Search

Enterovesical fistula (EVF) represents an abnormal channel between the intestine and the bladder. The EVF is a complication of inflammatory or neoplastic diseases and injuries. Diagnosis of EVF can be challenging and often delayed up to several months after the onset of the symptoms. This study aimed to determine the characteristics of patients with enterovesical fistula visiting Dr. Hasan Sadikin General Hospital Bandung, Indonesia. This retrospective descriptive study used the medical records of EVF patients treated in the urology department of Dr. Hasan Sadikin General Hospital from 2015 to 2019 as the secondary data to be analyzed. A total of 58 patients with EVF were enrolled in this study. By gender, that more than half of the patients were male patients (n=30, 51.7%) and 45% of patients were between 41 and 50 years old. The most common symptoms of EVF were pneumaturia and fecaluria which were seen in 30 (51.7%) and 20 (34.5%) patients, respectively. Twenty-nine (50%) patients experienced malnutrition and 18 (31.1%) patients had diabetes mellitus as a comorbid. The most common type of fistula was rectovesical fistula (n=45, 77.6%) and 26 (66.6%) patients suffered from rectosigmoid cancer and malignancy (68.95) had become the most predominant etiology. Escherichia coli was found in 42 (72.4%) urine cultures collected from the patients and cystoscopy with fistula biopsy was found in 43.1% of cases, followed by fistula repair (29.3%) and urethral catheter drainage (15.5%). Hence, malignancy and rectosigmoid cancer become the most common etiology of EVF while cystoscopy with fistula biopsy is the most frequently performed procedure.

Ulcerative colitis (UC), which mainly consists of mucosal lesions, rarely form colovesical or rectovesical fistulas, although few cases of fistula formation associated with comorbidities have been reported. We report a case of UC-associated rectal cancer diagnosed following symptoms associated with rectovesical fistula. A 40-year-old man with a 31-year history of extensive UC presented with difficulty in defecation. Two years before the current presentation, he had experienced pneumaturia, and the examination then had revealed a rectal neoplastic lesion and rectovesical fistula; however, tissue biopsy showed no malignancy. Therefore, he requested for observation with no further treatment. Current examination suggested the rectal tumor had grown to invade the bladder. Tissue biopsy showed no malignancy. However, the clinical symptoms and examination findings strongly indicated UC-associated rectal cancer with bladder invasion; thus, open total proctocolectomy with partial cystectomy was performed. Histopathological evaluation of the rectal neoplastic lesion revealed UC-associated rectal cancer originating from the inflammatory mucosa, and the rectovesical fistula was found to be caused by the rectal cancer invading the bladder. Therefore, other colorectal cancers should be considered even though tissue biopsy does not reveal malignant lesions in UC patients with fistula.

Rectovesical fistula (RVF) is defined as an abnormal communication between the rectum and the urinary bladder, most commonly after an iatrogenic injury during pelvic surgery. Patients with RVF may have various clinical presentations, ranging from fecaluria, pneumaturia, to urine leakage through the anus. The quality of life for patients with this pathology is adversely affected owing to the associated psychological burden. Surgery is the preferred treatment given the low success rates reported for conservative or minimally invasive approaches. Herein, we present a case of a 65-year-old man with RVF after radical prostatectomy successfully treated by a transperineal approach using a modified Martius procedure.

Introduction Colovesical fistulas (CVFs) account for approximately 95% enterovesical fistulas (EVFs). About 2/3 CVF cases are diverticular in origin. It mainly presents with urological signs such as pneumaturia and fecaluria. Diagnostic investigations aim at confirming the presence of a fistula. Although conservative management can be chosen for selected individuals, most patients are mainly treated through surgical interventions. CVF represents a challenging condition, which records high rates of morbidity and mortality. Our systematic review aimed at achieving deeper knowledge of both indications, in addition to short- and long-term outcomes related to CVF management. Evidence acquisition We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Pubmed/MEDLINE, Embase, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. Evidence synthesis The 22 included articles covered an approximately 37 years-study period (1982-2019), with a total 1,365 patient population. CVF etiology was colonic diverticulitis in most cases (87.9%). Pneumaturia (50.1%), fecaluria (40.9%) and urinary tract infections (46.6%) were the most common symptoms. Abdomen computed tomography (CT) scan (80.5%), colonoscopy (74.5%) and cystoscopy (55.9%) were the most frequently performed diagnostic methods. Most CVF patients underwent surgery (97.1%) with open approach (63.3%). Almost all patients had colorectal resection with primary anastomosis with or without ostomy and 53.2% patients underwent primary repair or partial/total cystectomy. 4% anastomotic leak, 1.8% bladder leak and 3.1% reoperations rates were identified. In an average 5-68 month follow-up, overall morbidity, overall mortality and recurrences rates recorded were 8%-49%, 0%-63% and 1.2%, respectively. Conclusions CVF mainly affects males and has diverticular origin in almost all cases. Pneumaturia, fecaluria and urinary tract infections are the most characteristic symptoms. Endoscopic tests and imaging are critical tools for diagnostic completion. Management of CVFs depends on the underlying disease. Surgical treatment represents the final approach and consists of resection and re-anastomosis of offending intestinal segment, with or without bladder closure. In many cases, a single-stage surgical strategy is selected. Perioperative and long-term outcomes prove good.

Rectovesical fistulae (RVF) are uncommon entities and usually occur after surgery for prostate, radiation, and sometimes due to penetrating trauma. However, RVF occurrence after blunt trauma to the abdomen or perineum is very rare. The management of RVF is challenging, and treatment options should be considered according to the individual. Here we present a case of a 10-year-old boy who presented with fecaluria, pneumaturia, the passage of urine per rectum, and burning micturition for four days after incurring a blunt injury to the perineum. Cystography revealed leakage of contrast material into the rectum and an MRI of the pelvis was done for confirmation, which revealed a 1.3 cm thick fistulous tract of 2.7 cm length with openings at the posterior bladder wall and anterior rectal wall. After conservative management for 14 days failed to show any improvement, primary repair of the fistulous tract along with fecal diversion and urinary diversion were done. The suprapubic catheter was removed after four weeks, and at the two-month follow-up, colostomy closure was done. No recurrence was found in the six-month follow-up period. In cases of small traumatic RVF where conservative management fails, fecal and urinary diversion can be considered, as it is associated with successful outcomes and less recurrence.

