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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., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Vescicouterine fistula (VUF) is a rare lesion accounting for only 4% of all urogenital fistulas. It is most often secondary to cesarean section and forms a connection between the bladder and the uterus. We report the case of a young patient with VUF secondary to cesarean section. This study aims to investigate the clinical and therapeutic features of this disorder., Competing Interests: Les auteurs ne déclarent aucuns conflits d'intérêts.

Preoperative fistulas are rare in patients with bladder mucosa-invading gynecological tumors. This is the first reported case of a vesico-vaginal fistula identified using 2-deoxy-2-[fluorine-18]fluoro-d-glucose positron emission tomography/computed tomography ( 18 F-FDG-PET/CT) in a patient with vaginal cancer. A 61-year-old woman with vaginal cancer underwent 18 F-FDG-PET/CT for assessment of the mass and lymph nodes. Assessment was difficult because overlap of FDG uptake occurred on 18 F-FDG-PET/CT images obtained 60min after FDG injection. However, dynamic 18 F-FDG-PET/CT clearly indicated the presence of a vaginal tumor-vesical fistula. This case illustrates the usefulness of dynamic 18 F-FDG-PET/CT imaging when assessing a vesico-vaginal fistula., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study is to compare anatomy pathological lesions seeing in urogenital fistula in Cocody Teaching Hospital between two decades, 1990 to 2000 and 2000 to 2010., Materiel and Method: This survey is retrospective and carries on 20 years (January 1990 to December 2011) 190 urogenital fistulas (140 cases between 1990 and 1999; 50 from 2000 to 2011) hospitalized in our unity. Anatomy clinical characteristics of these fistulas were determined by clinical or paraclinical examination., Results: Between 1990 and 1999, fistulas were classified in 20 bladder-uterine fistulas (14.29%), 16 uretro-vaginal fistulas (11.43%) and 104 bladder-vaginal fistulas (74.29%) of whom 80 isolated UGFs and 24 UGFs associated with recto-vaginal fistula. These 104 UGFs were located at: bladder neck 22 cases (21.15%), bladder trigonal 46 cases (44.23%), urethra 14 cases (13.46%). Twenty-two bladder sphincter were destroyed and represented 21.15% of fistula's bladder-vaginal fistula and 15.71% of all UGFs. The average fistula diameter was 3 cm [extremes: 1 and 12 cm]. In 22 cases (15.71%), fistula diameter was more than 10 cm. It was bladder neck and sphincter destruction. Hundred and twenty-six fistulas were isolated (90%). Only 10% (14 cases) were associated. Fistulas were primitive in 85.71% of cases (120/140), recurrent in 7 cases (7.86%) and multi-recurrent (>3 reinterventions) in 9 cases (6.43%). From 2001 to 2011, no bladder-uterine fistulas were seen, but: 6 (13.95%) isolated uretero-vaginal fistulas and 6 (13.95%) uretero-vaginal fistulas associated with bladder-vaginal fistula, 31 (62%) bladder-vaginal fistulas of whom 20 (64.52%) bladder trigonal fistulas, 6 (19.34%) retro-trigonal fistulas and 2 (6.45%) urethral fistulas. Only three (9,68%) recto-vaginal fistulas were associated. The average fistula diameter was 2 cm. The fistulas were isolated in 40 cases (80%) and associated (VVF+uretero vaginal F) in 10 cases (20%). Thirty-five cases (70%) were primitive and 10 cases (20%) recurrent of whom 5 (10%) many recurrent. Fistulas were classified in simple fistula in 7 cases (14%) and complex fistula in 43 cases (86%), Conclusion: UGF remained relatively frequent in Cocody Teaching Hospital, but the lesions have favorably evolved in the last decade. Simple type of fistula became more frequent than complex ones., Level of Evidence: 4., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Unlabelled: Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. It can cause complications in the form of ulceration, hemorrhage, intussusception, intestinal obstruction, perforation and, very rarely, vesicodiverticular fistulae as noted in six previously reported cases. 66-year-old woman was presented with an enterovesical fistula. Exploratory laparotomy revealed a vesico-diverticular fistula resulting from a perforated Meckel's diverticulum. Pathologic examination revealed that the diverticulum did not contain ectopic gastric or pancreatic tissue. The patient underwent a diverticulectomy and had an uneventful postoperative course. Unlike four of the six previously reported cases, our patient had no coexisting bowel or bladder disease occurring with her vesico-diverticular fistula., Conclusion: This is only the third reported case of a vesico-diverticular fistula resulting from a perforated Meckel's diverticulum that did not contain ectopic tissue.

