Vesicosigmoid Fistula as an Incidental Finding Accompanying Bladder Cancer

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CASE REPORTS

Vesicosigmoid Fistula as an Incidental Finding Accompanying Bladder Cancer N. E.STAVROPOULOS, D.S.KONTOGIANNIS, J.S. STAVRIDADIS and K. J. GOSSIOS, Department of Urology, University of lonnina. and Department of Computed Tomography, General Hospital “Hatjikosta‘:loannina, Greece

Fistulas between the intestinal tract and the urinary bladder are uncommon and are usually secondary to intestinal disease (Moisey and Williams, 1972).

Case Report A 72-year-old male with an indwelling catheter was referred with an 8-month history of voiding difficulties and episodes of painless haematuria. Physical examination revealed a frail old man with a tender mass in thelower abdomen. The urine was infected with Escherichiu coli. Laboratory investigations revealed the following: WBC 14.7 x 109/l;RBC 3.96 x 10‘*/1; H b 12.8 g/dl; Hct 38.8%; BUN 80 mg/dl; creatinine 2.6 mg/ dl; uricacid 11.3 mg/dl. ChestX-raywasnormal. Bilateral obstruction at the vesicoureteric junctions and poor delineation of the urinary bladder on the intravenous urogram led us to perform an abdominal CT scan (Figs 1 and 2). N o distant metastases were noted. Cystoscopy and biopsy demonstrated a large G 3 transitional cell carcinoma of the bladder. The patient refused treatment.

Fig. 2 CT scan showing gas in the left ureter and collecting system of the left kidney.

Comment The overall incidence of urological causes among 867 cases of enterovesical fistula presented in 23 series is 1.9% and among these bladder cancer is rare (Vidal Sans et al., 1986). While pneumaturia and faecaluria are present in a high percentageof patients (56%)and are regarded as symptoms diagnostic of enterovesical fistula, haematuria was the predominant symptom in our patient. The retrograde cystogram can delineate the fistulous tract in up to 67% of patients (Vidal Sans et al., 1986) and, if performed by computed tomography in cases of bladder cancer, the extent of the underlying disease can be evaluated at the same time.

References Moisey, C. U. and Williams, J. L. (1972). Vesico-intestinal fistulae. Br. J . Urol., 44,662-666. Vidal Sans, J., Pradell Teigell, J., Palm Redorta, J. e t d (1986). Review of 31 vesicoenteric fistulas: diagnosis and management. Eur. Urol., 12,21-27. Fig. 1 CT scan after instillation of contrast into the bladder, showing extravasation of contrast into the sigmoid colon, and gas in the bladder and left ureter.

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