid colon stricture and the other a congenital anomaly. In both cases a contrast enema was negative; in one case a voiding cystourethrogram was negative. The fistula was demonstrated in case 1 by repeating the enema and having the patient raise his intraabdominal pressure, and in case 2 by having the patient hold while attempting to pass flatus during a cystogram, which demonstrated gas bubbles entering the bladder. [ABSTRACT FROM AUTHOR]

Key Clinical Message Colovesical fistulae typically present with pneumaturia and/or fecaluria. Diverticulitis, inflammatory bowel disease, and malignancies of the colon are the commonest causes. The fistulous tract and adjacent organs are best demonstrated by contrast-enhanced CT scan with rectal contrast or MRI. Biopsy at cystoscopy/colonoscopy is necessary for complete evaluation and treatment planning. [ABSTRACT FROM AUTHOR]

Context: Emphysematous cystitis (EC) is a rare infection of the urinary tract that results in gas production in the bladder. It is more common in diabetic and female patients, and can be associated with more serious complications, including pyelonephritis. Case Report: We describe a case of recurrent bacterial cystitis caused by Escherichia coli (E. coli). An incidental finding in our patient of pneumaturia on computed tomography (CT) scan prompted further work-up. Differential diagnoses for pneumaturia include infection, trauma, and fistula, most commonly colovesicular. The patient history ruled out trauma and CT scanning ruled out a fistula; culture of the urine then showed a bacterial load greater than 100,000 E. coli/mL. The patient was then diagnosed with EC. She was treated with ceftriaxone and released in stable condition. Conclusion: The literature was scarce when it came to diagnoses of EC based on bacterial load. We present this case to increase health care providers' awareness of recurrent EC with a urine culture bacterial load greater than 100,000 E. coli/mL. [ABSTRACT FROM AUTHOR]

The article presents information on a 68-year-old man who suffered from appendico-vesical fistula. His medical report shows a history of epididymo-orchitis. An accurate pre-laparotomy diagnosis is advised to treat appendico-vesical fistula. An oedematous right ureteric orifice is found by the cystoscopy.