Urinary fistulas and leakages of lower urinary tract are serious complications of various surgical procedures. Radiologists need to have enough information about these situations to perform precise diagnosis and treatment. Various techniques [such as intravenous pyelography, ultrasound, computed tomography (CT), CT urography, cystoscopy, cystography and magnetic resonance (MR) imaging] are used for the diagnosis of these conditions. Application of all these techniques reduces the comfort and cooperation of the patients and increases the cost. Here we present four postoperative patients with lower urinary tract fistula or leakage. To the best of our knowledge, there is no report regarding the use of contrast-material-enhanced MR urography (CE-MRU) in the demonstration of postoperative lower urinary tract fistulae and leakages. In conclusion, CE-MRU could show the existence and location of the urinary fistulae and leakages clearly without the need for another investigation technique, as described in our patients. Also, CE-MRU is a safe and relatively inexpensive technique that avoids exposure to radiation as well as nephrotoxic and more allergic contrast-material administration., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Appendicovesical (AVF) fistula is rare complication in the modern era. Only a few cases of AVF were described in the literature of the last decade. AVF is meanly associated with a history of appendicitis. The guiding symptoms are coprosuria and pneumaturia, with recurrent infection of the urinary tract. The accurate pre-operative diagnosis is difficult to make. It usually took at least one year from the onset of symptom to confirm diagnosis. It has been reported a few cases of 15 year history of undiagnosed AVF. We represent a case of EVF, spontaneously developed after treated acute appendicular colic presenting an unusual long - 15 years undiagnosed history, without presenting of typical symptoms. The analyses of disease history after cystoscopy lead to correct pre-operative diagnosis. AVF can develop as a complication not only after untreated appendicitis, but also after "successfully" treated with antibiotics appendicular colic may indicate the presence of an AVF and needs to assessing patient's history and applying cystoscopy and modern examination methods in complex diagnosis issues.

A 68-year-old male patient presented with mild tenderness in the suprasymphyseal region, hematuria and dysuria. In this case typical symptoms of a sigmoid-vesical fistula were initially absent. Because of hematuria and the findings provided by urethrocystoscopy, the radiological diagnosis was a bladder tumor. Contrast-enhanced computed tomography with rectal contrast administration provided the decisive information. In addition to sigmoid diverticulitis (fat stranding/centipede sign) in the urographic phase, contrast media was well traceable intraluminally from the bladder through the bladder wall abscess and subsequently in the sigmoid colon.

Objective: To compare the characteristics of urogenital fistulae after cesarean delivery with those after spontaneous vaginal delivery., Methods: A retrospective analysis of hospital records of 597 consecutive patients with a urogenital fistula who received treatment at Panzi Hospital, Bukavu, Democratic Republic of Congo, during 2005-2007., Results: Of 576 women with an obstetric fistula, 229 (40%) had had a cesarean delivery; 55 (24%) of the 229 fistulae were considered to be iatrogenic. The distribution of risk factors (age, stature, parity, and labor duration) was similar to that among 226 women with a spontaneous vaginal delivery, but the odds ratios for having a ureterovaginal or a vesicouterine fistula were 11.9 (95% confidence interval [CI] 2.8-51.2) and 9.5 (95% CI 2.8-31.9), respectively. Vesicovaginal fistulae with cervical involvement were also significantly more frequent in the cesarean delivery group. The fistulae in this group had less surrounding fibrosis and there was less treatment delay. Stillbirth rates were 87% (cesarean delivery) and 95% (spontaneous vaginal delivery)., Conclusion: The data indicate that cesarean delivery-related fistulae are a separate clinical entity. Focus on this condition is important for fistula prevention and provision of adequate obstetric care, particularly for training in surgery and alternative delivery methods., (Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

A 72-year-old female known to have diabetes, multiple medical problems, and bedridden with indwelling Foley's catheter. She presented with an ulcer which progressed to a Grade 4 pressure ulcer. She was known to have recurrent urinary tract infection. Contrast study through the fistula revealed a communicating fistula between the left buttock ulcer and the bladder. Conservative way of management was followed due to the overall health status of the patient. She was sent to home with daily dressings, mattress, and an occupational therapy plan. Fortunately, her fistula healed spontaneously after six months. To our knowledge, in addition to the unique presentation and outcome, the case we reported is the first with such communication.

