A Case of Colon Diverticulitis with Concomitant Sigmoidovesical Fistulae Extending to the Bladder Trigone

概要

論文の詳細を見る
A 68-year-old man presented at our hospital with abdominal pain, pneumaturia, and fever in October 2009. At the time of this initial visit, bacteriuria was present, and abdominal CT showed multiple sigmoid diverticula, sigmoid wall thickening, and an abscess on the dorsal surface of the urinary bladder. MRI revealed fistulae extending from the sigmoid colon to the abscess and wall thickening of the bladder trigone. Cystoscopic examination showed marked edema and granulation of the bladder trigone. Based on these findings, colovesical fistulae and pelvic abscess due to sigmoid diverticulitis were diagnosed. The abscess was near the bladder trigone, and it was considered infeasible to avoid urinary tract diversion. Therefore, ileostomy was initially performed aiming at abscess shrinkage and closure of the fistulae. Approximately 10 months after confirmation of abscess shrinkage, partial resection of the sigmoid colon and closure of the ileostomy were conducted. The fistula closed, and partial resection of the bladder could thus be avoided. Although colon diverticulitis with fistulae extending to the bladder trigone is rare, partial bladder resection and urinary tract diversion can be avoided by employing a two-stage operative strategy.