Presentation
Lower abdominal pain and pain on micturition. No surgical history.
Patient Data
Multiple sigmoid colonic diverticulae.
Thickened sigmoid colon with pericolic inflammatory change.
Gas tracking across the wall of the sigmoid, with large volume of gas in the bladder ( which is not catheterized ).
Case Discussion
One of the commoner causes of a colovesical fistula is complicated diverticular disease.
This case shows multiple signs to confirm the diagnosis:
1. Thickened adjacent colon with pericolonic inflammatory change
2. Diverticulae in the sigmoid colon
3. Large volume of air in the bladder ( without prior catheterization or intervention )
4. Gas tracking across the colonic wall into the urinary bladder