We report a case of sigmoido-vesical fistula due to sigmoid diverticulitis. Magnetic resonance imaging enabled us to visualize the fistula itself in the bladder wall. Magnetic resonance imaging was highly effective in making a precise diagnosis and also provided important additional information for the preoperative work-up of the patient.

Purpose: The aim of this study was to perform a detailed histopathologic examination of the terminal colonic pouch and the colovesical fistula (CVF) excised during surgical management of male patients with the more severe forms (types I/II) of congenital pouch colon (CPC) associated with anorectal agenesis., Methods: From January 2005 to December 2006, 25 male patients with types I/II CPC underwent abdominal exploration with dissection of the terminal portion of the colonic pouch and associated CVF till the bladder, division-ligation of the fistula, and excision of the colonic pouch. In 6 of the 25 patients, a complete dissection of the fistula to the bladder was possible, and in them, the terminal portion of the colonic pouch and the CVF were subjected to detailed histopathologic examination. The 6 patients included 3 newborns in whom this surgery was performed as a primary procedure, and 3 patients aged 3 months, 15 months, and 2 years, respectively, in whom a window colostomy of the pouch had earlier been performed. After due processing, multiple sections from the specimens were stained using the routine H&E method and examined under the microscope under different magnifications., Results: In 4 specimens, the epithelial lining of the CVF consisted of transitional stratified epithelium with underlying anal/urethral glands. In 2 specimens, obtained from patients 15 months and 2 years old, respectively, the lining was of nonkeratinizing, stratified squamous epithelium. Other findings included aganglionosis in the muscle layers (n = 2), submucosal and subserosal fibrosis (n = 1), and thickening of muscle layers in the fistulous portion, suggestive of the presence of an internal sphincter (n = 2)., Conclusions: The CVF in patients with types I/II CPC shows histologic features of the normal anorectal canal.

Mantle cell lymphoma (MCL) has tropism for the gastrointestinal tract (GIT) identifiable as multiple polyps and mass lesions throughout the GIT. We describe 2 novel manifestations of MCL. A 60-year-old woman with known chronic lymphocytic leukemia (CLL) had an exophytic mass of the appendiceal orifice. Multiple polypoid masses of the distal ileum were identified in the right hemicolectomy specimen (multiple lymphomatous polyposis). Ancillary studies confirmed the coexistence of the 2 independent lymphoproliferative disorders. A 69-year-old man had recurrent urinary tract infections and pneumatouria caused by a colovesicular fistula complicating diverticulosis coli. Segmental resections of the sigmoid and ileocecum confirmed diverticulosis of the left and right colon. Histology identified infiltrates of MCL confined to the penetrating aspects of colonic diverticula. MCL has not been documented to coexist with CLL. An invaginating morphology of lymphoma, multiple lymphomatous diverticulosis is also a novel presentation. These 2 scenarios expand MCL's known manifestations within the GIT.

Objectives: To determine the clinical usefulness of magnetic resonance imaging (MRI) in the assessment of posterior urethral distraction defects., Methods: A total of 21 male patients, 6 to 35 years old, with posterior urethral distraction defects underwent MRI of the pelvis and combined antegrade retrograde urethrography before surgical repair. Repair was performed with a bulboprostatic urethral anastomosis through the perineum in 13 patients and transpubically in 8. The MRI and urethrographic findings were compared and correlated with the operative findings. The MRI findings were also correlated with the incidence of posttraumatic impotence., Results: On MRI, the length of urethral defect and type of prostatic displacement could be correctly determined in 86% and 89% of the patients, respectively. Also, MRI precisely delineated the extent of scar tissue, which varied according to the type and magnitude of the original trauma. Furthermore, MRI revealed the presence of paraurethral false tracks in 3 patients. In addition, MRI demonstrated avulsion of the corpus cavernosum, as well as lateral prostatic displacement in all 6 patients with posttraumatic impotence., Conclusions: Preoperative MRI can provide useful information that might help determine the appropriate surgical repair. It correctly estimates the length of the urethral defect, clearly demonstrates the type and degree of prostatic displacement, precisely delineates the site and density of scar tissue, and reveals the presence of paraurethral false tracks. Also, MRI can identify the cause of posttraumatic impotence such as avulsion of the corpus cavernosum and thus might predict the potency outcome in these cases.