Introduction Colovesical fistula is the pathological communication between the colon and urinary bladder. It is related with high morbimortality rate and it is and uncommon complication of diverticulosis in young adults. Case presentation We report a case of a 38-year-old Brazilian man with fecaluria and pneumaturia for eight months, whose colovesical fistula was undetectable in CT scan and with surgical management. Discussion Diverticulosis is the main inflammatory condition causing colovesical fistulas and the sigmoid colon is the most common part involved. It is more prevalent in patients over 60 years old and in western countries due to low fiber diet. Conclusion Colovesical fistula diagnosis is difficult, requiring high suspicious and proper investigation through good anamnesis, CT scan and also colonoscopy and cystoscopy when necessary., Highlights • Colovesical fistula is an uncommon disorder in young adults and it is more frequently in western countries. • Diverticulits is the main inflammatory condition causing enterovesical fistulas and the sigmoid colon the most common. • Colovesical fistula diagnosis is difficult, requiring proper investigation through CT scan or other exams. • Most cases of colovesical fistula are diagnosed during surgery approach and surgically managed.

A 60-year-old woman with recurrent urinary tract infection who had several operations for colorectal carcinoma underwent Tc-DMSA renal scintigraphy which showed an unexpected accumulation of radiotracer in the colon. When symptoms were reviewed, we noticed that she was suffering from pneumaturia and fecaluria which raised the suspicion of enterovesical fistula. Rectal contrast-enhanced computer tomography of pelvis demonstrated enterovesical and enterovaginal fistulas. Colonic radioactivity was considered to be related to retrograde peristalsis of Tc-DMSA from bladder activity via enterovesical fistula. In patients with pelvic surgeries and radiotherapy, radioactivity in the colon should raise the suspicion of enterovesical fistula.

Introduction & Objectives. Rectal injury and recto-urethral fistula (RUF) formation are severe complications after surgical treatment of prostate cancer . There are various surgical techniques as well as conservative methods for the treatment of RUF. Nonsurgical approach can be used in nontoxic, minimally symptomatic patients. Materials & methods From 2012 to 2016, 825 patients (mean age 68y) with LPR to be performed were recruited in the study. Postoperatively RUF developed in 7 patients (0.8%) in average in 10 days after surgery. Five cases were uncomplicated presented with pneumaturia, dysuria or urine per rectum. Two patients with fecaluria and previous history of radiotherapy or androgen deprivation were excluded from the study group. Conservative management include: 1)bowel rest 2)broad-spectrum antibiotics after urine culture 3) fully absorbable diet (combination of parenteral and enteral nutrition) 4) bladder drainage (urethral catheter or suprapubic tube). Duration of conservative treatment was 4 weeks. After treatment all patients underwent a voiding cystourethrogram. Results During the treatment one patient has developed severe UTIs and surgical treatment were perfomed. The remaining 4 patients had spontaneous healing of the fistula and normal cystourethrogram. With the median follow up of 24 month after RUF treatment all 4patients had no fistula signs and they were fully continent. Overall RUF closure using nonsurgical treatment was successful in 4 of 5 cases (80%). Conclusions Conservative management of RUF is a highly effective option which can be used to avoid major surgery and temporary colostomy. Nonsurgical treatment is a feasible method in selected patients with RUF.

We present the case of an enterovesical fistula (EVF) caused by ischemic enteritis. Ischemic enteritis is caused either by mesenteric macrovasculature occlusion or any pathophysiologic vasospasm of the microvasculature. In other words, ischemic enteritis (IE) occurs when the inflow of blood to the small intestines is reduced. The frequency of ischemic enteritis is less as compared to ischemic colitis because of the vast blood supply to the small intestine. It is the first case to be reported in the medical literature to date. EVF is a rare entity. It is a pathological connection between the bowel loops and the urinary bladder. EVF is a result of an underlying disease or injury. EVF is mostly caused by diverticular diseases, carcinoma colon, Crohn's, and inflammatory bowel disease, iatrogenic, appendicitis, carcinoma cervix, etc. Due to the formation of this abnormal connection, contents of the intestines, including the air, food content, etc., are usually found in the urine. Patients usually present with the complaint of irritative urinary tract symptoms and recurrent urinary tract infection (UTI). Surgical management is the mainstay of treatment although medical management is tried for those who cannot bear to undergo surgery.

Background: The presence of intra-calcular gas might indicate the coexistence of gas-forming bacterial infections, which are potentially severe and life threatening. Gas-containing renal stones are rare. Herein, we present a case of gas-containing renal matrix stone that was associated with emphysematous pyelitis and reflect on its management. Case Presentation: A 30-year-old woman, with no underlying comorbidities, presented at 30 weeks of pregnancy with symptoms of pyelonephritis. Imaging showed no renal stones. Postdelivery, she presented again with similar symptoms in addition to pneumaturia. Imaging showed several large gas-containing renal matrix stones associated with emphysematous pyelitis, pneumoureter, and pneumobladder. She improved with oral antibiotics and underwent percutaneous nephrolithotomy 6 weeks later. Conclusion: The presence of intra-calcular gas does not necessarily indicate a serious condition and the treatment can be planned according to the patient's symptoms and the presence and type of any emphysematous renal infection.

Emphysematous cystitis (EC) is a rare infection characterized by gas formation in the bladder wall. We present an unusual case of emphysematous cystitis of a 37-year-old female patient with pneumaturia, vomiting, nausea and abdominal pain. EC was diagnosed on a computed tomography (CT) scan which demonstrated abnormal bladder wall thickening that contained air. Urinalysis was positive for hematuria, bacteria and an elevated leukocyte esterase which further supported the diagnosis. This patient's atypical symptoms and lack of other risk factors that are commonly seen in patients with EC highlight the need for vigilance when assessing for EC.

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.

