Case Study - May 2010

A 78 year old man presents with recurrent urinary tract infections and more recently, passed air and faeces in his urine.

  1. What abnormality does this CT scan show?
  2. What investigations are usually performed?
  3. What are common causes?
  4. How are they usually managed?

Reveal Answer

Open answer There is no fixed answer to this question, however your response should be similar to the one below:

  1. This CT shows the presence of a colovesical fistula. Air is present is the bladder, this finding can occur with catheterisation. Also of note is the close proximity of the bowel to the bladder
  2. In addition to a CT scan, a flexible cystoscopy should be performed to exclude any worrying bladder pathology, such as transitional cell cancer of the bladder lining. The cystoscopy is also useful to confirm the presence of the fistula. Sometimes, additonal tests are necessary such as MRI or colonoscopy.
  3. Common causes include inflammatory conditions such as diverticular disease and Crohn's disease. Less common are malignant causes such as colonic cancer
  4. Treatment is surgical and involves removal of the diseased bowel, and sometimes part of the affected bladder. In this case, the patient underwent anterior resection. The histology of the specimen was Dukes C Adenocarcinoma of the bowel

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