Sidhu Kavina, Seyfi Doruk, Byrne Christopher
Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, AUS.
Cureus. 2023 Feb 23;15(2):e35376. doi: 10.7759/cureus.35376. eCollection 2023 Feb.
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.
结肠膀胱瘘是憩室炎公认的一种并发症。尽管其潜在病理通常源于结肠，但大多数患者表现为泌尿系统症状，典型的如气尿和尿路感染。附睾炎是一种罕见的表现。识别那些出现反复尿脓毒症和/或药物治疗无效的附睾炎的老年男性很重要，因为他们可能存在潜在的良性或恶性病因。这些病例的诊断挑战在于确认瘘管的存在、排除恶性肿瘤并确定潜在病理。我们报告一例老年男性憩室性结肠膀胱瘘病例，该患者在反复尿路感染的背景下出现附睾炎症状。左后外侧膀胱壁内存在膀胱内气体以及与乙状结肠中部连续的软组织增厚与结肠膀胱瘘相符。该患者接受了择期腹腔镜前切除术及结肠膀胱瘘修补术。