Introduction: Entero-neovesical fistula is a rare complication after radical cystectomy and orthotopic ileal bladder substitution. Typical presenting symptoms are faecaluria, pneumaturia, recurrent urinary tract infections and abdominal pain. Risk factors include history of pelvic radiation, chemotherapy and abdominal surgery, as well as diverticular colonic disease, inflammatory bowel disease and traumatic pelvic injury. The paucity of cases reported in the literature makes the management of this threatening complication very challenging. Conservative treatment has only anecdotally been reported. Case description: We describe two cases of entero-neovesical fistula with different presentation, which both required an immediate surgical treatment. The former patient was admitted to the emergency room with faecaluria, complete urinary incontinence and fever 2 years after radical cystectomy, and a fistula between the Y-shaped neobladder and the bowel anastomosis was detected. He had previously undergone chemotherapy because of tumour progression. Undiversion into an ileal conduit was required. The latter patient presented with faecaluria 20 days after an uneventful radical cystectomy, and a fistula between the Vescica Ileale Padovana neobladder and the sigmoid was documented. Treatment included resection of the sigmoid with several small diverticula, temporary ileostomy and closure of the neobladder fistula. Conclusion: Conservative treatment of entero-neovesical fistula can be attempted only in patients with small openings in the small bowel and no systemic symptoms. In all other cases, surgical treatment with bowel resection and either closure of the neobladder opening or undiversion should be the preferred option.

A 35-year-old diabetic woman was referred to the emergency department with fever, left flank pain, pneumaturia, and impaired vision of the left eye from 4 days ago. Fever, tachycardia, tachypnea, low blood pressure, metabolic acidosis, and azotemia were the first findings. The diagnosis was a coincidence of emphysematous pyelonephritis and emphysematous endophthalmitis due to computerized tomography of the patient. Immediate fluid and electrolytes resuscitation, intravenous antibiotic administration, and nephrectomy save the patient. Urine, blood, and vitreous cultures revealed mixed germ infection.

Introduction A rectoseminal vesicle fistula after a low anterior resection for rectal cancer is a rare complication despite their anatomic proximity. From a Medline search from 1966 to date, a total of twenty-one previous cases of coloseminal vesicle fistula have been reported. From these cases, eleven were a complication of laparoscopic low anterior resection for rectal cancer. Description of the case This report presents the case of a 63-year-old patient who was readmitted to the hospital on the fifteenth postoperative day after his surgical intervention for fever, abdominal pain, dysuria and pneumaturia. A sinography with water-soluble contrast revealed a tract between the rectum and the seminal vesicle. The condition was treated conservatively with antibiotics, urinary catheter and a transanastomotic Malecot probe for abscess drainage. The fistula had completely recovered on postoperative day 71 and the patient is still symptoms free, six months after the complication developed. Discussion This case reinforces the presumed link between anastomotic leakage and rectoseminal vesicle fistula in cases of low anterior resection while reviewing and summarizing similar previously reported cases on the course of the disease, diagnostic procedures and treatment options. Conclusion Seminal vesicle are susceptible to fistula in oncological resection of rectum. Both CT scan with water-soluble contrast or sinography are effective diagnostic examinations. Depending on the characteristics of the fistula, conservative approach may be adequate and benefits much less morbidities than the surgical options.

Highlights • Entero-vesical fistulas (EVFs) represent an uncommon complication of Crohn’s disease. • EVFs affects mostly men patients. • Conservative treatment improves symptoms but is associated with low rate of healing. • Surgical approach is usually necessary, establishing long-term remission., Background Entero-vesical fistula (EVF) is an abnormal link between the enteric lumen and the urinary bladder. Crohn's disease (CD) represents, nowadays, the most common cause in the formation of this fistula. Materials and methods The aim of this study was to describe the diagnostic and treating modalities applied in nine patients with CD and EVFs, the clinical/epidemiological features of this clinical entity and to perform a systemic review of the literature, concerning the diagnosis and treatment of this complication. Results The medical records of eight men and one woman (mean age 42 ± 12 years) with EVFs were analyzed. The terminal ileum and the ileocecal region were affected in three and six cases, respectively. The most common symptoms were pneumaturia, fecaluria, fever, urinary urgency and abdominal pain. The diagnosis was suspected by abdominal CT scan and by indirect findings of bladder infection in cystoscopy. MRI with concurrent cystography set the diagnosis in three patients. Colonoscopy was not helpful. Conservative treatment, including administration of antibiotics and immunosuppressive agents in all patients and anti-TNF-a agent (infliximab) in six patients, was ineffective. Surgical treatment was applied in seven cases (77.8%), including fistula repair in all patients, drainage of coexistent intraabdominal abscess in two, small bowel resection in four and ileocecectomy in two cases. Conclusion EFVs are uncommon but potentially dangerous complications of CD. Abdominal CT scan and cystoscopy are the most commonly used diagnostic modalities. Surgical treatment seems to be unavoidable in most cases, although medical treatment could also benefit a small cohort of patients.

We report the case of a 60-year-old man with pneumaturia due to gas production by Klebsiella pneumoniae in the bladder. Diabetes mellitus is a major risk factor, and K. pneumoniae produces carbon dioxide by fermenting glucose under anaerobic conditions. Antibiotic therapy successfully improved cystitis and pneumaturia. However, in the presence of urinary tract obstruction and/or emphysematous upper urinary tract infections, other interventions may be needed.

A case of a 79-year-old woman who developed emphysematous cystitis (EC) prior to scheduled lower back surgery, suffering from severe back pain was presented. She had neither of the known EC risk factors (diabetes mellitus, immunodeficiency, neurogenic bladder and recurrent urinary tract infections) and presented herself without classical signs of EC (dysuria, haematuria, abdominal pain, pollakiuria, pneumaturia). She had a persistent back pain that was masked by her chronic back condition, leukocytosis and increased C-reactive protein (CRP) concentrations. The abdominal ultrasound showed a suspiciously impeded, cloudy vision in the lower pelvis and a blurry, thickened presentation of the wall of the urinary bladder with high echogenicity. A CT scan of the abdomen was performed and confirmed the diagnosis of an emphysematous cystitis, as well as a secondary pyelonephritis Escherichia coli was isolated from urine and blood and successfully treated with ciprofloxacin. Contrast-enhanced CT imaging is the diagnostic method of choice.

