ABSTRACT
Colo-vesical fistula (CVF) is usually encountered in severe inflammatory and malignant conditions. Radiological imaging is crucial to the diagnosis of a colo-vesical fistula and helps gastroenterologists and surgeons select the best treatment option. This disorder is typically identified during follow-up of treatments for diverticulitis or chronic inflammatory bowel disease. The patients present with symptoms of pneumaturia and fecaluria. The most accurate imaging modality for diagnosing CVF is CT with rectal contrast. In this case report, we present a case of a 58-year-old male patient with complaints of fecaluria and pneumaturia for three months. Ultrasonography and barium enema revealed a clear fistulous tract between the sigmoid colon and the urinary bladder. Subsequently, the patient underwent exploratory laparotomy and the specimen was sent for histopathological evaluation to rule out malignancy. The diagnosis on imaging was consistent with post-operative findings of a CVF. This case report will add to the knowledge of radiologists about the imaging features of CVFs and their identification on imaging.