Colovesical Fistula

Indication for colonoscopy: recurrent UTI, foul-smelling urine, positive bacterial urine culture. Constipation. The female patient was hospitalized and initially diagnosed on a urology ward in a district hospital. Diagnosis: suspicion of colovesical fistula in cystoscopy. CT scan with contrast has not shown a communication between bladder and colon. The urologists recommended to perform a colonoscopy. Bowel preparation: excellent (Boston score 3/3/3=9/9). DRE: no abnormalities. The endoscope was inserted to sigmoid colon. Presence of diverticula narrowing the lumen; the colonoscope could not be advanced further. The colonosocope was converted to gastroscope. Whole large intestine was visualized - normal mucosa and normal vascular pattern. In sigmoid colon, approx. 25 cm from anus, single edematous fold was observed. Behind the fold a wide diverticular opening was visualized - the diverticulum was erythematous and edematous. It was probably the orifice of colovesical fistula. No other abnormalities detected. It is highly probable that the patient underwent diverticulitis complicated with fistula formation. Other earlier suspected cause (complication of hysterectomy due to leiomyomatosis) seems to be less plausible. The patient was referred to surgery unit for definitive treatment of complicated diverticular disease. The patient was given Xifaxan + Metronidazole p.o. and instructed to urgently present to hospital in case of severe abdominal pain and fever.