Purpose: Prostatourethrorectal fistula (PURF) is an uncommon complication resulting from surgery, radiation or trauma (1). The most common therapeutic management is transperineal surgery (1). Transabdominal approach is less used and limited to large fistulae needing cystectomy and rectal resection (1). The aim of this study was to show an original robotic technique of conservative treatment for PURF. Materials and Methods: A 75 years old man referred recurrent UTI, pneumaturia and urinary loss from rectum due to PURF arising after TURP performed after transvesical prostate adenomectomy. Cystogram, cystoscopy and MRI confirmed PURF. We used a robotic approach performing isolation, resection and suture of the fistulous tract on rectal and urethral side. Leak test was negative. We carried out an omental flap, positioned between rectum and prostatic urethra, and a temporary ileostomy without any bowel resection or urinary diversion. Results: Operative time was 210 minutes, estimated blood loss 50ml. Oral feeding was restored at 48 hours. Bladder catheter was removed on the 15th post-operative day. Post-operative cystogram was negative. Post-operative complications were ileus and urinary tract infection. Hospital stay was 10 days. At 6 months follow-up, before temporary ileostomy closure, cystoscopy showed a totally re-epithelised fovea, and cystogram and CT enterography were negative. Conclusions: Robotic conservative treatment of PURF seems to be safe and feasible (2, 3). Robotic approach allows accurate surgical dissection, through easier access to the rectal-prostatic plane, reducing the need for resection. To our knowledge, this is the first robotic conservative treatment for PURF reproducing the same steps of laparotomic approach with the advantages of minimally invasive technique (4).

The development of novel mechanical endoscopic closure systems allows now the management of some gastrointestinal fistula types in a minimally invasive way. However, the correct location of the fistulous tract is essential to achieve successful endoscopic closure. A 69-year-old woman with high risk for surgery presented with recurrent cystitis, pneumaturia, and enteruria 2 months after medical-treated diverticulitis. Computerized tomography demonstrated colovesical fistula but colonoscopy could not locate the fistulous opening. A cystoscopy was performed and the fistulous tract was shown using a guidewire. Then, a novel over-the-scope clip device Padlock® system was released in the sigmoid colon, with successful endoscopic closure through this not previously described collaborative approach between urologists, surgeons, and gastroenterologists.

Introduction Colovesical fistulas (CVFs) occur as a complication of diverticulitis, cancer, or Crohn’s disease. The sigmoid colon is the most frequently involved segment. The most common presenting symptoms are pneumaturia and dysuria, followed by faecaluria, abdominal pain and, rarely, haematuria. The diagnosis is usually made clinically but can be confirmed by cystoscopy, sigmoidoscopy, barium enema, CT scan, MRI, or virtual colonoscopy. The usual management for symptomatic patients is colonic resection (which can be performed laparoscopically) but this approach is associated with morbidity and mortality. Only a few cases of endoscopic management by clip closure, using through-the-scope (TTS) or over-the-scope (OTS) clips have been described in the literature. Here, we present a case of a CVF, which was managed with multiple TTS clips, thus avoiding surgical intervention. Methods A frail 84 year old man had a background history of coronary artery bypass graft, aortic valve replacement (tissue valve), dialysis dependent chronic renal failure and sigmoid diverticular disease. He was investigated for pneumaturia and recurrent urinary tract infections 12 months ago and was diagnosed on CT scan as having CVF secondary to sigmoid diverticular disease. He developed faecaluria, He was referred by the colorectal surgeon for endotherapy as he was considered too frail for any surgical intervention. A combined simultaneous cystoscopy and flexible sigmoidoscopy (using a gastroscope) was undertaken under conscious sedation. The cystoscopy identified a fistula in the dome of the bladder (on left side). The sigmoid colon was carefully examined and revealed diverticular disease but no obvious fistula was visible. Hence, indigocarmine solution (16 mg/litre), warmed to body temperature, was instilled into the bladder via the cystoscope and the blue solution was eventually seen to emerge in the sigmoid colon through the fistula. This site was marked with a Resolution 360 clip (Boston Scientific). After this, 4 further clips were placed onto the fistula in order to close it. Finally, the site was marked with a tattoo, in case a repeat procedure was needed in the future. Results The procedure took almost two hours and was successfully performed. The patient was discharged on the same day. Conclusion Although there are many surgical options available for management of CVF, only a few case reports exist regarding non-surgical management of CVF. We recommend that combined endoscopic management of CVF should be considered in patients who are too frail for surgery or have multiple co-morbidities.

Background: Enterovesical fistula is an abnormal communication between the bladder and the gastrointestinal tract. It is an uncommon type of genital fistula, occasionally complicating pelvic surgeries. However, it is the most common type of fistula associated with diverticular disease of the colon. Other causes include cancer, trauma and iatrogenic injuries. Pneumaturia and fecaluria usually implies enterovesical fistula. Enterovesical fistula complicating myomectomy is an uncommon finding. Our aim is to report a case of enterovesical fistula following myomectomy. Case presentation: She is a 33-year-old nullipara who presented at the National Obstetric Fistula Centre, Abakaliki, Ebonyi State, South-Eastern Nigeria with a history of fecaluria, pneumaturia and haematochezia which started after myomectomy. Feculent fluid was obtained on urethral catheterization. Cystography was suggestive of enterovesical fistula. Conclusion: Enterovesical fistula is a possible complication of myomectomy. A high index of suspicion for this rare but potentially devastating condition is important for early diagnosis and appropriate management.

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., 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.

We evaluated a 27-year old male with pneumaturia and fecaluria with a past history of right inguinal hernia repair. Though, cystoscopy and contrast enhanced computed tomography did not furnish any evidence to arrive at a diagnosis, interestingly, colonoscopy revealed a mesh in the sigmoid colon making apparent the diagnosis of colovesical fistula secondary to mesh migration. Later, surgical removal of the mesh from the sigmoid colon with rent closure of the fistulous opening was done successfully. Our case thus, highlights the vital role of common diagnostic tool like colonoscopy in making an uncommon diagnosis. Resumo: Avaliamos um homem de 27 anos com pneumaturia e fecalúria com antecedentes de reparo da hérnia inguinal direita. Embora a cistoscopia e a tomografia computadorizada com contraste (TCC) não tenham fornecido nenhuma evidência para obter-se um diagnóstico, curiosamente, a colonoscopia revelou uma malha no cólon sigmoide, estabelecendo o diagnóstico de fístula colovesical (FCV) secundária à migração da malha. Mais tarde, foi feita a remoção cirúrgica da malha do cólon sigmoide com fechamento da abertura fistulosa com sucesso. Nosso caso, portanto, destaca o papel vital de uma ferramenta diagnóstica comum, como a colonoscopia, para obter-se um diagnóstico incomum. Keywords: Colovesical fistula, Inguinal hernia repair, Mesh migration, Poliomyelitis, Palavras-chave: Fístula colovesical, Reparo de hérnia inguinal, Migração de rede, Poliomielite

Appendicovesical fistula is a rare type of enterovesical and a very rare complication of acute appendicitis. Herein, we report a case of a 22-year-old man who presented with cloudy urine and pneumaturia with a prior history of acute appendicitis. Imaging techniques including ultrasonography, CT and cystoscopy were performed to diagnose the abnormality. Diagnosis of this fistula is challenging and relies on detailed history and radiological imaging.

