Sigmoid Diverticulitis - Colovesical Fistula (7 of 8)

Colovesical fistulae primarily result from diverticular disease. Ileovesical fistulae are most likely associated with Crohn disease. Rectovesical fistulae are more common in the setting of trauma or malignancy. Appendicovesical fistulae tend to be associated with a history of appendicitis. The hallmark of enterovesicular fistulae may be described as Gouverneur syndrome, namely, suprapubic pain, frequency, dysuria, and tenesmus. Chills and fever are less common, and a colovesical fistula manifesting as sepsis is uncommon. Sepsis has been reported in 70% of patients with urinary outlet obstruction. The fistula may be asymptomatic and is seldom accompanied by dramatic or sudden abdominal symptoms or diarrhea. In most series, patients have been treated for recurrent UTI for 4-12 months before a fistula is diagnosed.