Ropero-Luis Guillermo
Department of Internal Medicine, Hospital de la Serranía, Ronda, ESP.
Cureus. 2023 Feb 15;15(2):e35007. doi: 10.7759/cureus.35007. eCollection 2023 Feb.
A 54-year-old man presented with symptoms of dysuria and cloudy urine, as well as a history of passing stool in urine and repeated urinary tract infections over the past three months. He had previously undergone surgery for diverticulitis with secondary peritonitis 22 years prior. At the time of examination, the patient was in good general condition and euvolemic and had a plasma sodium level of 128 mmol/L and abnormally elevated urinary osmolality. Treatment involved oral urea and drinking according to thirst. After ruling out hypothyroidism and secondary adrenal insufficiency, the patient was diagnosed with syndrome of inappropriate antidiuresis (SIAD). A neoplastic-like mass in the sigmoid colon that infiltrated the bladder floor with a fistulous tract was found. The patient underwent a planned surgical intervention and maintained eunatremia without urea treatment postoperatively. The biopsy showed diverticulosis with intense inflammation in the submucosa but no neoplasia. This is the first reported case of SIAD associated with a colovesical fistula due to chronic perforated diverticulitis.
一名54岁男性出现排尿困难和尿液浑浊症状，且在过去三个月中有尿中排粪史及反复尿路感染史。他曾在22年前因憩室炎继发腹膜炎接受过手术。检查时，患者一般状况良好，血容量正常，血浆钠水平为128 mmol/L，尿渗透压异常升高。治疗方法包括口服尿素并按需饮水。在排除甲状腺功能减退和继发性肾上腺功能不全后，患者被诊断为抗利尿激素分泌失调综合征（SIAD）。发现乙状结肠有一个类似肿瘤的肿块，该肿块浸润膀胱底部并伴有瘘管。患者接受了计划性手术干预，术后未进行尿素治疗即维持了血钠正常。活检显示为憩室病，黏膜下层有严重炎症，但无肿瘤形成。这是首例因慢性穿孔性憩室炎导致结肠膀胱瘘并发SIAD的报道病例。