N/A

Background Bevacizumab is an anti-angiogenesis agent used to treat patients with metastatic colorectal cancer and is associated with a variety of complications. We present a patient with rectal cancer who developed a delayed anastomotic leak more than 5 years after undergoing low anterior resection. Case report A 78-year-old man with hematochezia was diagnosed with two synchronous rectal cancers 7 years prior to presentation. Preoperative chemo-radiotherapy was given followed by a very low anterior resection. During follow-up, multiple lymph node metastases developed, which were treated with chemotherapy. First-line chemotherapy, capecitabine, oxizaliplatin, and bevacizumab, was given over 3 years, and second-line chemotherapy, capecitabine, irinotecan, and bevacizumab, was administered over a 3-month period. After the last treatment, the patient presented with pneumaturia and fecaluria. Computed tomography scan revealed extraluminal air between the prostate and rectum, adjacent to the anastomotic site. Ulceration and fistula formation were observed on colonoscopy, and contrast radiography demonstrated a fistula at the anastomotic site. An anastomotic-urethral fistula was diagnosed and transverse colostomy was performed. Conclusions This patient highlights a rare late adverse event at the anastomotic site associated with bevacizumab treatment and preoperative chemo-radiotherapy. Signs and symptoms suggesting anastomotic complications should be thoroughly evaluated during bevacizumab treatment, even long after surgical resection.

Emphysematous pyelonephritis (EPN) is a rare form of pyelonephritis causing a severe infection of the renal system that includes gas in the renal parenchyma, collecting system and surrounding tissue often presenting with sepsis. We report the case of a 60-year-old male with poorly controlled insulin dependent diabetes mellitus who presented with abdominal pain, nausea, vomiting, and “peeing air.” CT scan revealed air extending from the left renal parenchyma, perinephric fat and into the bladder, consistent with emphysematous pyelonephritis. Bedside point-of-care ultrasound (POCUS) subsequently revealed dirty shadowing and reverberation artifacts in the left kidney and the bladder consistent with gas in the urinary collecting system. By understanding the identifying artifacts seen with EPN, reflective shadow and reverberation artifact, the emergency physician may be alerted to the diagnosis sooner. Often this illness presents similarly to simple, acute pyelonephritis or undifferentiated sepsis. Therefore, POCUS allows for real time consideration of this condition while in the emergency department and thus prompter time to treatment.

An 82-year-old male with benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP) presented to the hospital with suprapubic pain, abdominal distension, and diarrhea. The physical examination was remarkable for an indwelling Foley’s catheter. Diagnostic imaging confirmed the diagnosis of a rectourethral fistula (RUF). The most common presenting symptoms of RUF are pneumaturia, fecaluria, and urine leakage from the rectum, which may present similarly to diarrhea. He lacked the common features of RUF such as pneumaturia and fecaluria, which may be explained by a blockage of the catheter with fecal material. This case represents a rare outcome following a TURP, and it is significant due to the high morbidity associated with RUF. As such, clinicians must suspect a RUF in a post-TURP patient with diarrhea and no other obvious etiology due to the morbidity associated with RUF.

Colovesical fistula is an atypical communication between the colon and the bladder. The most common causes of colovesical fistula are diverticulitis, inflammatory bowel disease, lymphoma and complication from radiation therapy. Patients with colovesical fistula present with recurrent urinary tract infections (UTI), dysuria, frequency, abdominal pain, pneumaturia, faecaluria, and hematuria. We present a case of a patient with stage IV lung adenocarcinoma presented with abdominal pain, dysuria, and faecaluria who was found to have a colovesical fistula. Although colovesical fistula may be sequelae of advanced colon or bladder cancer, it is a very uncommon presentation of metastatic cancer from distant sites. Our case is the first to show that colovesical fistula may present from metastatic lung adenocarcinoma. Clinical awareness of this very unusual presentation of metastatic cancer can lead to faster diagnosis and treatment, possibly minimizing excessive use of antibiotics.

Background Diverticular disease of sigmoid colon can rarely be complicated by a connective track to urinary bladder. Pneumaturia and fecaluria are the pathognomonic symptoms. Resection surgery is the preferred treatment to overcome the renal sequellae of the disease. The purpose of this study is to propose a guiding classification to help general surgeons during surgical management of diverticular disease complicated by sigmoidovesical fistula (SVF). Patients and methods The data of 40 cases with colovesical fistula due to diverticular disease of sigmoid colon were retrospectively analyzed. Clinicopathological variables, imaging reports, types of treatment and patient outcome were evaluated. Results There were 36 men (90%) and four women (10%) in which the ages ranged from 32 to 79 with a mean of 58.1 years. Pneumaturia was the most common presenting symptom in 38 cases (95%) followed by urinary symptoms in 35 cases (87.5%) then fecaluria in 33 cases (82.5%). 37 patients underwent surgical resection while three patients were in poor general condition to withstand major resection. 16 patients underwent one stage resection and anastomosis, 16 patients were managed by two stage procedure and the remaining 5 patients were treated by three stages operation. Conclusions Adequately performed CT followed by colonoscopy is the mainstay for diagnosis. Type 1 SVF should be treated in a single stage by complete resection and immediate anastomosis without a stoma. Type 2 cases are best managed in two stages while those with type 3 SVF are emergently managed by three stage procedure. Treatment of type 4 should be individualized.

