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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]

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.

Introdução: A pneumatúria consiste na eliminação de ar no jato urinário. É um sintoma quase patognomónico de fístula colo-vesical; contudo, devem ser considerados outros diagnósticos diferenciais como cistite enfisematosa, fístula vesicovaginal e lesões iatrogénicas decorrentes de algaliação ou procedimentos endoscópicos ou cirúrgicos recentes. Descrição do caso: Os autores descrevem o caso de um homem, de 55 anos, com antecedentes de doença diverticular do cólon e infeções urinárias de repetição, que referiu na consulta que “tenho a sensação de que elimino ar, no fim de urinar”. Perante a suspeita de pneumatúria foram pedidas TC abdomino-pélvica e colonoscopia, que documentaram uma fístula colo-vesical como complicação de doença diverticular do sigmoide. Foi submetido a resseção anterior do reto, via laparoscópica, que decorreu sem complicações e evoluiu com boa recuperação. Comentário: A pneumatúria é um sintoma pouco frequente na prática diária e pouco relatado na literatura. Por vezes, é o primeiro sintoma de fístula colo-vesical e deve sempre levantar suspeita desta complicação rara, principalmente em indivíduos com antecedentes de doença diverticular e infeções urinárias de repetição.

Objective: This study describes our 28-year experience with colovesical fistula at a major United States Department of Veterans Affairs Medical Center and highlights the clinical presentation and treatment strategies used to manage this condition. Methods: We reviewed patient charts from the electronic medical record of the Department of Veterans Affairs. All patients who underwent colectomies, bladder repairs and management of gastrointestinal fistulas were downloaded to identify those who had the diagnosis of CVF. The historical cohort identified 12 patients from 1992 to 2004, with an additional 29 patients managed from January 2005 to December 2020. Patient demographics, diagnostic approaches, and surgical treatment were collected and compared between the two groups. Results: In both cohorts, almost all patients were male and the average age among them was 65.9 years. The etiology of CVF was overwhelmingly due to diverticulitis, with bladder cancer, radiation treatment, and colon cancer responsible for the remainder. The findings between the two cohorts were very similar. Major symptoms included pneumaturia, fecaluria, and frequent bladder infections. Preoperative evaluation included CT, cystoscopy, cystography, intravenous pyelogram, barium enema, and colonoscopy. CT was most likely to confirm the diagnosis. Thirty-three of the 41 patients underwent surgical repair of their CVFs, most as a one-stage procedure, and many using laparoscopic techniques. Eight patients were managed with permanent ostomies because of serious co-morbid disorders. Conclusions: This 28-year experience indicates that diverticulitis is the leading cause of CVF followed by cancer of the bladder or colon, and radiation treatment. CT is the most reliable diagnostic imaging modality. A majority of patients can have their fistulas managed surgically, many with a one-stage procedure, and frequently performed laparoscopically with very good results.

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Colovesical fistula formation occurs in 65% to 75% of patients with complicated diverticular disease, but it is also a common complication of other inflammatory bowel conditions, such as Crohn's disease, malignancy, and radiation. Most fistulas will need a surgical approach to management, and those considered not fit for surgery due to comorbidities are left with a higher mortality rate due to the risk of urosepsis relating to the fistula. However, this case illustrates a comorbidity, such as benign prostatic hyperplasia (BPH), may reduce both morbidity and mortality. In fact, in this patient's case, his quality of life actually improved with BPH where he did not suffer from urinary tract infections. [ABSTRACT FROM AUTHOR]

Introduction. Fecaluria and pneumaturia are the patognomonic signs of an abnormal communication between the bladder and the intestinal tract. Therefore, when a history of digestive signs, symptoms or digestive diseases is missing, this borderline pathology leads the patients in the care of urologists. From diagnosis to treatment the management of these cases can be difficult and challenging. Materials and Methods. A 48 year old patient, without any significant medical history, presented to the emergency room for fecaluria, pneumaturia and an episode of haematuria. He had no prior digestive symptoms. The contrast enhanced abdominal and pelvic CT scan revealed a pelvic mass involving the sigmoid colon and the dome and the posterior wall of the bladder. The cystoscopy objectifies a tumor mass involving the right postero-lateral bladder wall, with extravasation of faeces. A biopsy was taken and the frozen section found mainly uncertain inflammatory type tissue. A colonoscopy couldn’t be done because of an impassable obstacle at 15 cm from the anus. Together with general surgeons we decided for en bloc resection of the tumor with partial cystectomy, right ureterocystoneostomy and rectosigmoid resection with mechanic end to end anastomosis. Results. The postoperative period was uneventful. The histopathological examination revealed an abscessed sigmoid diverticulum with vesico-sigmoid fistula and perilesional inflammatory tissue. Two years after the surgery the patient is asymptomatic with a normal function of the right kidney and restored bladder capacity. Conclusions. Being a borderline pathology, patients with fecaluria and pneumaturia and lack of digestive symptoms are referred and managed by the urologists. Despite extensive investigations, even when preoperative biopsies reveal inflammatory tissue the patients should be treated as oncologic cases. A close cooperation with general surgeons for en bloc multiorgan resection within oncologic safety margins is mandatory.

