Clinical Presentation, Management and Outcome in Diverticular Colovesical Fistulas - Our Experience.

Colovesical fistula (CVF) is an abnormal communication between the urinary bladder and the large intestine, usually sigmoid colon. Diverticulitis is the most common cause of CVF in most of the western studies, accounting for approximately 70% of cases. Diverticular CVF is uncommon in Asia. This case series shares the experience of six cases of diverticular CVF in Indian population. METHODSMedical records of six patients with diverticular colovesical fistulas during the period January 2016 - August 2019 were reviewed with regard to symptoms, diagnostic investigations, and management. Various aspects of the disease were analysed to determine the common features of colovesical fistula in our population. RESULTSAll patients with diverticular colovesical fistula were presented with urinary symptoms and none were aware about their existing colonic diverticulosis. Five out of the six cases presented with pneumaturia. Contrast enhanced computed tomography (CECT) abdomen detected sigmoid diverticulosis with vesical fistula in all cases. The most common site of fistula found on cystoscopy was on the left superolateral wall of bladder. All cases were operated as a single stage procedure including fistula repair, colonic resection, omental interposition with no temporary colostomy which provided an excellent surgical cure. CONCLUSIONSColovesical fistula secondary to diverticular disease has shown a rising incidence and can be effectively managed by a multidisciplinary team. It requires prompt diagnosis, adequate preoperative evaluation, perioperative care including bowel preparation, nutritional supplementation, appropriate antibiotics, and meticulous surgical skills allowing an elective one-stage approach.

Fungal pneumaturia: A case report on a large urinary bladder fungal bezoar in a young diabetic male

@#Fungal bezoars or fungus balls are extremely rare cases especially when they occur within the urinary tract. Reported here is a 26-year old diabetic male presenting with pneumaturia, passage of debris per urethra and lower urinary tract symptoms. He was initially managed as a case of enterovesical fistula. Further work-up revealed a urinary bladder fungal bezoar. The patient was managed by endoscopic morcellation and evacuation of the fungal ball from the bladder and anti-fungal therapy. Awareness of this rare clinical entity and its presentation will aid in its proper diagnosis and management.