A rare case of giant bladder calculus presenting with vesicocutaneous fistula is described. A 62-year-old woman presented with dysuria and ulcer of the hypogastric wall. Urine drained through the ulcer. Both X-ray and computed tomography (CT) of the abdomen showed a giant bladder calculus with vesicocutaneous fistula. We performed cystolithotomy followed by closure of the fistula. The calculus measured 95 x 60 x 55 mm and weighed 350 g. Worldwide, it is the second reported case of vesicocutaneous fistula caused by giant bladder calculus.

We present the case of a 41-year-old woman who presented with gross hematuria, urinary urgency and frequency, and intermittent abdominal pain after vaginal hysterectomy 2 years prior. The presence of an adnexal mass was suspected by pelvic examination and confirmed by transvaginal pelvic ultrasonography. Cystoscopy with biopsy was consistent with an inflammatory bladder polyp, which was initially discovered by pelvic ultrasonography and noted to be contiguous with the adnexal mass. The patient underwent exploratory laparotomy, lysis of adhesions, left salpingoophorectomy, and transvesical resection of the bladder mass. Histology was consistent with ovarian abscess and chronic sinus tract formation that was contiguous with an inflammatory bladder polyp.

The urachus is an embryonic remnant that connects the primitive bladder to the allantois. Multiple urachal anomalies have been described, including the urachal sinus, urachal cyst, patent urachus, and urachal diverticulum. We describe an unusual case in which a patient with urinary tract infection and dysuria was ultimately found to have urinary gallstones from a urachal connection with the gallbladder.

Urethral stones in men are rare clinical entity and most of them migrate from the urinary bladder. Urethral stones are rarely formed primarily in the urethra and are usually associated with urethral strictures or diverticula. We report a 41-year-old man with giant prostatic urethral stone (5.9x3.2x2.8 cm) associated with a urethrocutaneous fistula. The etiological factors, pathogenesis, clinical presentation, complications and management of giant urethral calculi are reviewed.

Vesico-sigmoid fistula is a rare complication of colic diverticular disease. It develops when the bladder sticks to an inflammatory colon making of a communication between the bladder and the digestive segment, usually the sigmoid. Liquid usually passes from the colon to the bladder because of the existing pressure gradient. Hence, urinary symptoms are the most frequent. Surgery is the treatment of choice. The present case is about a 72-year-old man who had a total hematuria for 3 months. The diagnosis of a vesico-sigmoid fistula secondary to colic diverticulitis was established by cystoscopy, colonoscopy and cystography. Surgery was underlaken and the postoperative outcome was excellent. Through this case the clinical features, special investigations and treatment of vesico-sigmoid fistula, are reported.

We report a rare complication of cesarean section in a 46-year-old woman presenting with incontinence. The patient was noted at cystoscopy to have a lesion on the posterior wall of the bladder. Histologic examination of the biopsied lesion demonstrated endocervical tissue, and subsequent magnetic resonance imaging revealed a vesicocervical fistula. She was treated by open excision of the fistula and repair of the bladder and cervix with omental interposition. Only 16 cases of vesicocervical fistulas have been previously reported, and this is the first to demonstrate the finding on magnetic resonance imaging.

A rare case of vesicocervical fistula following repair of a vesicovaginal fistula is presented. The patient complained of cyclical menouria since the first repair done 15 years ago and gradually worsening urinary incontinence. A laparoscopic assisted repair of the fistula was performed and the patient is fully continent at 12-months follow up.

Background: Vesicouterine fistula is a rare complication of Caesarean delivery. This is the third known report of vesicouterine fistula diagnosed during pregnancy., Case: Linda (pseudonym), a 28-year-old woman in her second pregnancy, having had a Caesarean delivery in her first pregnancy, was admitted to the delivery unit with possible preterm ruptured membranes at 23 weeks' gestation. She also complained of a fluid-filled sac bulging from her introitus during her admission assessment. Diagnosis of premature rupture of membranes was confirmed by a positive nitrazine paper test and appearance of ferning during microscopic evaluation of vaginal fluid. Cystoscopy, performed 3 days after admission, demonstrated ballooning of amnion into the bladder. At 24 weeks' gestation, the woman had a precipitous vaginal breech delivery. Two months later, the fistula was successfully repaired through a transabdominal route., Conclusion: Although uncommon in pregnancy, vesicouterine fistula should be considered in women who present with urinary incontinence or recurrent urinary tract infections after a lower transverse Caesarean section. Evaluation in pregnancy is usually limited to cystoscopy. Treatment is usually surgical and is often delayed until 2 to 3 months following delivery.

