c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Colovesical Fistula: 1

A D V E R T I S E M E N T

   
 

A 72-year-old man presented with a history of recurrent urinary tract infections, pneumaturia, hematuria, irritative voiding symptoms, and ultimately urinary incontinence. He had had a radical perineal prostatectomy in 1993 for prostate cancer (pT3aNxM0, Gleason sum 3+4=7). Seven years later he underwent local radiotherapy and hormone therapy for a rising psa without evidence of distant disease. The patient had no history of diverticulitis or inflammatory bowel disease. Cystoscopy on workup showed radiation changes in the bladder mucosa without a definite site of colovesical fistula. Flexible sigmoidoscopy showed diverticula and a stricture at 20cm that the scope could not be passed beyond.    

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Colovesical Fistula: 2

A D V E R T I S E M E N T

   
 

CT scan showed a thickened loop of sigmoid colon with diverticula and a narrowed lumen.       

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Colovesical Fistula: 3

A D V E R T I S E M E N T

   
 

There was close adhesion of the thickened loop of sigmoid to the posterior wall of the bladder.       

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This page was last modified on 7/11/2002.