Colovesical fistula in morbus Crohn, diagnostic and management challenges: a case report

Abstract

ABSTRACT

Introduction: Colovesical fistula secondary to Crohn’s disease is a rare complication and very challenging to diagnose. The causes of the formation of enterovesical fistulas are intestinal diseases occurring within the intestinal loop adjacent to the wall of the urinary bladder resulting in pathological communication between the above structures. Mainly diagnosis is made clinically but there are other diagnostic tools that help and can confirm the disease.

Case Presentation: In our case we present 81-year-old men with abdominal pain, pneumaturia and fecaluria. Based on diagnostic tools that we used, we confirmed the fistula between sigmoid part of the colon and bladder and was successfully treated with open laparotomy. The patient on 6-month follow-up is doing well with no signs of recurrence.

Discussion: Colovesical fistula, a pathological communication between bladder and colon is not a common condition (1). It is a very challenging condition to diagnose and treat. Between conservative and surgery management the latter is preferred option because the probability of fistula to close from conservative treatment is very low, so the definitive treatment remains the surgery.

Conclusion: Enterovesical fistula diagnosis is complex, requiring proper investigation through good anamnesis, cystoscopy, retrograde cystography, CT scan, and colonoscopy are crucial to confirm the diagnosis and surgical successfultreatment.

Keywords: Colovesical fistula, Crohn’s disease, cystoscopy, colonoscopy, CT, enterectomy