A spontaneous bladder rupture in an intact bladder without history of trauma has been reported before with different postulation for the pathogenesis. All these cases were reported in the adult age group. Patients with a neuropathic bladder associated with such a complication were post augmentation cystoplasty or catheter induced injury. We present our experience in a boy with a neuropathic bladder secondary to spina bifida who had a spontaneous bladder rupture with no surgical intervention carried out before, and discuss the possible pathogenesis.

Bladder tamponade is an uncommon clinical symptom among men suffering during sexual intercourse. The authors report on a 46-year-old man for whom this symptom appeared 4-5 years prior to hospitalization. Angiography confirmed the presence of left pudendal and obturator arterial bleeding, and embolotherapy of the internal pudendal and obturator arteries was performed. There was no mortality, or limb loss or sexual potency loss at follow-up.

The authors describe a case of enterovesical fistulas in a patient with Crohn's disease that presented exclusively as urinary symptoms manifesting as bladder tumor. Ultrasound examination showed a normal upper urinary tract and a bladder tumor. Cystoscopy examination revealed a bladder tumor at the retrotrigonal region without showing the fistula orifice. Transurethral resection of the tumor revealed an inflammatory pseudotumor of the urinary bladder at the results of histological studies. Magnetic resonance imaging showed a normal upper urinary tract but a bladder tumor and a sigmoidovesical fistula. The results of barium contrast studies established the presence of numerous enterovesical fistulas. Partial resection of the ileum, ileostomy, colostomy and suture of the bladder fistulas was performed. Histological diagnosis of the affected ileum was Crohn's disease. The clinical features, natural history and treatment of enterovesical fistula secondary of Crohn's disease were discussed.

The authors report a series of three cases of Youssef syndrome observed over a 10 year period. All the fistulas were secondary to cesarian section. The diagnosis was established on clinical findings in one case. The intravenous urography was performed in all the cases and visualised the uterine cavity in one case. In the remaining cases the diagnosis was established by the retrograd cystography. The treatment was surgical for two patients and the third one refused any treatment. With a mean recoil of fifteen months the results judged on the disappearance of the clinic signs were good in the two patients opered. The objective of this study is to analyse the aetiological, diagnosis and therapeutic aspects of this pathology.

The authors reports their experience of a large series of 1050 cases of vesico-vaginal fistulas recorded during 30 years and analyse their epidemiological, anatomo-clinical, and therapeutic aspects. Patients could be classified as a function of site of fistula into 3 types, according to the Benchekroun's classification: type I ureto-vaginal fistula (30%); type II cervico-vaginal fistula (22%); type III vesico-vaginal fistula (48%). Etiology was mainly obstetrical (93%). An associated lesion was detected in 10.4% of cases (uterine, ureteral and rectal). Treatment was only performed after a minimal period of three months with the following results in obstetrical vesico-vaginal fistulas. Type I fistula, using a low approach and requiring urethral refection in 100 cases, showed good results in only 60% of cases. Type II fistulae, usually treated through a low approach (80%), were treated with 80% good results. Type III fistula, were nearly always corrected (98%) after two procedures. The overall results are good in 80% of cases. The failures concerned in majority the complex vesico-vaginal fistulas type I, are treated by urinary diversion (51 Coffey, 5 Bricker) and since 1975, 73 continent ileocecal or ileal bladders using Benchekrouns' technique.

Enterovesical fistula is a relatively uncommon complication of colorectal and pelvic malignancies, diverticulitis, inflammatory bowel disease, radiotherapy, and trauma in Asian countries. A case of vesico-ileosigmoidal fistula and a literature review of this disease in Japan are presented. A 70-yr-old male was referred with complaints of urinary pain and pneumaturia. On admission, urinary tract infection and pneumaturia were presented. A barium enema demonstrated multiple diverticulum in his sigmoid colon and the passage of contrast medium into the bladder and ileum. Under the diagnosis of vesico-ileosigmoidal fistula due to suspected diverticulitis of the sigmoid colon, sigmoidectomy and partial resection of the ileum with partial cystectomy were performed. The histopathology revealed diverticulosis of the sigmoid colon with diverticulitis and development of a vesico-ileosigmoidal fistula. No malignant findings were observed. Until the year 2000, a total of 173 cases of vesico-sigmoidal fistula caused by diverticulitis had been reported in Japan. Pneumaturia and fecaluria are the most common types, presenting symptoms in 63% of the cases. Computed tomography, with a sensitivity of 40% to 100%, is the most commonly used diagnostic study. For patients with vesico-sigmoidal fistula, resection of the diseased sigmoid colon and partial cystectomy with primary anastomosis are the safest and most acceptable procedures, leading to the best results.