Rectourethral fistulais a relatively rare complication of radical prostatectomy but is extremely difficult to treat. We report a case with post-laparoscopic radical prostatectomy rectourethral fistula, treated with only endoscopic shielding.A 75-year-old man had undergone laparoscopic radical prostatectomy for prostate cancer, cT2cN0M0. Although there was no finding of rectal injury during the operation, pneumaturia, pyuria and diarrhea appeared at postoperative day 21 and diagnosed rectourethral fistula by colonoscopy and amidotrizoic acid enema. The fistula did not close spontaneously. Four months after the prostatectomy, we treated with endoscopic shielding by use of polyglycolic acid sheets and fibrin glue. The fistula have not recurred for 20 months after the endoscopic procedure.This method is simple and less-invasive for patients. We think it is worth trying this method before surgical management for narrow rectourethral fistula following radical prostatectomy.

ResumenIntroducciónLa enfermedad diverticular del colon es común en occidente. Posterior al primer episodio de diverticulitis, muchos pacientes se beneficiarán con terapia médica, pero de un 10 a un 20% de los casos desarrollarán abscesos, obstrucción, fístula.ObjetivoDescribir el tratamiento laparoscópico de las fístulas sigmoidovesicales secundarias a enfermedad diverticular.Material y métodosEstudio retrospectivo observacional de 10 pacientes consecutivos de 2011 a 2015 los cuales fueron sometidos a: 1) resección de fístula colovesical y cierre primario de vejiga y sigmoides o 2) sigmoidectomía laparoscópica técnica NOSE (extracción transanal del espécimen y anastomosis colorrectal, con cierre primario de vejiga).ResultadosSe operaron en total 10 pacientes en un periodo de tiempo de febrero de 2011 a febrero de 2015. Edad promedio 60.7(49-71)años. Se realizó sigmoidectomía con anastomosis primaria a 4 pacientes, resección y cierre primario a 6 pacientes, tiempo quirúrgico 140.4(80-210) minutos, sangrado 195(80-210) ml, tiempo para iniciar la vía oral 4.3 días (3–5) días. A todos los pacientes se les dejó el drenaje 10 días y la sonda transuretral dos semanas. Hasta ahora ninguno ha presentado recidiva de las fístulas o datos compatibles con estenosis de anastomosis intestinal.ConclusionesExisten reportes sobre el uso de la laparoscopia para el tratamiento de fístulas colovesicales demostrando resultados aceptables. Pocos son los estudios que se enfocan exclusivamente en fístulas colovesicales, generalmente los reportes incluyen fístulas de otros tipos también (colovaginales y colocutáneas). Las fístulas colovesicales son una patología que puede ser resuelta vía laparoscópica de manera eficaz segura.AbstractBackgroundDiverticular disease of the colon is common in the western world. After the first episode of diverticulitis, many patients benefit from medical therapy, but 10-20% develop abscesses, obstruction, or fistula.AimTo describe the laparoscopic treatment of sigmoidovesical fistula secondary to diverticular disease.Material and methodsAn observational, retrospective study was conducted on 10 consecutive patients within the time frame of 2011-2015 that had undergone: 1) colovesical fistula resection and primary closure of the bladder and sigmoid colon or 2) laparoscopic sigmoidectomy with the NOSE technique (transanal extraction of the specimen and colorectal anastomosis with primary closure of the bladder).ResultsTen patients were operated on within the time frame of February 2011 and February 2015. The mean age of the patients was 60.7(49-71) years. Sigmoidectomy with primary anastomosis was performed on 4 patients and resection and primary closure on 6 patients. Surgery duration was 140.4 (80-210) min, blood loss was 195 (80-210) ml, and length of time before beginning oral diet was 4.3 (3–5) days. The drain was left in place in all the patients for 10 days and the transurethral catheter for 2 weeks. Up to the present time, none of the patients has presented with fistula recurrence or data consistent with intestinal anastomosis stricture.ConclusionsReports on the use of laparoscopy for the treatment of colovesical fistulas have demonstrated acceptable results. Only a few studies concentrate exclusively on colovesical fistula; in general the reports include other types of fistula (colovaginal and colocutaneous), as well. Colovesical fistula is a pathology that can be resolved safely and efficaciously through laparoscopy.

Colorectal cancer is the third most common cancer in the United States. The use of bevacizumab (Avastin), a vascular endothelial growth factor (VEGF) inhibitor, has been increasing due to observed improvement in metastatic colon cancer survival, but so has the incidence of bowel perforation. We present one unusual complication of bowel perforation, a colovesical fistula in a colorectal cancer patient treated with bevacizumab.A 54-year-old white male diagnosed with Stage IV colorectal cancer was treated with folinic acid, leucovorin, fluorouracil, oxaliplatin (FOLFOX) and bevacizumab. Two months later, he developed pneumaturia and fecaluria. CT showed a rectosigmoid colovesical fistula. A laparoscopic diverting colostomy was created to overcome the proximal retention of feces and the fecaluria.Colovesical fistulas more commonly result from diverticulitis, cancer, or Crohn's, but rarely can arise from radiation or chemotherapy. Our patient had two risk factors, colorectal carcinoma and bevacizumab use. Although colon cancer itself can cause a colovesical fistula, at the time of diagnosis, our patient had an intact fat pad between the colon and bladder on CT and did not have symptoms consistent with a fistula, suggesting that bevacizumab was the culprit. The exact mechanism of action leading to bowel perforation is not completely understood. Three theories include first, the idea that bevacizumab increases the risk of thrombosis, second, that tumor destruction creates an area of weakness more prone to perforation, or third, it slows down wound healing, causing leakage at the anastomotic site following surgery.Hospitalists encounter patients with colorectal cancer on a regular basis, so clinicians must be aware of the uncommon but potentially serious side effect of bowel perforation when bevacizumab is used. This case has illustrated an even more rare complication, the formation of a colovesical fistula that was treated with laparoscopic surgical intervention with a diverting colostomy.

