IS case 512: Acquired rectovesical fistulas

Durga Singh, MD

University of Rochester


Imaging Sciences URMC 2010
Publication Date: 2010-09-10

History

Patient is a 70-year-old male with history of acute diverticulitis while in myxedema coma, status post perineal proctectomy with closure of rectovesical fistula.

Findings

Communicating tract between the bladder and the rectum.

Diagnosis

Acquired rectovesical fistulas

Discussion

Acquired rectovesical fistulas compose about 20% of all enterovesical fistulas. The most common causes include diverticulitis, Crohn's disease, trauma, and malignancy. Cancers of the cervix, prostate, bladder, colon, or rectum may cause fistulas between these two organs. Historically, however, infectious disease were more common causes. Such infections as typhoid, amebiasis, syphilis, and tuberculosis were likely etiologies previously.

Symptoms may include pneumaturia and fecaluria, as well as chronic urinary tract infections. Methods of diagnosis include CT imaging, cystography, barium enema, intravenous pyelography, and also cystoscopic or proctoscopic examination. Surgical correction of the fistula should be conducted to prevent cystitis and pyelonephritis.

References

  1. King RM, Beart RW Jr, McIlrath DC. Colovesical and rectovesical fistulas. Arch Surg. 1982 May;117(5):680-3. PMID: 7073489
  2. Naguib NN, Sharaf UI. Vesicorectal Fistula, Case report and review of the literature. Curr Urol 2008;2(4):211-213

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