Right-Sided Epididymo-Orchitis as a Presentation of Diverticular Colovesical Fistula.

A colovesical fistula is a recognized complication of diverticulitis. Although the underlying pathology is usually of colonic origin, the majority of patients present with urological symptoms, classically pneumaturia, and urinary tract infection. Epididymo-orchitis is a rare presentation. It is important to identify elderly males who present with recurrent urosepsis and/or epididymo-orchitis refractory to medical treatment as they may have an underlying benign or malignant etiology. The diagnostic challenge in these cases is to confirm the presence of a fistula, exclude malignancy, and determine the underlying pathology. We present a case of diverticular colovesical fistula in an elderly male who presented with symptoms of epididymo-orchitis on a background of recurrent urinary tract infections. The presence of intravesical gas within the left posterolateral bladder wall and soft tissue thickening continuous with the mid-sigmoid colon was consistent with a colovesical fistula. This patient underwent elective laparoscopic anterior resection and repair of colovesical fistula.

First Case of Enterovesical Fistula Caused by Ischaemic Enteritis.

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.

Emphysematous Cystitis in an Uncontrolled Diabetic: A Case Report.

Emphysematous cystitis is a rare potentially life-threatening infection of the urinary tract system commonly caused by gas forming micro-organisms like Escherichia coli. It is commonly seen in diabetics and middle-aged-elderly women. Presenting symptoms could be variable and unusual on many occasions. Therefore, a high index of suspicion is crucial in prompt/accurate diagnosis and treatment of this disease. This case report presents emphysematous cystitis in a middle-aged woman with poorly controlled diabetes mellitus. Pneumaturia and evidence of emphysematous cystitis on computerized tomography were also noted in this case.

A unique presentation of Colovesical fistula.

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.

Enterocutaneous Fistula Coexisting with Enterovesical Fistula: A Rare Complication of Ovarian Cystectomy.

Enterocutaneous fistula is an abnormal communication between the intestine and the skin, while enterovesical fistula is an abnormal communication between the intestine and the bladder. Both are not usual complications of ovarian cystectomy. We present a patient with enterovesical fistula coexisting with enterocutaneous fistula following ovarian cystectomy. She is a 24- year-old lady with background immunosupression who presented to the National Obstetric Fistula Centre, Abakaliki South-East Nigeria with a history fecaluria, pneumaturia and passage of feculent fluid through the skin following ovarian cystectomy. Fistulogram was in keeping with rectovesical fistula. She was repaired in a single stage and made an uneventful recovery. Enterovesical fistula and enterocutaneus fistula are uncommon but possible complications of ovarian cystectomy.

Colorenal fistula after renal tumour cryotherapy.

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.

Colovesical Fistula As An Uncommon Presentation Of Metastatic Lung Cancer.

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.

[Emphysematous cystitis]. / Emphysematöse Zystitis.

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

Appearance of a colovesical fistula at cystoscopy.

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

Emphysematous Cystitis: A Rare Disease of Genito-Urinary System.

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

Emphysematous cystitis in a patient with type-2 diabetes mellitus.

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

Emphysematous cystitis of the diabetic patient.

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