Healthy persons excrete urine that is largely free of proteins. The analysis of urine for the presence of proteins is important for the diagnosis of renal, cardiac, and thyroid-related diseases. Several physiological and pathophysiological mechanisms cause the urinary excretion of proteins. The normal protein excretion in urine is about 30–150 mg/day. About one third of the total urinary protein is albumin, and the remaining includes many small globulins. The presence of excess proteins in urine often causes the urine to become foamy, but other conditions like presence of bilirubin in the urine (bilirubinuria), pneumaturia (air bubbles in the urine), or drugs may also make urine foamy. The presence of increased amounts of proteins in the urine may indicate a serious disease problem or may appear before any other clinical symptoms.

Background Anastomotic leakage (AL) is one of the most dreadful postoperative complications because it can result in increased morbidity and mortality as well as poorer long-term prognosis. Although most studies of AL limited their investigation time to a period of 30 days postoperatively, only a few studies have shown that AL can occur after that period. Here, we report four patients of rectal cancer with delayed AL following laparoscopic intersphincteric resection (ISR) and conduct a literature review on delayed AL. Case presentation Case 1 was a 67-year-old male who underwent laparoscopic partial ISR in July 2009. Although the patient was asymptomatic, an anastomotic-urethral fistula was observed 57 months after ISR. Case 2 was a 44-year-old female who underwent laparoscopic partial ISR in July 2008. She presented with discharge of gas and feces from her vagina, and an anastomotic-vaginal fistula was observed 14 months after ISR. Case 3 was a 74-year-old man who underwent laparoscopic partial ISR in August 2007. He presented with pneumaturia and fecaluria, and an anastomotic-urethral fistula was observed 4 months after ISR. Case 4 was a 68-year-old woman who underwent laparoscopic subtotal ISR for rectal cancer in February 2013 and partial hepatic resection for liver metastases in March 2013. She presented with anal pain and purulent perineal discharge, and an anastomotic-perineal fistula was observed 9 months after ISR. All four cases presented with fistula formation and required reoperation (establishment of a diverting ileostomy). Conclusions Since delayed AL is not a rare postoperative complication, surgeons need to provide long-term follow-up and remain alert to the possible development of delayed AL.

Introduction: Emphysematous cystitis (EC) is a rare type of urinary tract infection characterized by the presence of gas in the bladder lumen. It is usually encountered in older women with uncontrolled diabetes mellitus (DM). Patients usually present with dysuria, hematuria, suprapubic pain, and less frequently, with pneumaturia. For definitive diagnosis, pathological examination is required but in most cases, computed tomography (CT) is adequate. With appropriate antibiotherapy and drainage; EC can be managed.Case Report: A 78-year-old woman who presented presented with hematuria was diagnosed with EC via CT scan. The patient was treated with antibiotherapy and placement of urethral Foley catheter.Conclusion: In the diagnosis and treatment of urinary tract infection in elderly women with uncontrolled DM, EC should be kept in mind because of its complications, and for suspicious cases, CT should be performed

Highlights • Colovesical fistula was occered in the extremely rare condition: partial situs inversus with persistent descending mesocolon (PDM). • Distinctive features of PDM were shortening adhesions noted at the dorsal aspect of the descending and sigmoid mesocolon without marginal vessel. • In this case, these congenital abnormalities might help the suture failure during the operation of sigmoid colectomy., Introduction Situs inversus viscerum, a congenital condition in which the visceral organs are a mirror image of their normal physiological positions, could be total or partial. Persistent descending mesocolon (PDM) is a congenital anomaly that is asymptomatic because of its short length. PDM causing intestinal obstruction is a known clinical complication. Presentation of case A 74-year-old woman presented with pneumaturia and enteruria for two months, and recurrent cystitis for a month. An enhanced computed tomography (CT) showed air in the bladder along with sigmoid colonic diverticula adherent to it, suspecting a fistula. The CT also showed partial situs inversus with the common hepatic artery, and left colic artery arising abnormally from the superior mesenteric artery (SMA). Minimally invasive endoscopic closure using the over-the-scope clipping system was difficult because of thickening and scar tissue due to chronic inflammation from diverticulitis. Thus, a sigmoidectomy was performed to close the fistula. Intraoperatively, we noted an abnormally fixed descending mesocolon. An emergency reoperation was performed on the sixth postoperative day owing to an anastomotic leak. Suture failure was attributed to these congenital abnormalities due to insufficient blood flow from an absent marginal vessel and a high endocolonic pressure by adhesions. Sigmoid colon re-resection and maturation of an ileostomy was performed. The patient had no specific postoperative complications, and the ileostomy was closed after three months. Conclusion We report an extremely rare case of colovesical fistula due to a PDM in a patient having partial situs inversus with abnormal branches originating from the SMA.

Fistulae forming between the alimentary tract and kidney after trauma are an anomaly. In contrast to general vesico-alimentary communication, a colonephric fistula almost invariably results secondary to an initial pathological process in the kidney. A primary infectious cause has by far been the most common renal pathology implicated in its formation. The diagnosis of this condition is suggested by pneumaturia but almost entirely based on radiological examination. Even though conservative strategies have been attempted, surgical resection is the treatment of choice and should be pursued if all else fails. We report a case of a subacute presentation of a colonephric fistula following blunt trauma with a documented injury to the kidney associated with a possible concomitant injury to the large bowel. However, the inciting event could also have been a primary occult colon injury overlying the renal injury, eventually culminating in a fistula between the two organs resulting in pneumaturia and signs of sepsis. A review of the literature on colonephric fistulae and their appropriate management strategies are reported and briefly discussed. It is important to be familiar with its clinical symptoms so that the diagnosis can be suspected, and adequate investigative and therapeutic approaches can be implemented.

The presence of air in different parts of renal excretory system needs accurate assessment, and careful consideration as its progression to renal parenchyma can lead to fulminant course with substantial mortality. Bilateral emphysematous pyelonephritis is a well-known entity, but bilateral emphysematous pyelitis (EP) along with emphysematous cystitis is extremely rare. An internet search with the term “bilateral emphysematous pyelitis” and “bilateral emphysematous pyelitis and ureteritis with cystitis” only found three case reports in English. We present an interesting case of bilateral EP, ureteritis, and cystitis in a nondiabetic male patient without any history of immunodeficiency (HIV or chronic steroid use) but with a history of nonobstructing bilateral multiple renal calculi who was successfully managed medically. EP, if diagnosed early and managed properly, has an excellent prognosis with complete recovery following medical treatment. The following core competencies are addressed in this article: Practice-Based Learning and Improvement, Patient care and Procedural skills, Medical Knowledge.