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]

Highlights • Percutaneous ablation techniques have been developed to treat renal tumours. • Bowel lesions after cryoablation are diagnosed using symptoms and imaging. • Most colorenal fistulas are treated conservatively with good results. • Surgical treatment is reserved for complicated or persistent colorenal fistulas. Abstract Introduction Computed tomography (CT)-guided percutaneous cryoablation is increasingly utilized for renal cell carcinoma. Bowel injury is a known complication but is extremely rare. We herein present the case of a 58-year-old man diagnosed with a colorenal fistula after cryoablation of a left renal tumour. Presentation of Case A left renal tumour was incidentally found on abdominal CT examination performed for a slight increase in transaminases. Abdominal ultrasonography revealed a 31 × 32-mm solid, well-defined, cortical tumour at the lower pole of his left kidney. The patient was asymptomatic and had no distant metastasis. The decision was made to treat the tumour with percutaneous cryoablation, with good response to the technique. Two months later, the patient had recurrent urinary tract infections and pneumaturia. In the absence of improvement with antibiotic treatment, CT was performed and revealed a fistula connecting the descending colon and renal parenchyma. The decision was made to perform surgery to repair the defect caused by percutaneous cryotherapy. Discussion To reduce adverse effects of the procedure and preserve renal function, percutaneous ablation techniques have been developed. Internal injury is a known complication and it is particularly common in cases of renal tumours located in the upper and anterior kidney. The diagnosis is based on symptoms and imaging. Most colorenal fistulas have been treated conservatively with good results. Conclusion The patient recovered from surgery and was discharged with no complications. [ABSTRACT FROM AUTHOR]

Emphysematous cystitis is a relatively rare clinical entity caused by gas-fermenting bacteria or fungus. Presentation is often nonspecific and imaging is the best diagnostic modality. We report a case of a 45-year-old male who presented with fever, dysuria, and pneumaturia, and was found to have emphysematous cystitis.

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]

Abstract: Background: Our experience with colovesical fistula (CVF) over a 12-year period was reviewed to clarify its clinical presentation and diagnostic confirmation. Methods: Twelve patients with CVF were identified. Presenting symptoms, etiologic factors, diagnostic investigations, and subsequent treatment were reviewed. Results: Underlying etiologies were diverticular disease (75%), colon cancer (16%), and bladder cancer (8%). Pneumaturia (77%) was the most common presentation, followed by urinary tract infections, dysuria and frequency (45%), fecaluria (36%), hematuria (22%), and orchitis (10%). The ability of various preoperative investigations to identify a CVF were: computed tomography (CT) (90%), barium enema (BE) (20%), and cystography (11%), whereas cystoscopy, intravenous pyelogram (IVP), and colonoscopy were nondiagnostic. All patients underwent single- or multiple-staged repair of the fistula. Conclusions: In patients with a suspected CVF, we recommend CT followed by a colonoscopy as a first-line investigation to rule out malignancy as a cause of CVF. Other modalities should only be used if the diagnosis is in doubt or additional information is needed to plan operative management. [Copyright &y& Elsevier]

A colovesical fistula (CVF) is a pathological connection between the colon and the urinary bladder. Although they are uncommon, consequences can severely affect quality of life and mortality. Diverticula are the most common cause of CVF. This case details a patient's CVF diagnosis in the emergency department with unremitting gastrointestinal and urinary symptoms. A 78-year-old male patient with recent hospitalization for stroke and left carotid endarterectomy complicated by urinary retention treated with a Foley catheter presented to the Emergency Department with a chief complaint of hematuria and unremitting diarrhea. Foley exchange resulted in improved urinary retention and diarrhea during hospitalization. One day following hospital discharge, the patient presented again with a blocked Foley catheter and diarrhea. Foley irrigations resulting in near immediate diarrhea and lack of bladder filling on bladder scan portended to a diagnosis of colovesical fistula despite no history diverticula or colon malignancy. An abdominal/pelvic computed tomography scan and cystogram confirmed a colovesical fistula. This case highlights the need for consideration of colovesical fistula in a seemingly simple ED complaint of urinary retention. It is prudent to closely follow bladder scan volumes when flushing a Foley catheter. Given the significant comorbidities such as urosepsis and health care impact of repeat ED visits and hospitalizations, CVF can and should be entertained and rapidly diagnosed in the emergency department. Our case highlights the need for consideration of a vesico-colic fistula despite the absence of initial relevant risk factors. [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]