A 66-year-old man with recurrent urinary tract infections reports passage of gas in the urine and occasionally faecal matter in the urine. CT shows sigmoid diverticular disease with thickening between the sigmoid colon and the bladder dome. What is the most likely underlying cause of this fistula?
- A Crohn's disease of the ileum
- B Diverticular disease of the sigmoid colon ✓
- C Carcinoma of the bladder
- D Radiation cystitis following prostate brachytherapy
Correct answer: B. Diverticular disease of the sigmoid colon
Explanation
Diverticular disease of the sigmoid colon is the commonest cause of acquired colovesical fistula, accounting for roughly half to two thirds of cases, followed by malignancy and Crohn's disease. Pneumaturia is the classic presenting symptom, with faecaluria and Gouverneur's sign of pain on micturition less frequent. Crohn's disease more typically produces enterovesical or rectovesical fistulas from ileal disease, and there is no history of pelvic radiotherapy here.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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