We report a case of right ovarian dermoid cyst fistulized in the bladder and revealed by recurrence urinary infections. The diagnostic has not been conformed but 5 years after the urinary first manifestations. The cystoscopy has been a cardinal importance but the right seat of the lesion has been determined only during laparotomy. This unusual complication of ovarian dermoid cyst must call the practitioner's attention to urinary symptoms with a pelvic tumour. Moreover, the left ovary agenesis and the young patient's age have constrained the surgeon to preservative method. The functional efficiency of this method has been proved by the periods recovery, 5 months later.

Objective: The authors reported the preliminary results of levator ani muscle flap in the treatment of vesicovaginal fistula., Materials and Methods: Twenty-six patients whose age varied between 13 and 18 years (mean: 30 years) are selected. All the patients are treated by the vaginal approach using the part of superficial rectal fibers of the levator ani muscle., Results: Among the 26 patients, 14 are free after the first cure of vesicovaginal fistula (54%), and 4 patients (15%), after the treatment of some complications., Conclusion: The musculofascial levator ani flap with its vascular pedicle and its mobilisation can successfully close the vesicovaginal fistula. The preliminary results obtained (88%) tie up with that previously described in the literature.

A 1-day-old boy who presented with an anorectal malformation (ARM) was found to have a segmental dilatation of the colon (SDC) associated with a typical congenital pouch colon (CPC) malformation. The distal colonic pouch terminated in a high colovesical fistula. The posterior portion of the perineal raphé was duplicated and ended in 2 anal dimples. Both dilated segments of the colon were excised. The similarity between CPC and SDC is highlighted, and the possible embryogenesis of both conditions is discussed., (Copyright 2001 by W.B. Saunders Company.)

An 8-hour-old Standardbred filly was evaluated because of an enlarging umbilical mass and stranguria. It was suspected that the mass was the urinary bladder; this was confirmed on surgical exploration of the abdomen. Despite a normal umbilical ring, the bladder had descended and partially everted through its urachal communication with the umbilical stalk. Partial cystectomy and umbilical resection were performed and resulted in an excellent clinical outcome. Evagination of the urinary bladder via the umbilicus has rarely been described in human infants, and, to our knowledge, it has not been reported in the veterinary literature.

We describe a case of primary Hodgkin disease of the terminal ileum in a 38-year-old man with Crohn disease of 24 years' duration. The infiltrate was located in an ulcerated fistula involving the terminal ileum and urinary bladder. Reed-Sternberg cells and their variants were characteristically positive for CD15, fascin, and CD30 and showed focal positivity for CD20. Epstein-Barr virus messenger RNA was also detected in the neoplastic cells. Staging revealed no evidence of other lymph node or organ involvement. Although rare, primary gastrointestinal Hodgkin disease arising in the setting of Crohn disease may have a stronger association with Epstein-Barr virus infection than conventional Hodgkin disease.

We report an unusual presentation of metastatic seminoma within the prostate gland. Histological diagnosis was obtained using trans-rectal ultrasound guided prostatic biopsy. The patient developed a rectovesical fistula after ten weeks of chemotherapy, which healed following a complete radiological response to treatment

A neonate with umbilical evagination of the bladder (UEB) and omphalocele minor (OM) is reported. The findings in this case support the origin of the urachus from the upper end of the cloaca rather than the allantois. The frequent occurrence of OM with urachal anomalies, including UEB, suggests an embryological association between the two conditions.

We report a unique case of a postcaesarean section uterovesical fistula lined by intermediate trophoblast. The patient, a 42-year-old woman, presented with cyclical haematuria, and she had had a lower segment caesarean section 1 year previously. She was found to have uterovesical fistula, which was excised. On microscopic examination the fistula tract was lined by intermediate trophoblast characterised by cells with abundant eosinophilic cytoplasm, occasional multiclefted nuclei, and cytoplasmic immunoreactivity for epithelial cytokeratins and human placental lactogen. This finding has not, to our knowledge, been previously described and indicates that the survival of third trimester intermediate trophoblast is independent of pregnancy.