A 3-year-old Ugandan boy presented with 18 months of constipation and 12 months of pneumaturia and fecaluria. Physical exam revealed abdominal distension and a palpable mass anterior to the rectum. Previous contrast enema had been non-diagnostic, and a voiding cystourethrogram (VCUG) had confirmed a recto-urethral fistula. After surgical evaluation, a computed tomography (CT) scan suggested colonic duplication, and a laparotomy was performed for rapidly progressive bowel obstruction. A tubular colonic duplication with fecal impaction was found, necessitating fecal disimpaction and a double divided colostomy. Two months later at re-laparotomy, the septum between the duplicated colonic lumens was found to extend proximally to the mid transverse colon and distally to the upper rectum, and was divided. No urethral fistula was identified, and the colostomy was recreated. At a third operation, the colostomy was reversed. The patient is well at one-year follow up, without evidence of recurrent fistula or stricture. This case shows that colonic duplication in children can be an elusive diagnosis. Often, a variety of radiographic studies may be needed and may be difficult to interpret. In cases with colo-urinary fistula, the fistula may respond to fecal diversion without requiring operative repair. Management in a resource-limited setting can still yield positive outcome.

Fistula formation is a complication of diverticulitis in 4% to 20% of cases. The left or sigmoid colon is the most commonly involved segment. The most common presenting symptom is pneumaturia and dysuria, followed by fecaluria, abdominal pain and, rarely, hematuria. Some colovesical fistulas (CVFs) are asymptomatic. CVF is more common in males and in females with a history of hysterectomy. The diagnosis is usually made clinically but can be confirmed by cystoscopy, sigmoidoscopy, barium enema, computed tomography (CT) scan, magnetic resonance imaging (MRI), or virtual colonoscopy. The usual management for symptomatic patients is colon resection, and there is still controversy in the approach to asymptomatic patients. Left colectomy for CVF secondary to diverticular disease can be very challenging owing to the presence of acute and chronic inflammation, which makes the tissues harder and more prone to bleeding. It is also more difficult to visualize and find proper anatomic planes and to identify vital structures. Conversion rates of laparoscopic sigmoidectomy complicated with diverticulitis are double that for cancer and as high as 30%. In general, a colectomy for diverticulitis is considered a more difficult operation than a colectomy for cancer, whether or not a laparoscopic or open approach is chosen. Some authors have proposed laparoscopic surgery as the gold standard approach for diverticular disease and CVF management. The safety of robotic surgery for colorectal diseases has been previously addressed in other studies. The

Introduction Colovesical fistulae (CVF) are the relatively uncommon presentation in colorectal surgical practice. However, the rarity of the disease gives rise to problems in diagnosis and treatment as adequately powered data is lacking in published literature. Furthermore, the aetiology of CVF in Asia differs from the West which plays an important role in patient management. Methods The records of all the patients with CVF managed in the Gastrointestinal and Urological surgical units of a tertiary care centre over a nine-year period were collected and analysed. Follow-up data have been collected prospectively to assess the outcome. Results A total of 11 patients (M: F=9:2) with a median age of 59 years were studied. Faecaluria, pneumaturia and recurrent urinary tract infections were the commonest presenting symptoms. The diagnosis was based on clinical evaluation. Cystoscopy, colonoscopy and CECT were utilized to identify the underlying pathology, complications and for staging. Commonest benign pathology was diverticular disease (n=7), followed by tuberculosis (n=1). Adenocarcinoma of the sigmoid colon and squamous cell Carcinoma of the bladder were reported in three patients. Majority of patients (n=9) were managed successfully by open-left colonic resection with or without temporary ileostomy and bladder repair, while inoperable patients were managed with a stoma. Conclusion CVF is a relatively uncommon condition in our setup and mostly related to isolated diverticular disease of the sigmoid colon. Diagnosis of CVF can be made with accuracy by proper clinical assessment. Cystoscopy and LGIE are essential components of the diagnostic workup of a patient with suspected CVF. During surgery, segmental resection of the colon is favoured than local repair.

Appendicovesical fistula (AVF) is an uncommon type of enterovesical fistula and a very rare complication of acute appendicitis. Herein, we report a case of 39-year-old male patient who presented with persistent urinary tract infection, recurrent abdominal pain, and pneumaturia. Imaging techniques including ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) were performed to identify the abnormality. However, definitive diagnosis of AVF was made by cystoscopy.

We report a case of a patient with seminal vesicle-rectal fistula, an extremely rare complication of low anterior resection of the rectum. A 53-year-old man with rectal adenocarcinoma underwent low anterior resection in our hospital. The patient experienced diarrhea, pneumaturia, and low-grade fever on postoperative day 13. A computed tomography scan showed emphysema in the right seminal vesicle. We concluded that anastomotic leakage induced a seminal vesicle-rectal fistula. The patient underwent conservative therapy with total parenteral nutrition and oral intake of metronidazole. Diarrhea and pneumaturia rapidly improved after metronidazole administration and the patient was successfully cured without invasive therapy such as colostomy or surgical drainage. A seminal vesicle-rectal fistula is a rare complication of low anterior resection, and therapeutic strategies for this condition remain elusive. Our report provides valuable information on the successful conservative treatment of a secondary seminal vesicle-rectal fistula that developed after low anterior resection of the rectum in a patient.

A 25-year-old man was referred to the urology department after a subacute history of left back pain, burning micturition associated with pneumaturia and fecaluria. Ultrasonography was performed showing hydronephrosis, and plain film radiography demonstrated a long vertical left pelvic calculi. Uro-computed tomography (CT) combined with a water enema CT showed a 10 cm long calculus with the cranial extremity fistulating the sigmoidal wall. Surgical treatment included left nephroureterectomy and sigmoidectomy with a colorectal anastomosis. Postoperative course was uneventful.

Colovesical fistulae are uncommon complications of complex pelvic surgery, colonic diverticular disease or malignancy [1, 2]. The clinical presentation usually is storage lower urinary tract symptoms and pneumaturia. Evaluation includes CT cystography, cystoscopy and colonoscopy. Management is disconnection of fistula and treating underlying cause by open surgery or laparoscopy.